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

Total documents retrieved: 170 Results Generated From: Embase <1980 to 2026 Week 25> Embase Weekly Updates (updates since 2026-06-12) - (170 records) <1> Accession Number 650959748 Title Effect of preoperative respiratory prehabilitation on cardiopulmonary function in patients undergoing lung resection for non-small cell lung cancer: a randomized controlled trial. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 20 Apr 2026. Author Huang F.; Kong P.; Liu J.; Wang C.; Xia P.; Pan L.; Jin Y.; Hu H.; Zhang X. Institution (Huang, Wang, Pan, Jin, Hu, Zhang) Department of Nursing, First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China (Kong, Xia) Department of Thoracic Surgery, First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China (Liu) Department of Nursing, First Affiliated Hospital of Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China Abstract BACKGROUND: Preoperative respiratory prehabilitation has attracted increasing attention as a perioperative strategy in thoracic surgery, but evidence regarding its short-term effects on early postoperative functional recovery remains limited. This randomized controlled trial investigated the effect of a 7-day preoperative respiratory prehabilitation program on postoperative pulmonary function, cardiopulmonary exercise capacity, and postoperative complications in patients undergoing curative-intent lung resection for non-small cell lung cancer (NSCLC). METHOD(S): This single-center exploratory randomized controlled trial enrolled 120 patients with suspected NSCLC who were scheduled to undergo curative-intent anatomical lobectomy or wedge resection between January 2025 and November 2025. Patients were randomly assigned in a 1:1 ratio to routine perioperative care alone (control group, n = 60) or routine perioperative care plus a 7-day preoperative respiratory prehabilitation program (intervention group, n = 60). The primary endpoint was pulmonary function on postoperative day 7, assessed by forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). Secondary endpoints included within-group preoperative pulmonary function change in the intervention group, cardiopulmonary exercise capacity on postoperative day 7, and postoperative complications. RESULT(S): Baseline characteristics were generally comparable between the two groups. In the intervention group, FEV1, FVC, and PEF were all significantly higher 1 day before surgery than before training (all P < 0.001). At admission, no significant between-group differences were observed in pulmonary function. On postoperative day 7, the intervention group had significantly higher FEV1 (1.86 +/- 0.64 vs. 1.55 +/- 0.48 L, P = 0.003), FVC (2.30 +/- 0.58 vs. 1.78 +/- 0.42 L, P < 0.001), and PEF (4.50 +/- 0.67 vs. 3.85 +/- 0.64 L/s, P < 0.001) than the control group. Cardiopulmonary exercise variables were also higher in the intervention group, including VO2max, VO2/kg, anaerobic threshold, and O2 pulse (all P < 0.001). The postoperative complication rate was numerically lower in the intervention group than in the control group (6.67% vs. 18.33%), although this difference should be interpreted cautiously (P = 0.053). CONCLUSION(S): In this single-center exploratory randomized trial, short-term preoperative respiratory prehabilitation was associated with better pulmonary function and cardiopulmonary exercise capacity on postoperative day 7 in patients undergoing curative-intent lung resection for NSCLC. These findings suggest that short-term respiratory prehabilitation may be a feasible perioperative strategy to support early postoperative functional recovery. TRIAL REGISTRATION: Medical Research Registration and Record Information System of the National Healthcare Security Information Platform, MR-33-25-019022. Copyright © 2026. The Author(s). <2> Accession Number 2046146450 Title Comments raised by 'Quality of life during electronic patient-reported outcome (ePRO) monitoring in thoracic surgery patients: a pilot randomized controlled trial'. Source Quality of Life Research. 35(7) (no pagination), 2026. Article Number: 185. Date of Publication: 01 Jul 2026. Author Kishi Y.; Inumaru A.; Saito Y. Institution (Kishi, Inumaru, Saito) Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, Japan Publisher Springer Science and Business Media Deutschland GmbH <3> [Use Link to view the full text] Accession Number 2046033218 Title Opioid Free anesthesia in cardiac surgery: The OFACAR randomized clinical trial. Source Anesthesiology. Publish Ahead of Print (no pagination), 2026. Date of Publication: 22 May 2026. Author Guinot P.-G.; Besch G.; Jonval L.; Nguyen M.; Grelet T.; Bouhemad B. Institution (Guinot, Nguyen, Bouhemad) Department of Anesthesiology and Intensive Care, Dijon University Hospital, France (Guinot, Nguyen, Bouhemad) University of Burgundy Europe, Dijon, France (Guinot, Nguyen, Bouhemad) Center for Translational and molecular Medicine (CTM), INSERM UMR1231, Lipness Team, Dijon, France (Besch, Grelet) Universite Marie et Louis Pasteur, CHU Besancon, Inserm CIC 1431, SINERGIES (UR 4662), Departement d'Anesthesie Reanimation Chirurgicale, Besancon, France (Jonval) Delegation a la recherche clinique et a l'innovation, Dijon University Hospital, France Publisher Lippincott Williams and Wilkins Abstract Background: - Opioid-free anesthesia (OFA) may reduce postoperative complications in cardiac surgery, but evidence from large randomized trials is limited. Method(s): - We conducted a randomized, controlled, blinded, multicenter superiority trial at two tertiary university hospitals in France from August 2021 to December 2023. We enrolled 320 adult patients undergoing elective cardiac surgery with cardiopulmonary bypass. Patients were randomized to receive either OFA (n=159) consisting of intravenous ketamine, dexamethasone, lidocaine, and magnesium sulfate, or opioid anesthesia with sufentanil (n=161). The primary outcome was a composite of postoperative neurological, respiratory, cardiovascular, renal complications, and/or death within 30 days after surgery. Result(s): - Among 320 participants (mean age 66.4 +/- 10.5 years; 247 men [77.2%]), the primary outcome occurred in 120 patients (75.4%) in the OFA group compared with 136 patients (84.5%) in the control group (Risk Ratio [RR], 0.90; 95% confidence interval [CI], 0.80-0.99; P = 0.049). The fragility index for the primary outcome was 1. OFA was associated with significant reductions in cardiovascular complications (64.2% vs. 75.2%; RR, 0.86; 95% CI, 0.74-0.99; P = 0.031), particularly postoperative myocardial damage (61.6% vs. 72.1%), and digestive complications (2.5% vs. 11.2%; RR, 0.22; 95% CI, 0.08-0.65; P = 0.007). No death occurred in the OFA group compared with 6 patients in the control group (P=0.014). Conclusion(s): - In patients undergoing cardiac surgery with cardiopulmonary bypass, opioid-free anesthesia may reduce composite postoperative complications compared with opioid anesthesia. The primary endpoint composite fragility index indicate that these results should be considered hypothesis-generating and warrant confirmation in larger trials. Trial registration: - NCT04886453 Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Anesthesiologists. <4> Accession Number 2043371464 Title Ticagrelor-Based antiplatelet therapy versus aspirin alone after coronary artery bypass grafting: A systematic review and Meta-Analysis with trial sequential analysis. Source Journal of Thrombosis and Thrombolysis. 59(4) (pp 876-887), 2026. Date of Publication: 01 Apr 2026. Author Bacha Z.; Khalid A.A.; Sikandar M.; Siddique K.; Rashid A.Z.; Shah Z.A.; Qazi K.; Javed J.; Khan N.A. Institution (Bacha, Sikandar, Shah, Khan) Department of Medicine, Khyber Medical College, Peshawar, Pakistan (Khalid) Department of Medicine, Peshawar Medical College, Peshawar, Pakistan (Siddique) Department of Medicine, Nishtar Medical University, Multan, Pakistan (Rashid) Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan (Qazi, Javed) Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan Publisher Springer Abstract Introduction: Coronary artery bypass grafting (CABG) is a common surgical treatment for coronary artery disease; however, long-term success is limited by saphenous vein graft (SVG) occlusion. Aspirin remains the standard lifelong antiplatelet therapy; however, graft failure and adverse events persist after its use. More potent agents, such as ticagrelor, have been proposed, although the evidence is inconsistent, and concerns about bleeding risk remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ticagrelor-based therapy with aspirin monotherapy in patients who underwent CABG. A comprehensive literature search of major databases was performed until August 2025. The primary endpoints were major bleeding, MACE, and all-cause mortality. The secondary outcomes included saphenous vein graft failure, stroke, myocardial infarction, and repeat revascularization. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Five randomized controlled trials comprising 4,208 patients (ticagrelor-based therapy = 2,108; aspirin monotherapy = 2,100) were included. Across the primary clinical endpoints, ticagrelor-based therapy showed no significant advantage over aspirin, with comparable rates of MACE (RR 1.05, 95% CI 0.78-1.41; p = 0.75; I2 = 20%), all-cause mortality (RR 1.02, 95% CI 0.74-1.40; p = 0.93; I2 = 0%), and major bleeding (RR 1.09, 95% CI 0.68-1.74; p = 0.73; I2 = 51%). Similarly, no significant differences were observed for stroke (RR 1.10, 95% CI 0.70-1.75; p = 0.67; I2 = 0%), myocardial infarction (RR 1.52, 95% CI 0.94-2.46; p = 0.09; I2 = 27%), or repeat revascularization (RR 1.02, 95% CI 0.71-1.45; p = 0.93; I2 = 7%). In contrast to the neutral clinical outcomes, ticagrelor-based therapy was associated with a significant reduction in saphenous vein graft (SVG) failure compared with aspirin monotherapy (RR 0.62, 95% CI 0.50-0.78; p < 0.0001; I2 = 0%). Subgroup analysis revealed no meaningful differences between ticagrelor monotherapy and ticagrelor plus aspirin for major clinical events. Ticagrelor-based therapy did not reduce major clinical outcomes (MACE, mortality, MI, stroke, revascularization, or major bleeding) compared with aspirin after CABG, although it was associated with improved SVG patency. Routine use cannot be recommended; ticagrelor may be considered in selected high-risk patients. Further large, long-term trials are needed to determine whether patency benefits translate into improved clinical outcomes. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <5> Accession Number 2046228707 Title Predictors of early cerebrovascular events after transcatheter aortic valve replacement: a systematic review and meta-analysis. Source Journal of Geriatric Cardiology. 23(5) (pp 309-316), 2026. Date of Publication: 2026. Author Zhang Y.; Yao Y.-J.; Xiong T.-Y.; Chen M. Institution (Zhang, Zhang, Yao, Xiong, Chen) Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (Zhang, Zhang, Yao, Xiong, Chen) Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China (Zhang, Zhang, Yao, Xiong, Chen) Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China Publisher Tsinghua University Press Abstract Background Early cerebrovascular events (CVEs) following transcatheter aortic valve replacement (TAVR) are severe complications, but effective methods for predicting and preventing these events have not been well established. A systematic review and meta-analysis were performed to identify significant predictors of early CVEs post-TAVR. Methods MEDLINE/Embase databases were searched for articles published between December 2015 and April 2023. Original studies evaluating predictors of CVEs within 30 days post-TAVR after adjusting for confounders were included. Two investigators independently extracted data following the PRISMA statement. Meta-analyses of multivariable data were performed using DerSimonian and Laird random-effects models, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Robustness was assessed via Harbord's test, nonparametric trim-and-fill analysis, leave-one-out sensitivity analysis, the QUIPS quality assessment tools, meta-regression, and subgroup analyses. Results Among the 74 included studies, multivariate meta-analyses identified 11 predictors of early CVEs, including 9 patient-level predictors-a CHA<inf>2</inf>DS<inf>2</inf>-VASc >= 5, no prior heart failure, diabetes, isolated aortic stenosis, carotid artery stenosis, peripheral artery disease, advanced age, New York Heart Association class >= III, and significant left ventricular outflow tract calcification- and 2 procedure-level predictors: the absence of cerebral embolization protection and post-dilation. Additionally, 10 patient-level factors and 5 procedure-level factors were not associated with early CVEs, although significant heterogeneity was observed in most analyses. Conclusions This study identified multiple patient-level and procedure-level factors associated or not associated with early CVEs after TAVR. These findings support the development of a comprehensive risk prediction model that can accommodate diverse patient populations and evolving procedural techniques, thereby enhancing clinical risk management strategies. Copyright © 2026 JGC All rights reserved; <6> [Use Link to view the full text] Accession Number 2044707274 Title Association of baseline D-dimer with adverse outcomes after percutaneous coronary intervention in patients with coronary heart disease: A meta-analysis. Source Medicine (United States). 105(4) (pp e46910), 2026. Date of Publication: 23 Jan 2026. Author Li H.; Liang Y.; Yuan Z.; Lu L.; Liao T. Institution (Li, Liang, Yuan, Lu, Liao) Department of Cardiovascular Medicine, Dongguan Dalong Hospital, Guangdong Province, Dongguan, China Publisher Lippincott Williams and Wilkins Abstract Background: - To investigate the association between baseline D-dimers (DD) and adverse outcomes after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD) by meta-analysis. Method(s): - Relevant literature was obtained by searching PubMed, Web of Science, Cochrance Library, and Embase until November 2024. The hazard ratio (HR) and 95% confidence interval (CI) were pooled for each study using either a fixed or random-effects model. The clinical outcomes analyzed were all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), and revascularization. Result(s): - A total of 10 articles were included in this meta-analysis. The results of meta-analysis showed that high baseline DD levels were associated with an increased risk of all-cause mortality (HR = 2.35, 95% CI: 1.78-3.10, P < .001), cardiovascular mortality (HR = 2.94, 95% CI: 1.99-4.33, P < .001), and MACE (HR = 1.74, 95% CI: 1.25-2.42, P = .001) after PCI in patients with CHD. However, no association was found between baseline DD level and revascularization risk (HR = 1.02, 95% CI: 0.76-1.37, P = .893). Conclusion(s): - Baseline DD level can predict adverse clinical outcomes after PCI in patients with CHD. High baseline DD levels were significantly associated with an increased risk of all-cause mortality, cardiovascular mortality, and MACE. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc. <7> Accession Number 2039522298 Title The impact of pregnancy on bioprosthetic structural valve deterioration: a systematic review and meta-analysis. Source Obstetric Medicine. 19(2) (pp 98-103), 2026. Date of Publication: 01 Jun 2026. Author Wilkie G.L.; Semenov E.; Leung K.; Baltich Nelson B.; Scott N.S.; Harrington C.M. Institution (Wilkie, Semenov, Leung, Baltich Nelson) Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States (Scott, Harrington) Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA, United States Publisher SAGE Publications Inc. Abstract Objective: This systematic review and meta-analysis sought to assess the impact of pregnancy on bioprosthetic valve (BPV) structural valve deterioration. Method(s): We searched Ovid MEDLINE, Scopus, Clinicaltrials.gov, and Cochrane Library from inception through October 17, 2022. We included all studies that compared patients with BPV with and without a pregnancy history. The initial search yielded 1748 unique citations that were screened in Covidence by two independent reviewers. Our outcome of interest was structural valve deterioration. Result(s): We performed random-effects meta-analyses from nine eligible studies. Meta-analysis of 321 individuals with a pregnancy history and 987 control individuals without pregnancy showed there was an increased odds in development of structural valve deterioration among those with a pregnancy history (OR 2.34, 95% CI 1.40-3.89) with an I2 of 59.8%. Conclusion(s): A pregnancy history was associated with an increased risk of structural valve deterioration; however, further research is needed due to the heterogeneity of results. Copyright © The Author(s) 2025 <8> Accession Number 2046395866 Title The impact of pre-transplant atherosclerosis and coronary artery disease on cardiovascular and graft outcomes in kidney transplant recipients: a systematic review and meta-analysis. Source Journal of Nephrology. 39(1) (pp 63-71), 2026. Date of Publication: 01 Jan 2026. Author Abdel-Rahman S.M.; Mizrak B.; Narin A.E.; Guldan M.; Yilmaz Z.Y.; Ozbek L.; Copur S.; Genc C.; Goren K.H.; Covic A.; Kanbay M. Institution (Abdel-Rahman, Mizrak, Narin, Guldan, Yilmaz, Ozbek, Copur, Genc, Goren) Department of Medicine, Koc University School of Medicine, Istanbul, Turkey (Covic) Clinic of Nephrology, C.I. Parhon University Hospital, Iasi, Romania (Kanbay) Department of Medicine, Section of Nephrology, Koc University School of Medicine, Istanbul, Turkey Publisher Oxford University Press Abstract Background: Kidney transplant recipients with pre-existing atherosclerosis or coronary artery disease (CAD) have an increased risk of adverse post-transplant outcomes. However, the extent to which pre-transplant CAD influences mortality, cardiovascular events, and graft function remains unclear. This systematic review and meta-analysis aims to evaluate the impact of pre-existing CAD on all-cause mortality, post-transplant cardiovascular events, and graft failure in kidney transplant recipients. Method(s): A systematic literature search was conducted using PubMed, Scopus, Web of Science, Cochrane Library, and Ovid MEDLINE. Studies reporting outcomes in kidney transplant recipients with and without pre-existing CAD were included. The primary outcomes were all-cause mortality, major cardiovascular events, and graft failure post-transplantation. Risk estimates were pooled using a random-effects model, with heterogeneity assessed using the I2 statistic. The study protocol was registered with PROSPERO (CRD42024600751). Result(s): A total of 16 studies involving 112,416 kidney transplant recipients were included. Patients with pre-transplant CAD had a significantly higher risk of all-cause mortality compared to those without CAD (hazard ratio [HR] = 1.68, 95% confidence Interval [CI]: 1.38-2.06, P < .01), with high heterogeneity (I2 = 60.0%). The risk of post-transplant cardiovascular events was also significantly increased in patients with CAD (HR = 2.78, 95% CI: 2.00-3.86, P < .01), with moderate heterogeneity (I2 = 36.1%). Graft failure was more common in recipients with pre-transplant CAD, although the effect size was smaller (HR = 1.09, 95% CI: 1.03-1.16, P < .01), with no observed heterogeneity (I2 = 0%). Conclusion(s): Pre-existing CAD in kidney transplant recipients is associated with a significantly increased risk of all-cause mortality and post-transplant cardiovascular events, as well as a modestly but significantly increased risk of graft failure. These findings stress the need for enhanced cardiovascular risk assessment and management strategies in transplant candidates with CAD to improve long-term outcomes. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of Societa Italiana Nefrologia/Italian Society of Nephrology; Society ownership. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) <9> Accession Number 2046302184 Title Comparing perioperative heparin bridging strategies in mechanical heart valve patients undergoing surgery: A systematic review and Bayesian meta-analysis. Source Thrombosis Research. 263 (no pagination), 2026. Article Number: 109735. Date of Publication: 01 Jul 2026. Author Batista P.G.; Montenegro M.V.; Gaelzer G.C.; Molinari M.E.; Malik M.; Silva R.R.A.D.S.; de Lucena L.A.; Bacca C.O.F.; Giorgi J. Institution (Batista) Federal University of Paraiba, Brazil (Montenegro) University of Pernambuco, Brazil (Gaelzer) Pontifical Catholic University of Parana, Brazil (Molinari, Bacca) University Center for the Development of Alto Vale, Brazil (Malik) Beth Israel Deaconess Medical Center, United States (Silva) Federal University of Ceara, Brazil (de Lucena) Federal University of Rio Grande do Norte, Brazil (Giorgi) Hospital Sirio Libanes, Sao Paulo, Sao Paulo, Brazil (Giorgi) Albert Einstein Hospital, Sao Paulo, Sao Paulo, Brazil Publisher Elsevier Ltd Abstract Introduction: Perioperative heparin bridging in surgical mechanical heart valve (MHV) patients aims to prevent thromboembolism but risks bleeding. Addressing a lack of comparative data, this study synthesizes current literature to evaluate the net clinical outcomes of bridging versus no bridging. Purpose(s): To perform a meta-analysis providing clinically actionable estimates of the benefits and risks of perioperative bridging in surgical MHV patients. Method(s): We systematically searched PubMed, Embase, and the Cochrane Library for studies comparing heparin bridging versus no bridging in surgical MHV patients. We used a Bayesian random-effects meta-analysis to estimate risk ratios (RRs) and 95% credible intervals (95% CrIs). Posterior probabilities were then calculated to assess the treatment benefit or harm. Result(s): Four studies comprising 1847 patients (64.48% bridged) met the inclusion criteria. The estimated RR for thromboembolism was 1.36 (95% CrI, 0.27 to 6.97), with only a 35.1% posterior probability of risk reduction (RR <= 1), suggesting no clear benefit. All-cause mortality estimates were uncertain (RR, 0.68; 95% CrI, 0.12 to 3.90). Conversely, safety endpoints yielded high probabilities of hemorrhagic complications. The RR for major bleeding was 2.04 (95% CrI, 0.81 to 5.14), carrying an 82.5% probability of clinically meaningful harm (RR > 1.33). Minor bleeding showed a similar pattern (RR, 1.53; 95% CrI, 0.61 to 3.93). Conclusion(s): Routine perioperative heparin bridging in surgical MHV patients increases bleeding risk without meaningful thromboembolic benefit, supporting a shift toward selective, risk-adapted management. Registration: PROSPERO identifier no. CRD420261359162. Copyright © 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <10> Accession Number 2046140023 Title Deep learning for predicting cardiac procedure outcomes: A scoping review of recent advances. Source Artificial Intelligence in Medicine. 180 (no pagination), 2026. Article Number: 103463. Date of Publication: 01 Oct 2026. Author Jauhiainen S.; Rautiainen I.; Vasankari T.; Ayramo S. Institution (Jauhiainen, Rautiainen, Ayramo) Faculty of Information Technology, University of Jyvaskyla, Jyvaskyla, Finland (Vasankari) The UKK Institute for Health Promotion Research, Tampere, Finland (Vasankari) Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (Ayramo) Wellbeing Services County of Central Finland, Jyvaskyla, Finland Publisher Elsevier B.V. Abstract Accurate prediction of outcomes after cardiac procedures is critical for personalised decision-making and risk stratification. While machine learning (ML) has shown promise in this domain, most prior studies rely on traditional ML methods that require structured data and manual feature engineering, limiting scalability. Many deep learning (DL) architectures offer an alternative by enabling automated feature extraction, particularly from unstructured data such as text, images, and signals. This scoping review summarises recent advances in DL-based prediction of outcomes for four major cardiovascular procedures: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valvuloplasty. Following PRISMA-ScR guidelines, we searched PubMed and IEEE Xplore for studies published between 2020 and March 2025. Finally, 457 studies were retrieved and nine eligible studies were included after screening. DL models demonstrated varying performance across data types, with particularly strong results for text and imaging tasks. Multimodal approaches combining clinical, imaging, and signal data showed added predictive value. Compared with traditional ML, DL models often reduce the need for manual feature engineering, though they still require preprocessing and validation to mitigate overfitting. Overall, these findings suggest that DL has potential to support preoperative risk stratification, although evidence for clinical utility remains preliminary. Moreover, all included studies lacked external validation, and challenges remain regarding generalisability, explainability, and integration into clinical workflows. Future research should prioritise large, diverse cohorts, multimodal data fusion, and interpretable DL models to enable safe and effective clinical implementation. Copyright © 2026 The Authors. <11> Accession Number 2046148022 Title Association between SGLT2 inhibitors and outcomes after heart transplant in patients with type 2 diabetes: A systematic review and meta-analysis. Source Heart Failure Reviews. 31(1) (no pagination), 2026. Article Number: 70. Date of Publication: 01 Dec 2026. Author Costa T.A.; de Sousa L.M.T.; Nogueira A.; Chagas G.C.L.; Abreu M.; Allen L.A.; Cornwell W.K.; Harrington J. Institution (Costa, Allen, Cornwell) Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States (de Sousa) Department of Medicine, University of Miami, Miami, FL, United States (de Sousa) Postgraduate Program in Cardiovascular Sciences, Federal University of Ceara, Ceara, Brazil (Nogueira) Postgraduate Program in Cardiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Nogueira) MOVE Academic Research Organization, Hospital Moinhos de Vento, Porto Alegre, Brazil (Chagas) Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States (Abreu) Division of Endocrinology and Metabolism, Department of Internal Medicine, The University of Texas Southwestern, Dallas, TX, United States (Allen, Cornwell, Harrington) Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, United States (Harrington) Colorado Prevention Center, 12631 E. 17th Ave, Aurora, CO, United States Publisher Springer Abstract Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are recommended for multiple populations-type 2 diabetes (T2D), chronic kidney disease, and heart failure-but their role after heart transplant (HTX) remains unclear. We searched PubMed, Cochrane, and Embase for studies of HTX recipients with T2D comparing outcomes in SGLT2i users vs. non-users. Outcomes of interest were all-cause mortality, urinary tract infection (UTI), and estimated glomerular filtration rate (eGFR) change from baseline. Odds ratios (ORs) and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were pooled using a random-effects model for binary outcomes. Three retrospective observational studies were included in the all-cause mortality meta-analysis, four in the UTI incidence meta-analysis, and five in the qualitative analysis evaluating eGFR change (n = 3,564). Mean follow-up ranged from 9 to 83 months. SGLT2i use was associated with a lower risk of all-cause mortality compared with non-use in both unadjusted (OR 0.43; 95% CI 0.26-0.71; p < 0.001; I2 = 79%) and adjusted analyses (aHR 0.69; 95% CI 0.51-0.93; p = 0.02; I2 = 20%), without increasing the risk of UTI (OR 0.77; 95% CI 0.14-4.05; p = 0.75; I2 = 48%). Most studies suggested stable or increased eGFR from baseline with SGLT2i exposure. SGLT2i use, compared with non-use, was associated with lower all-cause mortality without an increased incidence of UTIs in HTX recipients with T2D. Additionally, the pooled data suggest a possible renal benefit. The totality of these observational data, despite their limitations, provide important context for ongoing SGLT2i use following HTX. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <12> Accession Number 2045013401 Title Efficacy and safety of stem cell therapy for myocardial infarction and heart failure: an updated systematic review and meta-analysis of randomized controlled trials. Source Systematic Reviews. 15(1) (no pagination), 2026. Article Number: 144. Date of Publication: 01 Dec 2026. Author Almuhammadi G.A.; Alhabeeb S.W.; Alharbi R.B.; Yamani M.H.; Alzughaibi R.A.; Mufti B.M.; Morsy M.M.F.; Alnozha F.A. Institution (Almuhammadi, Alharbi, Yamani, Alzughaibi) College of Medicine, Taibah University, Madina, Saudi Arabia (Alhabeeb) College of Medicine, Royal College of Surgeons, Dublin, Ireland (Mufti) College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Morsy) Consultant of Paediatric Cardiology, Cardiac Center, Madina, Saudi Arabia (Morsy) Professor of Paediatric Cardiology, Faculty of Medicine, Sohag University, Sohag, Egypt (Alnozha) Consultant of Cardiology, Cardiac Center, Madina, Saudi Arabia Publisher BioMed Central Ltd Abstract Background/objectives: Cardiovascular diseases (CVDs), particularly myocardial infarction (MI) and heart failure (HF), remain global causes of morbidity and mortality, despite the current treatment options. Stem cell therapy (SCT) has emerged as a promising intervention aimed at halting disease progression and promoting cardiac repair. Nonetheless, the clinical efficacy, optimal cell type, delivery method, and safety profile of SCT remain inadequately defined. Method(s): This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SCT in patients diagnosed with ischemic heart disease (IHD) and HF. PubMed, Web of Science, Embase, Scopus, and Science Direct were searched to retrieve randomized controlled trials (RCTs) investigating SCT in patients with MI or HF. Primary outcomes encompassed changes in left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes (LVEDV, LVESV), infarct size, functional status, and quality of life measures. Risk ratios were calculated for safety outcomes. Subgroup analyses were executed based on follow-up duration, delivery method, and type of stem cell utilized. Result(s): This review included 35 RCTs comprising 3345 patients (1875 in the SCT group and 1488 in the control group). The SCT indicated that significantly enhanced LVEF at 3, 6, and 12 months (mean difference [MD] = 1.43; 95% CI 0.92 to 1.95; p < 0.00001), while simultaneously reducing LVEDV (MD = - 5.23; 95% CI - 7.55 to - 2.91; p < 0.0001) and LVESV (MD = - 6.91; 95% CI - 9.01 to - 4.82; p < 0.00001). Additionally, infarct size demonstrated significant reductions at 6 and 12 months. Patients undergoing SCT exhibited improvements in functional status and quality of life. The safety profile of SCT indicated that it was well tolerated. Conclusion(s): SCT appears to be a safe and modestly effective adjunctive therapy for patients with IHD and HF. The standardization of treatment protocols and the conduct of longer-term studies are critical to validate its clinical utility and optimize therapeutic outcomes. Systematic review registration: PROSPERO CRD42024582716 Copyright © The Author(s) 2026. <13> Accession Number 2046298650 Title Applications of Implementation Science in Graduate Surgical Education: A Scoping Review. Source Journal of Surgical Education. 83(9) (no pagination), 2026. Article Number: 104013. Date of Publication: 01 Sep 2026. Author Cohen I.; Madkins K.; Scott K.; Reasner E.; Hu C.; Little J.; Hinchcliff E.; Williams-Karnesky R.L. Institution (Cohen, Madkins, Scott, Reasner, Hu, Little, Hinchcliff, Williams-Karnesky) Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois, United States Publisher Elsevier Inc. Abstract Objective: Implementation Science (IS) is the study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use. The use of IS in graduate surgical education has not been well characterized. This scoping review aims to identify key barriers, facilitators, and best practices for integrating IS into surgical education. Design(s): Embase, PubMed, Scopus, Cochrane Library, and ERIC were searched in accordance with PRISMA guidelines. Included studies utilized a validated IS strategy to implement an educational or curricular intervention for surgical residents. Qualitative analysis was used to map the IS theories, models, and frameworks used in the included studies to existing IS frameworks, as well as characterize barriers and facilitators to implementation via the Theoretical Domains Framework (TDF). Result(s): Six studies were identified with surgical residents from general surgery, urology, obstetrics-gynecology, vascular surgery, and cardiothoracic surgery programs. Each study used a different approach informed by IS to successfully implement an educational intervention (e.g., quality improvement research curriculum, faculty-resident coaching program, or surgical skills simulation course). IS theories, models, and frameworks included: the Replicating Effectiveness Programs Framework, Fixsen's 6-stage Implementation Framework, Expert Recommendations for Implementing Change, RE-AIM Framework, Normalization Process Theory, and Theory of Change Methodology. Barriers to implementation included variability in resident schedules and competing demands of clinical responsibilities. Facilitators to implementation included protected didactic time, endorsement from program leadership, and incorporation into established educational programming. Conclusion(s): The studies identified in this review utilized a variety of IS theories, models, and frameworks to successfully implement new educational practices. The majority of barriers and facilitators identified fit into the "Environmental Context and Resources" and "Social Influences" domains of the TDF. Key facilitators to implementation shared across the six studies included protected didactic time, buy-in from leadership, and integration into established resident education time. IS represents a promising field for enhancing graduate surgical education. Copyright © 2026 Association of Program Directors in Surgery <14> Accession Number 2041192686 Title Modern anticoagulation strategies in cardiovascular surgery: nonvitamin K antagonist oral anticoagulants versus warfarin after aortic bioprosthetic valve replacement. Source Journal of Thrombosis and Thrombolysis. 59(4) (pp 902-916), 2026. Date of Publication: 01 Apr 2026. Author Chaudhri M.; Mahrizi A.D.A.; Nadeem S.A.; Canal A.; Rajendran P.; Rapelli V.R.; Gill H.; Haroon B.; Shahzad A.; Acquah F.; Kaunzinger C.; Albert C.; Raza M.R. Institution (Chaudhri, Acquah, Kaunzinger, Raza) Hackensack Meridian Ocean University Medical Center, Brick Township, NJ, United States (Mahrizi, Haroon) Faculty of Medicine and Surgery, University of Malta, Msida, Malta (Nadeem) Drexel University, Philadelphia, PA, United States (Canal, Rapelli, Gill) Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ, United States (Rajendran) Hackensack Meridian School of Medicine, Hackensack, NJ, United States (Shahzad) Saint Barnabas Hospital, Bronx, NY, United States (Albert) Robert Wood Johnson University Hospital, New Brunswick, NJ, United States (Chaudhri) Department of Medicine, Hackensack Meridian Ocean University Medical Center, Brick, NJ, United States Publisher Springer Abstract The optimal postaortic valve replacement (AVR) anticoagulation strategy remains poorly defined, particularly when comparing nonvitamin K antagonist oral anticoagulants (NOACs) versus warfarin. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of NOACs compared with warfarin in these patients. Our study was registered on PROSPERO (ID CRD420251028998). A search of the PubMed, EMBASE, and Cochrane databases was conducted on April 9, 2025, for studies published between 2015 and 2025 that compared NOACs to warfarin after aortic bioprosthetic valve replacement. Inclusion criteria included randomized controlled trials (RCTs) and observational studies reporting thromboembolic events, major bleeding, and mortality with at least 6 months of follow-up. Studies on mechanical valves, case reports, and publications that could not be translated into English were excluded. Data extraction was conducted based on study design, patient demographics, clinical outcomes, and effect sizes, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs) using a random effects model. Risk of bias was assessed using the ROBINS-I tool. Seventeen studies (n = 93,510 participants) were included. NOACs were associated with an HR of 0.91 for thromboembolic events (95% CI: 0.76-1.09) and a pooled HR of 1.22 for major bleeding (95% CI: 0.88-1.68). Several studies have suggested a trend toward lower all-cause mortality and major bleeding with NOACs, particularly in patients with lower bleeding risk. In patients undergoing aortic bioprosthetic valve replacement, NOACs show similar efficacy and safety to warfarin for preventing thromboembolic events and major bleeding. However, anticoagulation decisions should be individualized, and larger RCTs are needed to determine the optimal approach. Copyright © The Author(s) 2025. <15> Accession Number 2043340493 Title The impact of acute normovolemic hemodilution on blood transfusions in cardiac surgery: a GRADE-assessed systematic review and meta-analysis of 30 randomized controlled trials with trial sequential analysis. Source Naunyn-Schmiedeberg's Archives of Pharmacology. 399(8) (pp 11035-11054), 2026. Date of Publication: 01 May 2026. Author Alam U.; Rath S.; Ansab M.; Khattak F.; Siddiqui H.T.; Burhan M.; Moiz A.; Sabir V.; Afridi Z.A.K. Institution (Alam, Khattak, Sabir, Afridi) Khyber Medical College, Peshawar, Pakistan (Rath) All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India (Ansab) Services Institute of Medical Sciences, Lahore, Pakistan (Siddiqui) Jinnah Sindh Medical University, Karachi, Pakistan (Burhan) Dow University of Health Sciences, Sindh, Karachi, Pakistan (Moiz) Bacha Khan Medical College, Mardan, Pakistan Publisher Springer Science and Business Media Deutschland GmbH Abstract Acute normovolemic hemodilution (ANH) is an intraoperative blood conservation technique that involves removing a portion of the patient's blood after anesthesia induction and replacing it with fluids to maintain normovolemia. The purpose of this systematic review and meta-analysis was to assess the efficacy and safety of ANH in reducing transfusion requirements and improving hemorrhagic outcomes in adult cardiac surgery patients. Studies were identified through systematic searches of PubMed, Embase, and Cochrane Central databases. Effect estimates were calculated using random-effects models, with heterogeneity assessed using the I2 statistic. Trial sequential analysis (TSA) was employed to evaluate the robustness of cumulative evidence. randomized controlled trials (RCTs) involving 4473 patients were included for further analysis. ANH was associated with a 27% relative reduction in the incidence of allogeneic blood transfusions (RR = 0.73, 95% CI = 0.60 to 0.88; p = 0.0008) and a decrease in the volume of allogeneic red blood cell units transfused (MD = - 0.75 units, 95% CI = - 1.41 to - 0.08; p = 0.020). Fresh frozen plasma transfusion requirements were also significantly reduced (MD = - 0.21 units, 95% CI = - 0.39 to - 0.03; p = 0.0248), along with total blood loss (MD = - 64.35 mL, 95% CI = - 114.57 to - 14.13; p = 0.012). However, chest tube drainage, surgical revision, and stroke incidence showed no significant differences between ANH and usual care. This meta-analysis demonstrates that ANH significantly reduces the need for allogeneic blood transfusions and improves outcomes such as red blood cell and fresh frozen plasma usage during cardiac surgery. The findings highlight ANH's potential as an effective blood conservation strategy, though variability in outcomes and heterogeneity warrant further high-quality research to optimize its application in contemporary cardiac surgical practices. Copyright © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026. <16> Accession Number 2044435760 Title Safety and efficacy of ticagrelor plus aspirin vs. aspirin monotherapy in patients undergoing coronary artery bypass grafting: A meta-analysis with trial sequential analysis. Source Journal of Thrombosis and Thrombolysis. 59(4) (pp 832-849), 2026. Date of Publication: 01 Apr 2026. Author Hammadeh B.M.; Hussein A.M.; Alhamwi N.; Odat R.M.; Naseem M.; Asawaeer M. Institution (Hammadeh, Hussein) Al-Balqa' Applied University, As-Salt, Jordan (Alhamwi) The University of Jordan, Amman, Jordan (Odat) Jordan University of Science and Technology, Irbid, Jordan (Naseem) Department of Internal Medicine, LSU HEALTH Shreveport, Shreveport, LA, United States (Asawaeer) Burnett School of Medicine, Texas Christian University, Fort Worth, TX, United States (Asawaeer) Division Chief of Cardiology, Texas Health Harris Methodist Hospital Fort Worth, Fort Worth, TX, United States Publisher Springer Abstract Optimal antiplatelet therapy after coronary artery bypass grafting (CABG) remains debated. While aspirin is standard, the benefit of adding ticagrelor, a P2Y12 inhibitor with distinct pharmacological properties, is unclear. We compared the efficacy and safety of ticagrelor plus aspirin versus aspirin alone in patients undergoing CABG. We systematically searched major databases for randomized controlled trials and observational studies comparing ticagrelor plus aspirin with aspirin alone in post-CABG patients. The primary efficacy endpoint was trial-defined MACE. Secondary efficacy endpoints included all-cause mortality, cardiovascular death, stroke, MI, revascularization, and saphenous vein graft failure. The primary safety endpoint was major bleeding. A total of seven studies (five randomized controlled trials (RCTs) and one observational study) were included, enrolling 11,893 patients post-CABG, primarily for acute coronary syndrome or stable angina. The majority of studies had a follow-up duration of one year. Ticagrelor plus aspirin significantly reduced the risk of trial-defined MACE (RR 0.61, 95% CI 0.45-0.84; I2 = 0%) and stroke (RR 0.49, 95% CI 0.29-0.82; I2 = 11.5%), but did not reduce all-cause mortality, myocardial infarction, or cardiovascular death. However, it significantly increased the risk of major bleeding (RR 1.70, 95% CI 1.06-2.71; I2 = 42%), while minor bleeding showed no difference (RR 2.38, 95% CI 0.88, 6.43; I2 = 39%). In a sensitivity analysis restricted to RCTs alone (n = 4,905), the reduction in trial-defined MACE remained significant (RR 0.61, 95% CI 0.45-0.84), while the reduction in stroke (RR 0.74, 95% CI 0.35-1.56) and the increase in major bleeding (RR 1.82, 95% CI 0.77-4.34) were no longer statistically significant. In patients undergoing CABG, the addition of ticagrelor to aspirin reduces trial-defined MACE and stroke compared with aspirin alone, but increases the risk of major bleeding without a mortality benefit. These findings support a personalized, risk-stratified approach to antiplatelet therapy, though they are limited by the number and heterogeneity of available studies. Further trials are warranted to define the optimal antiplatelet regimen in this population. Clinical Trial Registration Number: Not applicable. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <17> Accession Number 2045455061 Title Cryoanalgesia in Thoracic Surgery. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 21(2) (pp 106-109), 2026. Date of Publication: 01 Mar 2026. Author Drake L.; Weksler B. Institution (Drake, Weksler) Division of Thoracic and Esophageal Surgery, Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA, United States Publisher SAGE Publications Ltd Abstract Cryoanalgesia is a technique for reducing postoperative pain that involves freezing peripheral nerves while preserving their ability to regain function over time. The technique has been used for decades, and randomized trials have shown a reduction in pain and opioid use in some patients undergoing thoracotomy and pectus excavatum repair. In these trials, outcomes were highly dependent on the control groups. Randomized studies of patients undergoing minimally invasive thoracic surgery have failed to show the same results. Furthermore, several studies have reported chronic pain and neuropathic-type pain in patients treated with cryoanalgesia. In this review, we discuss the electrophysiologic and histopathologic basis of cryoanalgesia, highlight randomized trials of cryoanalgesia in thoracic surgery, and outline potential pitfalls, such as chronic pain, to offer insight into which patients may benefit most from cryoanalgesia and potential future directions of study. Copyright © The Author(s) 2026 <18> Accession Number 2045590972 Title Multimodal personalised executive function intervention (E-Fit) for school-aged children with complex congenital heart disease in Switzerland: a randomised controlled feasibility study. Source BMJ Open. 16(5) (no pagination), 2026. Date of Publication: 01 May 2026. Author Schmid A.S.; Ehrler M.; Bunge S.A.; Kretschmar O.; Landolt M.A.; Rousson V.; Tuura R.O.; Wehrle F.M.; Latal B. Institution (Schmid, Ehrler, Wehrle, Latal) Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland (Schmid, Ehrler, Kretschmar, Landolt, Tuura, Wehrle, Latal) Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland (Ehrler) Department of Forensic and Neurodevelopmental Sciences, King's College London Institute of Psychiatry Psychology & Neuroscience, London, United Kingdom (Bunge) Department of Psychology, Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, United States (Kretschmar) Department of Cardiology, University Children's Hospital Zurich, Zurich, Switzerland (Kretschmar, Tuura, Wehrle, Latal) University of Zurich, Zurich, Switzerland (Landolt) Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland (Landolt) Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland (Rousson) Division of Biostatistics, Center for Primary Care and Public Health (Unisante), University of Lausanne, Lausanne, Switzerland (Tuura) MR Research Centre, University Children's Hospital Zurich, Zurich, Switzerland (Latal) URPP Adaptive Brain Circuits in Development and Learning, University of Zurich, Zurich, Switzerland Publisher BMJ Publishing Group Abstract Objective: To explore the feasibility of a novel multimodal executive function intervention in school-aged children with complex congenital heart disease (cCHD). Design(s): Single-centre, single-blinded, randomised-controlled 8-week multimodal personalised executive function intervention (E-Fit) study. Outcomes were measured throughout the intervention, post-intervention (T1) and at 4-month follow-up (T2). Setting(s): Tertiary care centre between May 2022 and May 2024. Participant(s): Children 10 to 12 years (M=11.0, SD=0.9) with cCHD without a genetic diagnosis with infant open-heart surgery and reported difficulties (T-scores >=60) on any of the summary scales of the parent- or teacher-reported Behavior Rating Inventory for Executive Function (BRIEF). Intervention(s): Children with cCHD were randomly assigned to one of two groups: the intervention or the control group. The 8-week intervention was multimodal including three modalities: (1) computerised executive function (EF) training 3x20 min/week with CogniFit; (2) a weekly, remote standardised 1:1 individual EF strategy coaching; (3) analogue games played at convenience. The control group completed activity logs. Feasibility measures: Acceptability: Acceptance and Feasibility Scale (AFS) and coach-rated engagement during coaching sessions. Demand: Number of completed computerised training, strategy coaching and analogue game sessions. Implementation: E-Fit Fidelity Measurement System, assessing adherence to core components. Practicality: Retention rate. Integration: AFS integration items. Exploratory efficacy: BRIEF, neuropsychological EF testing and psychosocial variables at baseline, post-intervention (8 weeks) and at 4-month follow-up. Result(s): We recruited 42 participants (N<inf>female</inf>=20). Acceptability: The intervention was acceptable, with moderate observed engagement. Demand: median number of computerised training sessions completed was 16 of 24 sessions (67%, (IQR; 6 to 19)), all children attended all scheduled coaching sessions, analogue games were played in total a median of 9 times (IQR 4 to 14). Implementation: Coaching sessions could be implemented by the coaches as intended. Practicality: Overall retention rate was 90%. Integration: E-Fit was well integrable into the home setting. Exploratory efficacy favoured the intervention group with improvements in the parent-rated Behavioral Regulation Index of the BRIEF (adjusted Hedge's (g<inf>A1</inf>) = -0.408 to -0.903) and in social responsiveness (g<inf>A1</inf> = -0.427 to -0.521) at T1 and at T2. Conclusion(s): E-Fit is a feasible intervention suggesting EF and social responsiveness improvements in children with cCHD. Motivational strategies to improve adherence to computerised training should be refined before a full-scale efficacy trial. Trial registration number: NCT05198583. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/. <19> Accession Number 2046322119 Title Percutaneous left atrial appendage closure following catheter ablation therapy of atrial fibrillation: outcomes stratified by bleeding risk - a sub-analysis of the OPTION study. Source Europace. 28(6) (no pagination), 2026. Article Number: euag093. Date of Publication: 01 Jun 2026. Author Phillips K.P.; Nair D.G.; Boersma L.V.A.; Doshi R.N.; Healey J.S.; Jaber W.A.; Mansour M.; Reddy V.Y.; Tondo C.; Natale A.; Sukumar A.; Leger K.; Christen T.; Sutton B.S.; Wazni O.M. Institution (Phillips) The Brisbane AF Clinic, Greenslopes Private Hospital, Suite 23, Greenslopes Specialist Centre, Newdegate Street, Brisbane, QLD, Australia (Nair) Cardiac Electrophysiology Division, St. Bernards Medical Center & Arrhythmia Research Group, Jonesboro, AR, United States (Boersma) Cardiology Department, St. Antonius Hospital, Nieuwegein and UMC, Amsterdam, Netherlands (Doshi) Cardiac Electrophysiology Division, Arizona State University John Schufeldt School of Medicine and Advanced Medical Engineering, Scottsdale, AZ, United States (Healey) Department of Cardiac Electrophysiology, McMaster University, Hamilton, ON, Canada (Jaber) Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, United States (Mansour) Department of Cardiac Electrophysiology, Massachusetts General Hospital, Boston, MA, United States (Reddy) Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, New York, NY, United States (Tondo) Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy (Tondo) Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy (Natale) Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, United States (Natale) Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy (Sukumar) Boston Scientific Corporation, Marlborough, MA, United States (Leger) Boston Scientific Corporation, Marlborough, MA, United States (Christen) Boston Scientific Corporation, Marlborough, MA, United States (Sutton) Boston Scientific Corporation, Marlborough, MA, United States (Wazni) Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, United States Publisher Oxford University Press Abstract Aims: Concerns have been raised over the safety and necessity of continuing oral anticoagulation (OAC) in patients following catheter ablation for atrial fibrillation (AF). OPTION demonstrated the safety and efficacy of left atrial appendage closure (LAAC) in a post-ablation population. We sought to analyse the impact of baseline bleeding risk, per HAS-BLED scores, on the outcomes for patients in a pre-specified sub-analysis. Methods and Results: Patients with AF and high stroke risk undergoing catheter ablation were randomly assigned to LAAC vs. OAC in OPTION and were stratified by HAS-BLED score: 0, 1, 2, >=3. OPTION enrolled 1600 patients (CHA<inf>2</inf>DS<inf>2</inf>-VASc score: 3.5 +/- 1.3; HAS-BLED score: 1.2 +/- 0.8); randomized 1:1 to ablation/LAAC or ablation/OAC. Primary effectiveness (all-cause death/stroke/systemic embolism) and safety (bleeding composite) endpoints were directionally similar in HAS-BLED subgroups; both thromboembolic and bleeding event rates were higher in patients with increasing HAS-BLED score. A significant reduction in primary safety bleeding events was noted in favour of LAAC across HAS-BLED subgroups, with more striking reductions noted for lower HAS-BLED scores of 0 (n = 265; hazard ratio: 0.25; 95% confidence interval: 0.20, 0.50) and 1 (n = 890; hazard ratio: 0.41, 95% confidence interval: 0.27-0.61). Conclusion(s): Regardless of bleeding risk, LAAC is comparable to OAC in stroke protection while demonstrating greater freedom from bleeding in a post-ablation AF population, even in patients with low HAS-BLED scores. The OPTION study highlights an opportunity to mitigate future bleeding risk with a strategy of LAAC after ablation in patients deemed at high risk of stroke according to clinical guidelines. Trial registration number: NCT03795298 Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. <20> Accession Number 2044600821 Title Prophylactic Dexmedetomidine Reduces Junctional Ectopic Tachycardia and Facilitates Postoperative Recovery in Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis of Prospective Trials. Source Paediatric Anaesthesia. 36(7) (pp 767-777), 2026. Date of Publication: 01 Jul 2026. Author Singh M.; Anilkumar A.; Vondivillu Srinivasan R.; Jabbar J.A.; Malaichamy N.; Jayaraman R. Institution (Singh, Anilkumar, Vondivillu Srinivasan, Jabbar, Malaichamy, Jayaraman) First Faculty of Medicine, Charles University, Prague, Czechia Publisher John Wiley and Sons Inc Abstract Objective: To evaluate the efficacy and safety of prophylactic dexmedetomidine in preventing Junctional Ectopic Tachycardia (JET) and its impact on postoperative recovery in pediatric congenital heart surgery, restricting analysis to prospective trials. Method(s): We systematically searched PubMed, Scopus, and CENTRAL through October 16, 2025, for prospective randomized and quasi-randomized trials. Retrospective cohorts were excluded. The primary outcome was postoperative JET incidence. Secondary outcomes included mechanical ventilation duration, ICU length of stay (LOS), Vasoactive-Inotropic Score (VIS), and safety. Data were synthesized using random-effects models and certainty of evidence was assessed using the GRADE framework. Result(s): Five prospective trials (n = 639) met the inclusion criteria. Prophylactic dexmedetomidine was associated with a significant reduction in postoperative JET incidence (OR 0.37; 95% CI 0.23-0.58; p < 0.0001; I2 = 0%), supported by moderate-certainty evidence. For secondary outcomes, pooled analyses suggested reductions in mechanical ventilation (MD -4.80 h) and ICU LOS (MD -19.83 h), but these were characterized by substantial clinical heterogeneity and low to very-low certainty of evidence. A significant reduction in VIS emerged only in the sensitivity analysis; these findings remain hypothesis-generating. No significant differences were observed for mortality or hypotension. Conclusion(s): In prospective pediatric cardiac surgery trials, prophylactic dexmedetomidine was associated with reduced postoperative JET, supported by moderate-certainty evidence. While dexmedetomidine may help facilitate earlier recovery, its impact on secondary outcomes remains suggestive rather than definitive due to low evidence certainty. Future large-scale, multicenter randomized trials are required to confirm if these potential benefits translate into consistent clinical improvements. Copyright © 2026 The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd. <21> Accession Number 2044821607 Title Uni-leaflet mitral valve in adults: a systematic review of case reports and case series. Source Future Cardiology. 22(5) (pp 557-565), 2026. Date of Publication: 2026. Author Mookadam M.; Mookadam S.A.; Morris M.; Pradhan S.; Mookadam F. Institution (Mookadam, Pradhan) Department of Family Medicine, Mayo Clinic Arizona, Scottsdale, AZ, United States (Mookadam) Neuroscience, Arizona State University, Tempe, AZ, United States (Morris) Cardiac Radiology, Banner University Medical Center Phoenix, Phoenix, AZ, United States (Mookadam) Banner MD Anderson Cancer Center-Phoenix, University of Arizona and Cardio-Oncology Services, Phoenix, AZ, United States Publisher Taylor and Francis Ltd. Abstract Introduction: Uni-leaflet mitral valve (ULMV) is a rare congenital anomaly historically considered incompatible with long-term survival, yet increasing reports describe diagnosis in adulthood. We conducted a systematic review to characterize clinical presentation, anatomy, imaging findings, management, and outcomes in adults with ULMV. Method(s): Following PRISMA guidelines, major databases were searched from 1960 through January 2024. Eligible studies reported adult patients with confirmed ULMV. Data were extracted on demographics, valve morphology, symptoms, associated anomalies, imaging modalities, interventions, and outcomes. Result(s): Thirty-six publications comprising 40 adult patients met inclusion criteria. Mean age at diagnosis was 50.5 years, with female predominance. Posterior leaflet hypoplasia or agenesis accounted for 97.5% of cases. Most patients were symptomatic, commonly with dyspnea or heart failure, and over half had moderate or greater mitral regurgitation. Atrial fibrillation, atrial septal defects, and aortic valve abnormalities were frequent comorbidities. Transthoracic echocardiography was used universally, with transesophageal and three-dimensional imaging providing incremental anatomical detail. Approximately one-third underwent mitral valve repair or replacement, with generally favorable outcomes. Conclusion(s): Adult ULMV demonstrates marked clinical and anatomical heterogeneity and may represent a developmental spectrum rather than a single entity. Standardized definitions and prospective registries are needed to improve risk stratification and guide management. Protocol Registration: http://www.crd.york.ac.uk/prospero identifier is CRD420251083213. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <22> 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. 24(6) (pp 2025-2039), 2026. Date of Publication: 01 Jun 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). <23> Accession Number 2045824947 Title Preoperative Stellate Ganglion Block for Postoperative Sore Throat in Patients Undergoing Double-Lumen Endotracheal Intubation: A Randomized Clinical Trial. Source Drug Design, Development and Therapy. 20 (no pagination), 2026. Article Number: 610843. Date of Publication: 2026. Author Cong P.; Tan Y.; Li H.; Zhang H.; Zhang L.; Shan L.; Zhao Y.; Jin Y.; Wu Q.; Chen Z.; Li N. Institution (Cong, Wu, Chen) Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, 1279 Sanmen Road, Hongkou District, Shanghai, China (Tan, Li, Zhang, Zhang, Li) Department of Anesthesiology, The Second Qilu Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Shandong, Jinan, China (Jin) Department of Epidemiology and Biostatistics, School of Public Health, Wannan Medical University/ Institute of Chronic Disease Prevention and Control, Wuhu, China (Shan, Zhao) Department of Thoracic Surgery, The Second Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China (Jin) Department of Anesthesiology and Perioperative Medicine, Shandong Public Health Clinical Center, Shandong University, Shandong, Jinan, China Publisher Dove Medical Press Ltd Abstract Background: As a common complication of double-lumen endobronchial tube (DLT) intubation during thoracic surgery, postoperative sore throat (POST) brings adverse impacts on patient recovery. Although stellate ganglion block (SGB) can modulate sympathetic tone and inflammatory reactions, its efficacy in preventing DLT-related POST is still inconclusive. This trial aimed to determine whether SGB reduces the incidence of POST at 6 h after surgery in patients undergoing DLT intubation. Method(s): In this single-center prospective randomized controlled trial, 124 patients undergoing elective thoracic surgery with left-sided DLT intubation were randomized 1:1 to two groups: the intervention group received preoperative ultrasound-guided right-sided SGB (5 mL of 0.5% ropivacaine), and the control group received standard care (ultrasound scanning without injection plus 1% tetracaine gel lubrication). The primary endpoint was the incidence of POST at 6 h after surgery. Result(s): Of the 124 randomized patients, 111 eligible subjects were finally included in the full analysis. The incidence of POST at 6 h after surgery, was significantly decreased in the ultrasound-guided SGB intervention group compared with the standard care control group (14.3% vs 38.2%; RR = 0.37; 95% CI: 0.18-0.77; P = 0.008). This significant protective effect of SGB against POST was consistently observed at the early postoperative time point of 2 h (P = 0.017) and sustained up to 24 h after surgery (P = 0.036). SGB also significantly reduced POST severity at all time points, lowered sleep disturbance rate and improved anxiety/depression scores at 24 h after surgery (all P < 0.05). No between-group differences were observed in the incidence or severity of hoarseness or in other outcomes, and no notable complications occurred. Conclusion(s): Preoperative ropivacaine-based SGB could reduce the incidence and severity of POST in patients for DLTs in thoracic surgery, with this protective effect persisting for at least 24 h after surgery. These preliminary results require validation in larger multicenter studies. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR2400092313. Copyright © 2026 Cong et al. <24> Accession Number 2045682996 Title Prevalence of dysglycemia following paediatric cardiac surgery: a systematic review and meta-analysis. Source BMJ Paediatrics Open. 10(1) (no pagination), 2026. Date of Publication: 2026. Author Abera E.G.; Sime H. Institution (Abera) Department of Public Health, Jimma University, Oromia, Jimma, Ethiopia (Abera) Clinical Trial Unit, Jimma University, Oromia, Jimma, Ethiopia (Sime) King Faisal Hospital Rwanda, Kigali, Rwanda (Sime) Africa Health Science University, Kigali, Rwanda Publisher BMJ Publishing Group Abstract Background: Postoperative dysglycemia is a common but under-recognised complication in paediatric cardiac surgery, driven by physiologic stress, hormonal changes and cardiopulmonary bypass. Reported prevalence varies widely, and no meta-analysis has synthesised the evidence. Therefore, this study aimed to estimate the pooled prevalence of postoperative dysglycaemia and describe associated postoperative outcomes, such as intensive care unit (ICU) stay and mechanical ventilation duration. Method(s): We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines and the Joanna Briggs Institute (JBI) methodology for prevalence studies. Eligible studies included paediatric patients (<=18 years) undergoing cardiac surgery reporting postoperative dysglycaemia (hyperglycaemia or hypoglycaemia). A random-effects model was used to calculate pooled prevalence and 95%CIs, with logit transformation applied to prevalence proportions and heterogeneity assessed using I2 statistics. Subgroup analyses were performed by region/continent, study design, age group and glycaemic threshold. All included studies were critically appraised using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias 2 tool for randomised trials. The protocol was registered with PROSPERO (CRD420251161893). Result(s): 22 studies involving 3864 patients were included. The pooled prevalence of postoperative dysglycemia was 68.6% (95% CI 52.8 to 81.0), with hyperglycaemia accounting for most cases (71.2%) and hypoglycaemia observed in 8.1%. Prevalence was higher in Asia and North America (~75%) than in Europe (45.2%), though not statistically significant. Studies using lower hyperglycaemia thresholds (126-139 mg/dL) reported significantly the highest prevalence (82.3%, p<0.032). The pooled mean ICU stay among dysglycemic patients was 180.3 hours (95% CI 82.3 to 279.3), and mean mechanical ventilation duration was 94.6 hours (95% CI 5.2 to 184.1). Sensitivity analyses showed that no single study disproportionately influenced the overall pooled estimates, and no publication bias was detected. The certainty of evidence assessed using the GRADE approach was moderate for overall dysglycemia prevalence. Conclusion(s): Dysglycaemia is highly prevalent following paediatric cardiac surgery, particularly hyperglycaemia, with prolonged ICU and mechanical ventilation times observed among affected patients. These findings underscore the need for vigilant perioperative glucose monitoring, standardised definitions of dysglycaemia, and evidence-based glycaemic management protocols. Future multicentre studies are warranted to establish optimal glycaemic thresholds and evaluate targeted interventions to improve postoperative outcomes in this vulnerable population. 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/. <25> Accession Number 2045634297 Title Outcomes of Aortic Valve Repair: A Systematic Review and Meta-Analysis Using Reconstructed Individual Patient Data. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 21(2) (pp 111-121), 2026. Date of Publication: 01 Mar 2026. Author Cerqueira R.J.; Mascarenhas J.Q.; Rodrigues M.; Miranda J.O.; Kawczynski M.J.; Vojacek J.; Arabkhani B.; Bidar E.; Leite-Moreira A.; Saraiva F.; Heuts S. Institution (Cerqueira, Mascarenhas, Rodrigues, Miranda, Leite-Moreira, Saraiva) UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal (Cerqueira, Leite-Moreira) Cardiothoracic Surgery Department, Centro Hospitalar Universitario Sao Joao, Portugal (Kawczynski, Bidar, Heuts) Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Netherlands (Kawczynski, Bidar, Heuts) Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Netherlands (Vojacek) Department of Cardiac Surgery, University Hospital Hradec Kralove, Czechia (Arabkhani) Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, Netherlands Publisher SAGE Publications Ltd Abstract Objective: The progressive dissemination of isolated aortic valve repair (AVRep) and valve-sparing root (VSR) procedures has resulted in a cumulative expansion of the available literature. This work aims to synthesize the current knowledge and identify predictors of mortality and reintervention in patients undergoing such valve-preserving procedures. Method(s): A systematic review and meta-analysis were conducted in 2 databases (last search January 2025). Studies with >=200 adult patients undergoing AVRep or VSR with a minimum mean follow-up >=5 years were included. Short-term outcomes were summarized using weighted descriptive statistics. Forest plots, funnel plots, and the Newcastle-Ottawa Scale were used to evaluate the risk of bias. Long-term survival and freedom from reoperation were analyzed through reconstructing individual patient data from Kaplan-Meier curves, and a mixed-effects Cox frailty model was used to identify study-level predictors of these endpoints. Result(s): There were 48 studies included, encompassing 20,914 patients with a mean weighted age of 52.42 (50.28 to 54.57) years. Early outcomes included hospital mortality (1.34% [1.04% to 1.73%]), bleeding (3.77% [2.76% to 5.13%]), myocardial ischemia (0.44% [0.26% to 0.77%]), pacemaker implantation (1.00% [0.63% to 1.59%]), neurologic events (1.27% [0.91% to 1.78%]), and postoperative residual aortic regurgitation (3.48% [1.90% to 6.29%]). Pooled survival at 1, 5, 10, and 20 years of follow-up was 96.8%, 92.5%, 83.8%, and 67%, respectively; freedom from reoperation at the same time points was 97.9%, 93.9%, 88.2%, and 77.5%, respectively. Factors such as older age, female sex, aortic dissection, and isolated valve repair were associated with higher mortality. Conclusion(s): These findings suggest that AVRep and VSR are associated with low early mortality and morbidity and excellent long-term outcomes. However, heterogeneity in definitions and endpoints across studies underlines the need for standardized definitions and conduction of properly designed randomized trials. Copyright © The Author(s) 2026 <26> Accession Number 2045795503 Title S722 Transesophageal Echo Associated Gastrointestinal Injuries: A Pooled Rate of Injuries. Source The American Journal of Gastroenterology. Conference: 2023 ACG Annual Meeting Abstracts. Vancouver Canada. 118(10S) (pp S529-S530), 2023. Date of Publication: 01 Oct 2023. Author Gangwani M.K.; Hayat U.; Awan R.U.; Aziz A.; Dahiya D.S.; Aziz M.; Lee-Smith W.M.; Amantul-Raheem H.; Nawras Y.; Kamal F.; Inamdar S. Institution (Gangwani, Aziz, Lee-Smith, Nawras) University of Toledo, Toledo, OH, United States (Hayat) Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, United States (Awan) Ochsner Rush Medical Center, Meridian, MS, United States (Aziz) University of Augusta, Augusta, GA, United States (Dahiya) University of Kansas School of Medicine, Kansas City, KS, United States (Amantul-Raheem) Deccan College of Medical Sciences, Toledo, OH, United States (Kamal) Thomas Jefferson Health, Philadephia, PA, United States (Inamdar) University of Arkansas, Toledo, OH, United States Publisher Embase Conference Abstracts Abstract Introduction: - Transesophageal echocardiography (TEE) is a growing modality that plays a significant role in guiding clinical decision-making. However, upper gastrointestinal (GI) injuries are frequently observed as complications of TEE. The objective of this study is to systematically review the incidence rates and different types of GI injuries associated with TEE. Method(s): - A comprehensive literature search was performed across multiple databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and the Global Index Medicus. The search utilized specific keywords related to "TEE" and "GI injuries". Pooled rates were calculated for overall injuries, GI complications, lacerations, and perforations, with corresponding 95% confidence intervals (CI). Additionally, a subgroup analysis was conducted using odds ratios (OR) to compare bleeding rates between the variceal and non-variceal groups. Result(s): - A total of 1, 151 articles were evaluated, and 26 studies with 55, 319 patients were included in the analysis. The overall rate of adverse events was found to be 0.51% with a 95% confidence interval (CI) of 0.3% to 0.7%. Among all adverse events, bleeding was the most commonly reported, followed by dysphagia and lacerations (refer to Table 1 for details). The highest rates of adverse events were observed in liver transplant patients at 1.35%, followed by critically ill patients in the intensive care unit (ICU) and in-hospital settings at 1.1%. Adverse events during intraoperative TEE were noted at a rate of 0.7%, while patients undergoing cardiac procedures experienced adverse events at a rate of 0.67%. The pooled complication rate for bleeding was calculated to be 0.17% with a 95% CI of 0.1% to 0.3%. The rate of odynophagia/dysphagia was estimated to be 0.27% with a 95% CI of -0.1% to 0.5%, and lacerations had a rate of 0.12% with a 95% CI of -0.1% to 0.5%. A subgroup analysis comparing variceal and non-variceal cohorts across three studies revealed no significant difference in bleeding rates (Figure 1). Conclusion(s): - Our review documented the complications associated with TEE and their correlation with different patient subgroups. Our study demonstrates benefits of TEE outweigh the minimal risks involved in at-risk patients including those with varices. Further studies are needed to validate our findings and provide valuable insights for future clinical decision-making. (Figure presented.) Copyright © 2023 by The American College of Gastroenterology <27> Accession Number 2045395107 Title Operative predictors of mortality and neurologic outcomes after modified Bentall for acute aortic dissection: A systematic review and meta-analysis. Source Asian Cardiovascular and Thoracic Annals. 34(5) (pp 430-444), 2026. Date of Publication: 01 Jun 2026. Author Kurniawan K.; Wartono D.A. Institution (Kurniawan) Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia (Wartono) Department of Cardiothoracic and Vascular Surgery, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia Publisher SAGE Publications Inc. Abstract Introduction: The modified Bentall procedure is frequently required in acute type A aortic dissection (ATAAD) with root involvement, a high-risk subgroup with substantial early mortality and neurologic complications. Prior studies have examined operative predictors such as cardiopulmonary bypass (CPB) time, cross-clamp duration, circulatory arrest, and conduit type, but findings remain inconsistent. This systematic review and meta-analysis aimed to determine whether specific operative parameters influence early mortality or neurologic outcomes following the Bentall procedure in ATAAD. Method(s): A systematic search of PubMed, Embase, CENTRAL, ProQuest, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifteen observational studies evaluating adult ATAAD patients undergoing the modified Bentall procedure were included. Pooled proportions of early mortality and neurologic complications were calculated using a random-effects model. Heterogeneity, publication bias, sensitivity testing, and meta-regression were conducted to assess associations between operative variables-including CPB time, cross-clamp time, circulatory arrest duration, operative time, conduit type, and concomitant coronary artery bypass grafting (CABG)-and postoperative outcomes. Result(s): Across 1547 patients, pooled early mortality was 13%, and the pooled rate of postoperative neurologic complications was likewise 12%. Sensitivity analyses showed stable results. Meta-regression demonstrated no significant association between any operative parameter and early mortality or neurologic events (all p > 0.05). No substantial publication bias was detected. Conclusion(s): Among ATAAD patients undergoing the modified Bentall procedure, early mortality and neurologic complication rates remain acceptable. The absence of significant operative predictors suggests that advances in perfusion, myocardial protection, and cerebral management may mitigate time-related risks. Further multicenter studies are needed to refine risk stratification. Copyright © The Author(s) 2026 <28> Accession Number 2045135062 Title Outcomes of off-pump versus on-pump coronary artery bypass grafting in diabetic patients: A propensity-adjusted systematic review and meta-analysis. Source Asian Cardiovascular and Thoracic Annals. 34(5) (pp 452-460), 2026. Date of Publication: 01 Jun 2026. Author Murad Z.A.; Lahcen A.A.; Alkhawam M.; Al-awadh M.F.; Ali M.; Saeed S.A.S.; Elghazaly S.M. Institution (Murad) Faculty of Medicine and Health Science, University of Aden, Aden, Yemen (Lahcen) Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco (Alkhawam) University of Alabama at Birmingham, Birmingham, AL, United States (Al-awadh) University of Bahri, Alkadroo, Sudan (Ali, Elghazaly) Faculty of Medicine, Assiut University, Assiut, Egypt (Saeed) Ibn Sina University, Khartoum, Sudan Publisher SAGE Publications Inc. Abstract Objective: Diabetes is a major risk factor for coronary artery disease. We compared outcomes of off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass grafting in diabetic patients using propensity-adjusted observational studies. Method(s): We searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing OPCAB and ONCAB in diabetic patients using propensity-score matching or covariate adjustment. Eligible studies reported short-term or long-term clinical outcomes. Primary endpoints were early (in-hospital or 30-day) mortality and long-term survival. Secondary outcomes included stroke, myocardial infarction, reoperation for bleeding, atrial fibrillation, renal replacement therapy, low cardiac output syndrome, and completeness of revascularization. Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Result(s): Nine studies (observation periods 1996-2021), including >10,000 diabetic patients, met criteria. There was no significant difference in early mortality between OPCAB and ONCAB (OR 0.71, 95% CI 0.44-1.14; P = .15). Long-term mortality was significantly higher with OPCAB (HR 1.16, 95% CI 1.01-1.33; P = .04), while mid-term survival showed no difference. OPCAB was associated with lower risks of stroke (OR 0.47, 95% CI 0.24-0.94; P = .03) and reoperation for bleeding (OR 0.60, 95% CI 0.41-0.88; P = .009), but higher risks of incomplete revascularization (OR 2.07, 95% CI 1.60-2.68; P < .00001) and atrial fibrillation (OR 1.70, 95% CI 1.16-2.47; P = .006). Conclusion(s): In diabetic patients undergoing CABG, OPCAB lowers stroke and bleeding risk but increases incomplete revascularization and is associated with significantly higher long-term mortality. Choice of technique should be individualized with emphasis on complete revascularization. Copyright © The Author(s) 2026 <29> Accession Number 2045455340 Title Global research trends in artificial kidneys (2014-2024): A bibliometric and visualization study. Source International Journal of Artificial Organs. 49(5) (pp 298-315), 2026. Date of Publication: 01 May 2026. Author Ye T.; Li F.; Zhu D. Institution (Ye) Department of Urology, Jinhua TCM Hospital Affiliated to Zhejiang Chinese Medical University, China (Li) Jiande Hospital of Integrated Traditional Chinese and Western Medicine, Zhejiang, China (Zhu) Department of Urology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, China Publisher SAGE Publications Ltd Abstract When renal function is lost following resection of renal tumors, in the setting of end-stage kidney disease, or after traumatic nephrectomy, kidney transplantation is typically required; however, owing to constraints in healthcare resources, only a minority of patients can access transplantation. In this context, the development of efficient artificial kidneys as alternative therapies may help alleviate donor scarcity and holds potential clinical applicability, underscoring the substantial significance of this research. In the present study, a bibliometric analysis was conducted on the global literature in the field of artificial kidneys from 2014 to 2024, delineating overall developmental trends and technological hotspots. The findings indicate a marked increase in publications related to artificial kidneys over the past decade, with the field evolving from conventional renal replacement therapies toward a multidisciplinary paradigm integrating medicine, engineering, and artificial intelligence. The United States and other countries have made prominent contributions, and collaboration among multiple institutions has become increasingly frequent. Key research hotspots include the use of artificial intelligence in kidney-disease prediction models and clinical decision support, the development of implantable or wearable fully functional artificial kidneys, and advances in bioartificial kidneys and tissue-engineering technologies. The results further suggest that artificial-kidney technologies are entering a new stage characterized by increasing intelligence and convergence with biological and tissue-engineering approaches. Progress in novel immunomodulatory materials and biosensing technologies is expected to facilitate the development of artificial kidneys with therapeutic efficacy approaching that of kidney transplantation. This analysis provides an important reference for researchers, may help guide future research directions and promote cross-disciplinary collaboration, and ultimately may accelerate the realization of an ideal artificial kidney and improve the prognosis of patients with end-stage kidney disease. Copyright © The Author(s) 2026 <30> Accession Number 649469461 Title Defining optimal muscle surface area thresholds for sarcopenia-related mortality after cardiovascular interventions. Source Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 115(2) (pp 185-193), 2026. Date of Publication: 01 Jun 2026. Author Jarvinen O.; Tynkkynen J.; Lindstrom I.; Virtanen M.; Maaranen P.; Soderlund M.; Huhtamo H.; Vakhitov D.; Laurikka J.; Oksala N.; Hernesniemi J. Institution (Jarvinen) Faculty of Medicine and Health Technology Tampere University Kalevantie 4 Tampere FI-33014 Finland Finnish Cardiovascular Research Centre Tampere Tampere Finland (Tynkkynen, Vakhitov, Oksala) Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland (Lindstrom, Soderlund, Huhtamo, Vakhitov, Laurikka, Oksala, Hernesniemi) Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland (Virtanen, Maaranen, Laurikka, Hernesniemi) Heart Hospital, Tampere University Hospital, Tampere, Finland (Laurikka, Oksala, Hernesniemi) Finnish Cardiovascular Research Centre Tampere, Tampere, Finland Abstract BACKGROUND AND AIMS: Psoas muscle surface area (PMA) can estimate sarcopenia related long-term mortality risk. This study explored whether this association is linear or non-linear and if a meaningful threshold defines patients at high risk. METHOD(S): This retrospective individual participant-level meta-analysis included four different cohorts of 3893 patients undergoing cardiovascular interventions: 1302 abdominal aortic aneurysm repairs (AAA), 1099 transcatheter aortic valve insertions (TAVI), 593 surgeries for thoracic aortic and aortic valve pathology (TA) and 899 procedures for peripheral artery disease (PAD). The association between PMA and mortality was visualized using pooled spline curves. Cox models were fitted separately within each cohort with three levels of adjustment, and hazard ratios were combined using inverse-variance meta-analysis. Results were replicated in a retrospective dataset of 561 patients undergoing carotid endarterectomy or thrombectomy for ischemic stroke, where sarcopenia status was estimated using masseter muscle surface area. RESULT(S): Age and sex were the most important features associating with PMA (p < 0.001), but significant variation between the cohorts was also observed (p < 0.001). The association between PMA and long-term mortality was inverse and linear (p < 0.001). Patients with poor muscle status (Z-values -1.5 or less for PMA) had significantly higher adjusted risk of death (hazard ratio (HR) of 1.6 with 95% confidence interval (CI) 1.3-2.0, p < 0.001) when compared to all other patients. Similar results were observed in the replication cohort (HR 1.7, 95% CI 1.0-2.82, p = 0.04). CONCLUSION(S): Long-term mortality after a cardiovascular intervention increases linearly as the PMA value decreases. Patients with poor muscle status (Z-values below -1.5) seem to have consistently elevated mortality risk independent of other risk factors. <31> Accession Number 2044082163 Title Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Transplant Recipients: A Systematic Review and Meta-analyses. Source American Journal of Cardiovascular Drugs. 26(4) (pp 419-433), 2026. Date of Publication: 01 Jul 2026. Author Cahuapaza-Gutierrez N.L.; Calderon-Hernandez C.C.; Umeres-Bravo M.M.; Villavicencio-Escudero T.V. Institution (Cahuapaza-Gutierrez, Calderon-Hernandez, Villavicencio-Escudero) Universidad Cientifica del Sur, Lima, Peru (Cahuapaza-Gutierrez, Calderon-Hernandez, Umeres-Bravo) Cardiology Research Department, N y C-Center of Research and Medical Excellence (CRME), Lima, Peru (Umeres-Bravo) Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad de Aquino Bolivia, Cochabamba, Bolivia Publisher Adis Abstract Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy and safety in patients with type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, their effects in heart transplant recipients, a population with high cardiovascular risk, remain poorly understood. Method(s): Clinical trials and observational studies were included. A systematic search was conducted in PubMed, Scopus, EMBASE, and Web of Science. Mean differences (MD) were calculated for continuous outcomes and risk ratios (RR) for binary outcomes, both with 95% confidence intervals (CI). Analyses were performed using RevMan version 5.4.1. Result(s): Five retrospective cohort studies including 1512 heart transplant recipients (312 SGLT2i users and 1200 controls) were analyzed. SGLT2i use was not associated with significant changes in renal function (MD in eGFR: 3.96 mL/min/1.73 m2; 95% CI: - 2.33 to 10.26; p = 0.22) or glycemic control (MD in HbA1c: - 0.20%; 95% CI: - 0.73 to 0.34; p = 0.47). Mortality was comparable between groups (RR: 0.64; 95% CI: 0.29-1.40; p = 0.26), with no significant increase in urinary tract infections (RR: 1.40; 95% CI: 0.25-7.72; p = 0.70). However, SGLT2i use was associated with significant reductions in body mass index (MD: - 0.90 kg/m2; 95% CI: - 1.67 to - 0.14; p = 0.02) and systolic blood pressure (MD: - 4.69 mmHg; 95% CI: - 7.27 to - 2.12; p < 0.001). Conclusion(s): In heart transplant recipients, the use of SGLT2 inhibitors was not associated with significant improvements in renal function or glycemic control and did not increase mortality or the incidence of urinary tract infections. However, SGLT2 inhibitor therapy was associated with significant reductions in body mass index and systolic blood pressure, suggesting a potential cardiometabolic benefit in this high-risk population. Given that hypertension and obesity are well-established cardiovascular risk factors and that hypertension, in particular, is a common complication among heart transplant recipients, these blood pressure and weight-lowering effects may be clinically meaningful. Systematic Review Registration: PROSPERO CRD420251057335. Copyright © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026. <32> 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. 26(4) (pp 435-451), 2026. Date of Publication: 01 Jul 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. <33> Accession Number 2046059315 Title Artificial intelligence optimizes immune rejection prediction and management in heart transplantation: a structured narrative review. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1790244. Date of Publication: 14 May 2026. Author Chen K.; Lai J.; Luo Y.; Li C.; Wang G. Institution (Chen, Lai, Luo, Wang) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Li) Department of Cardiovascular Surgery, Zhongnan Hospital, Wuhan University, Hubei, Wuhan, China Publisher Frontiers Media SA Abstract Background - Heart transplantation remains the definitive therapy for end-stage heart failure, yet long-term outcomes are limited by three core clinical bottlenecks in immune rejection management: imprecise preoperative donor-recipient matching, overreliance on invasive endomyocardial biopsy (EMB) for postoperative rejection surveillance, and high inter-observer variability in manual pathological diagnosis of rejection. Artificial intelligence (AI) has emerged as a promising tool to address these gaps, but the methodological quality and clinical translation readiness of supporting evidence have not been comprehensively synthesized. Methods - This structured narrative review synthesized original research published between October 1, 2020, and October 1, 2025, identified via a targeted PubMed search and manual reference screening. Two independent reviewers performed study selection and data extraction, with discrepancies resolved by consensus. Common methodological limitations across included studies were synthesized qualitatively. Results - A total of 42 studies were included in the final qualitative synthesis. Preoperatively, 3D-Convolutional Neural Networks (3D-CNNs) enabled automated, accurate total cardiac volume (TCV) measurement for anatomical matching, while machine learning models identified non-linear synergistic risk factors for postoperative adverse events, outperforming traditional regression models. Postoperatively, AI models integrating non-invasive biomarkers (gene expression profiles, extracellular vesicles, donor-derived cell-free DNA) showed high diagnostic accuracy for rejection, with one single-center retrospective study estimating a 56.8% reduction in unnecessary EMB procedures (prospective clinical validation is still required). For pathological diagnosis, AI models improved the sensitivity of high-grade acute cellular rejection (ACR) detection from 39.5% to 74.4% compared with manual assessment, generative adversarial networks (GANs) addressed rare rejection sample scarcity with a rejection region detection AUROC of 98.84%, and explainable AI tools aligned model decisions with pathologists' judgment. The overall methodological quality of included studies was suboptimal, with most studies limited by single-center retrospective design, small sample size, and lack of independent external validation. Conclusions - AI has demonstrated promising potential to optimize donor-recipient matching, enable non-invasive rejection surveillance, and standardize pathological diagnosis in heart transplantation. However, most current evidence comes from exploratory, single-center retrospective studies with important methodological limitations that restrict their immediate clinical translation. Future research should prioritize prospective, multi-center clinical validation, standardized biomarker and model reporting, and federated learning data ecosystems to translate AI innovations into routine clinical practice. Copyright © 2026 Chen, Lai, Luo, Li and Wang. <34> Accession Number 2045912849 Title Impact of Obesity on Outcomes after Minimally Invasive Mitral Valve Surgery: A Systematic Review and Meta-Analysis. Source IJC Heart and Vasculature. 64 (no pagination), 2026. Article Number: 101944. Date of Publication: 01 Jun 2026. Author Onyeji P.C.; Momplaisir-Onyeji S.; Majumdar A.; Nowakowski P.; Passos F.S.; Kirov H.; Treml R.E.; Doenst T.; Tkebuchava S.; Caldonazo T. Institution (Onyeji) All Saints University School of Medicine, Roseau, Dominica (Momplaisir-Onyeji) American University of Barbados, School of Medicine, Bridgetown, Barbados (Majumdar) GMERS Medical College and Hospital, Ahmedabad, Sola, India (Nowakowski) Medical University of Silesia, Zabrze, Poland (Passos) Department of Thoracic Surgery, MaterDei Hospital, Salvador, Brazil (Kirov, Doenst, Tkebuchava, Caldonazo) Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany (Treml) Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, United States Publisher Elsevier Ireland Ltd Abstract Background: Minimally invasive mitral valve surgery (MIMVS) is increasingly used as an alternative to conventional sternotomy for patients with mitral valve pathologies. This systematic review and meta-analysis aimed to evaluate whether obesity (BMI >=30 kg/m2) is associated with different perioperative and postoperative outcomes in patients undergoing MIMVS. Method(s): MEDLINE, EMBASE, and Cochrane Library were systematically searched to identify studies comparing outcomes between BMI groups in patients undergoing MIMVS. The primary outcome was in-hospital mortality. The secondary outcomes were stroke, re-exploration for bleeding, intensive care unit (ICU) length of stay (LOS), hospital LOS, postoperative atrial fibrillation (POAF), requirement of permanent pacemaker implantation (PPI), duration of mechanical ventilation, and wound complications. A random-effects model was performed. Results Six studies comprising 5,925 patients met the inclusion criteria. Compared with BMI <30 kg/m2, obesity was not associated with higher in-hospital mortality (RR 1.29; 95%CI 0.67 to 2.48; p=0.446; I2=31.6%). However, obese patients had significantly higher rates of postoperative atrial fibrillation (RR 1.28; 95%CI 1.12 to 1.46; p<0.001; I2=0%), longer intubation duration (MD 0.88; 95%CI 0.11 to 1.65; p=0.02; I2=35.7%), longer hospital LOS (MD 0.51; 95%CI 0.04 to 0.99; p=0.03; I2=82.3%), and higher requirement for permanent pacemaker implantation (RR 1.43; 95%CI 1.01 to 2.01; p=0.043; I2=0%). No significant differences were observed in stroke, ICU LOS, re-exploration for bleeding, or wound complications. Sensitivity analyses confirmed the robustness of the pooled estimates. Conclusions In patients undergoing MIMVS, obesity was associated with higher rates of POAF and modestly prolonged postoperative recovery, without increased in-hospital mortality. Copyright © 2026 The Authors <35> Accession Number 2045791736 Title Minimally Invasive Aortic Valve Surgery: State-of-the-Art Review of Transaxillary, Thoracotomy, and Ministernotomy Approaches. Source Life. 16(5) (no pagination), 2026. Article Number: 777. Date of Publication: 01 May 2026. Author Kowalowka A.R.; Jodlowski M.; Bachowski R.; Gocol R. Institution (Kowalowka, Jodlowski, Bachowski, Gocol) Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland (Kowalowka, Jodlowski, Bachowski, Gocol) Department of Cardiac Surgery, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Minimally invasive aortic valve replacement (MIAVR) via transaxillary access, right anterior thoracotomy (RAT), and ministernotomy has matured from niche innovation to guideline-endorsed standard, yet comparative data remain heterogeneous and fragmented. Objective(s): This state-of-the-art review synthesizes contemporary evidence to define the role of each approach within modern valve care pathways. Method(s): A PRISMA 2020 systematic review with PROSPERO registration identified studies reporting outcomes of isolated AVR performed through transaxillary, RAT, or ministernotomy access. Primary endpoints were 30-day mortality, operative times, and length of stay; secondary endpoints included complications, long-term survival, learning curves, and patient-reported outcomes. Result(s): Forty-two studies encompassing 15,328 patients were included: transaxillary (n = 2156), RAT (n = 4892), and ministernotomy (n = 8280). All approaches achieved excellent perioperative safety (mortality 0.4-2.5%) and long-term survival comparable to full sternotomy, while consistently reducing blood loss, transfusion, ventilation time, and hospital stay. Ministernotomy offered the broadest anatomical applicability and the shortest learning curve (20-30 cases). RAT combined complete sternal preservation, the lowest bleeding rates, and superior cosmetic and functional recovery in anatomically suitable patients. Transaxillary access provided hidden scarring and attractive options in redo or sternum-avoidance scenarios, but higher reported stroke rates (2.0-6.3%) and greater technical demands limited its use to high-volume centers. Conclusion(s): MIAVR via ministernotomy, RAT, and transaxillary access now represents a mature, durable alternative to full sternotomy. A structured, anatomy- and center experience-driven selection strategy is essential to fully realize its benefits across diverse patient populations. Copyright © 2026 by the authors. <36> Accession Number 2045417696 Title Invasive vs Conservative Strategy for Frail Older Patients with Myocardial Infarction: A Secondary Analysis of the SENIOR-RITA Randomized Clinical Trial. Source JAMA Network Open. 9(4) (no pagination), 2026. Article Number: e267316. Date of Publication: 2026. Author Rubino F.; Mossop H.; Ripley D.P.; Carter J.; Twomey D.; Cooke J.; Austin D.; Veerasamy M.; Kelly D.; Felmeden D.; Anand A.; Newby D.E.; Storey R.F.; Fox K.A.A.; Pocock S.J.; Kunadian V. Institution (Rubino, Kunadian) Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom (Mossop, Austin) Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (Ripley) Cardiology Department, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (Carter) North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, United Kingdom (Twomey) County Durham and Darlington NHS Trust, Darlington, United Kingdom (Cooke) Chesterfield Royal Hospital, Chesterfield, United Kingdom (Austin) Academic Cardiovascular Unit, The James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom (Veerasamy) Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom (Kelly) Royal Derby Hospital, Derby, United Kingdom (Felmeden) Torbay and South Devon NHS Foundation Trust, Torquay, United Kingdom (Anand, Newby) Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (Storey) NIHR Sheffield Biomedical Research Centre, Sheffield University, Sheffield, United Kingdom (Fox) University of Edinburgh, Edinburgh, United Kingdom (Pocock) London School of Hygiene and Tropical Medicine, London, United Kingdom (Kunadian) Cardiothoracic Centre, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom Publisher American Medical Association Abstract Importance: Frail older patients with non-ST-elevation myocardial infarction (NSTEMI) experience an increased risk of major adverse cardiovascular events. The beneficial role of an invasive strategy over a conservative strategy among frail patients with NSTEMI is unclear. Objective(s): To compare the clinical outcomes of an invasive strategy with those of a conservative strategy among older patients with NSTEMI stratified by frailty status. Design, Setting, and Participant(s): In this prespecified exploratory subgroup analysis from the SENIOR-RITA randomized clinical trial, patients were screened across 48 National Health Service trusts in England and Scotland from November 1, 2016, through March 31, 2023. The SENIOR-RITA trial included patients with NSTEMI aged 75 years or older, randomized to an invasive strategy with coronary angiography, revascularization if needed, and optimal medical therapy vs a conservative strategy with optimal medical therapy only. In this analysis, frailty status was defined using the Fried frailty criteria (frail, >=3 criteria present). Statistical analysis was performed from March through November 2025. Intervention(s): Invasive vs conservative strategy. Main Outcomes and Measures: The primary composite outcome was the time to cardiovascular death or nonfatal myocardial infarction. All participants were analyzed according to the intention-to-treat principle. Result(s): Fried frailty criteria were available for 1446 of the 1518 randomized patients (95.3%), of whom 469 (32.4%; median age, 83 years [IQR, 80-86 years]; 240 women [51.2%]) met criteria for frailty. The primary outcome among frail patients occurred among 87 of 231 patients (37.7%) in the invasive group and 70 of 238 patients (29.4%) in the conservative group (hazard ratio [HR], 1.21; 95% CI, 0.88-1.67) over a median follow-up of 4.1 years (IQR, 2.8-4.6 years). When frailty was analyzed as a continuous variable, there was a significant interaction with treatment such that patients at the highest levels of frailty had a potential signal for harm with routine invasive strategy. There were no significant treatment differences across frailty categories for cardiovascular death (HR, 1.44; 95% CI, 0.97-2.10) or nonfatal myocardial infarction (HR, 1.00; 95% CI, 0.61-1.63). Conclusions and Relevance: In this subgroup analysis of a randomized clinical trial, an invasive strategy did not reduce the risk of a composite outcome of cardiovascular death or nonfatal myocardial infarction compared with a conservative strategy, with a potential signal for increased risk of harm among those at the highest levels of frailty. These findings underscore the need for individualized, frailty-informed treatment strategies. Trial Registration: isrctn.org Identifier: ISRCTN11343602 Copyright © 2026 Rubino F et al. <37> [Use Link to view the full text] Accession Number 644224784 Title Improved Early Outcomes With Off-Pump Coronary Artery Bypass Grafting in Patients With Left Ventricular Dysfunction: A Systematic Review and Meta-Analysis. Source Cardiology in review. 34(4) (pp 341-346), 2026. Date of Publication: 01 Jul 2026. Author Abdul Qadeer M.; Khalid M.; Abdul Muqeet Farid A.; Fatima T.; Mariam Khalid F.; Ali S.I.; Mujtaba G.; Elahi N.; Kamal Siddiqi A.; Said S.M. Institution (Abdul Qadeer, Ali) From the Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan (Khalid) Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan (Abdul Muqeet Farid, Kamal Siddiqi) Department of Medicine, Ziauddin Medical University, Karachi, Pakistan (Fatima, Mujtaba, Elahi) Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (Mariam Khalid) Department of Emergency Medicine, Jinnah Medical and Dental College, Karachi, Pakistan (Said) Division of Pediatric and Adult Congenital Cardiac Surgery, Maria Fareri Children's Hospital, Valhalla, NY, United States (Said) Department of Surgery, Westchester Medical Center, Valhalla, NY, United States (Said) Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt Abstract The ongoing debate surrounding coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass persists, particularly in individuals with left ventricular dysfunction. The objective of this study was to evaluate the safety and efficacy of these 2 strategies through a comprehensive meta-analysis of existing studies. A systematic search of PubMed, EMBASE, Web of Science, and the Cochrane Central Registry was conducted from inception to July 2023. The primary focus was on studies comparing on-pump versus off-pump CABG as the primary treatment for multivessel coronary artery disease in patients with left ventricular dysfunction (ejection fraction <=40%), with mortality as the primary outcome. The meta-analysis included 26 studies with a total of 35,863 patients. The results revealed a significant reduction in mortality risk [risk ratio (RR), 0.75; 95% confidence interval (CI), 0.60-0.93; P = 0.009] and other perioperative morbidities associated with off-pump CABG. These included stroke (RR, 0.67; 95% CI, 0.54-0.82; P = 0.0002), myocardial infarction (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), pulmonary complications (RR, 0.71; 95% CI, 0.55-0.92; P = 0.010), postoperative transfusion (RR, 0.70; 95% CI, 0.55-0.88; P = 0.002), neurological dysfunction (RR, 0.80; 95% CI, 0.64-1.00; P = 0.05), infection (RR, 0.74; 95% CI, 0.56-0.97; P = 0.03), renal failure (RR, 0.79; 95% CI, 0.67-0.95; P = 0.010), and reoperation for bleeding (RR, 0.66; 95% CI, 0.52-0.84; P = 0.0006). However, no significant difference was observed between the 2 groups regarding postoperative atrial fibrillation (RR, 0.97; 95% CI, 0.84-1.12; P = 0.69). In conclusion, off-pump CABG demonstrates a lower perioperative mortality risk and improved overall early outcomes compared with on-pump techniques in individuals with reduced left ventricular function. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved. <38> Accession Number 2045228461 Title Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy and Renal Impairment: Analyses From HELIOS-B. Source Journal of Cardiac Failure. 32(5) (pp 853-863), 2026. Date of Publication: 01 May 2026. Author Sheikh F.H.; Dang J.; Fontana M.; Audard V.; Garcia-Pavia P.; Khouri M.G.; Jobbee-Duval A.; Brailovsky Y.; Gillmore J.; Zheng H.; Eraly S.; Moffitt C.; Yilmaz A. Institution (Sheikh) MedStar Heart and Vascular Institute/Georgetown University School of Medicine, Washington, DC, United States (Dang) Assistance Publique des Hopitaux de Paris, Hopital Ambroise Pare, Service de Nephrologie, Boulogne-Billancourt, France (Fontana, Gillmore) National Amyloidosis Centre, University College London, London, United Kingdom (Audard) Assistance Publique des Hopitaux de Paris, Nephrology Department Henri Mondor Hospital University, University Paris Est Creteil, and National Institute of Health and Medical Research U955, Creteil, France (Garcia-Pavia) Hospital Universitario Puerta de Hierro, IDIPHISA, CIBERCV, and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (Khouri) Duke University School of Medicine, Durham, NC, United States (JobbeE-Duval) Medipole Hopital Mutualiste, Villeurbanne, France (Brailovsky) Columbia University Irving Medical Center, New York, NY, United States (Zheng, Eraly, Moffitt) Alnylam Pharmaceuticals, Cambridge, MA, United States (Yilmaz) Division of Cardiovascular Imaging, University Hospital Munster, Munster, Germany Publisher Elsevier B.V. Abstract Background In HELIOS-B (HELIOS-B: A Study to Evaluate Vutrisiran in Patients With Transthyretin Amyloidosis With Cardiomyopathy), vutrisiran reduced the risk of all-cause mortality and cardiovascular events associated with ATTR-CM. We assessed the effects of vutrisiran on renal function and on outcomes by renal function. Methods Patients were randomized to double-blind treatment with vutrisiran 25 mg or placebo every 3 months for <=36 months. We evaluated the proportion of patients with a >=40% decline in the estimated glomerular filtration rate (eGFR) from baseline and the primary composite end point (all-cause mortality or recurrent cardiovascular events) in subgroups based on baseline eGFR levels, and development of chronic kidney disease (CKD) stage >=4 (eGFR <30 mL/min/1.73 m2) during treatment. Results In HELIOS-B, 654 patients were randomized and treated with vutrisiran ( n = 326) or placebo ( n = 328). A >=40% decline in the eGFR was seen in significantly fewer patients receiving vutrisiran vs placebo in the overall (12.7% vs 21.2%, P = .0041) and monotherapy (12.0% vs 21.9%, P = .0102) populations. The effect of vutrisiran on the primary composite end point in subgroups based on renal function was directionally consistent with the effect in the overall population. Among patients receiving vutrisiran vs placebo, 9.5% vs 9.8%, respectively, developed CKD stage >=4. The risk of a primary composite end point event was significantly lower with vutrisiran vs placebo in patients who developed CKD stage >=4 (hazard ratio 0.467, 95% confidence interval 0.258-0.845). No new safety concerns were identified. Conclusions Vutrisiran may slow eGFR decline and is effective and well-tolerated in patients with ATTR-CM with declining renal function, including those developing CKD stage >=4. Copyright © 2026 The Author(s). <39> [Use Link to view the full text] Accession Number 2045018743 Title Management of acute coronary syndromes in the elderly: updated meta-analysis after SENIOR-RITA trial. Source Clinical Orthopaedics and Related Research. 26(4) (pp 191-194), 2025. Date of Publication: 01 Apr 2025. Author Improta R.; Di Pietro G.; Comitini G.; d'Ascenzo F.; Stefanini G.; Sardella G.; Mancone M. Institution (Improta, Di Pietro, Comitini, Sardella, Mancone) Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy (d'Ascenzo) Division of Cardiology, Citta della salute e della scienza, Turin, Italy (Stefanini) Department of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy (Stefanini) Humanitas Research Hospital IRCCS, Viale del Policlinico 155, Rozzano - Milan, Italy Publisher Wolters Kluwer Health Inc <40> [Use Link to view the full text] Accession Number 2044372050 Title The effect of intravenous sodium ferric gluconate complex (Ferrlecit) on outcomes of patients undergoing transcatheter aortic valve implantation: a prospective randomized controlled trial. Source Journal of Cardiovascular Medicine. 27(5) (pp 389-397), 2026. Date of Publication: 01 May 2026. Author Bar O.; Zukermann R.; Halhal B.; Marcusohn E. Institution (Bar, Zukermann, Halhal, Marcusohn) Department of Cardiology, Rambam Healthcare Campus, United States (Zukermann, Marcusohn) Technion Israel Institute of Technology, Haifa, Israel Publisher Lippincott Williams and Wilkins Abstract Aims - The aim of this trial was to evaluate whether intravenous sodium ferric gluconate could provide benefit beyond transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis.Methods and results - Between 1 October 2020 and 1 July 2023, we conducted an investigator-initiated, single-center, randomized, single-blind, placebo-controlled trial enrolling patients electively admitted for TAVI due to severe symptomatic aortic stenosis. Patients were randomly assigned to receive intravenous sodium ferric gluconate or a placebo before the procedure and were followed for up to 3 months. After screening, 44 patients were included: 20 patients randomized to intravenous sodium ferric gluconate complex treatment and 24 patients to placebo. There was no difference in the baseline-adjusted 6-min walk distance between the two treatment arms (P = 0.215). Quality-of-life measures such as Kansas City Cardiomyopathy Questionnaire score and New York Heart Association class did not differ between the treatment arms.Conclusion - Treatment with intravenous sodium ferric gluconate did not provide clinical benefit beyond TAVI in patients with severe aortic stenosis.Clinical Trial Registration: ClinicalTrials.gov NCT04797832 Copyright © 2026 Italian Federation of Cardiology - I.F.C. All rights reserved. <41> Accession Number 2045791719 Title Valve-in-Valve TAVR in Surgical Stentless Aortic Bioprostheses, a Challenging Scenario. Source Medicina (Lithuania). 62(5) (no pagination), 2026. Article Number: 844. Date of Publication: 01 May 2026. Author Saltarocchi S.; D'Abramo M.; Chourda E.; De Orchi P.; Spunticchia F.; Totaro M.; Vinciguerra M.; Romiti S.; Giunti G.; Greco E.; Miraldi F. Institution (Saltarocchi) Department of General Surgery, Surgical Specialty and Anesthesiology "Paride Stefanini", Sapienza University of Rome, Rome, Italy (Saltarocchi, Giunti) Cardiac Surgery Unit, Department of Cardiovascular Science, San Carlo Hospital, Potenza, Italy (D'Abramo, Chourda, Spunticchia, Totaro, Miraldi) Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy (De Orchi) Division of Cardiac Surgery, Azienda di Rilievo Nazionale e Alta Specializzazione "G. Brotzu", Cagliari, Italy (Vinciguerra, Romiti, Greco) Department of Health and Life Sciences, European University of Rome, Rome, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and objectives: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an established treatment for failed surgical bioprostheses in patients at high surgical risk. However, procedures performed in degenerated stentless aortic valves remain particularly challenging because of the absence of a radiopaque frame, variable surgical implantation techniques, and a potentially increased risk of coronary obstruction. Evidence in this specific setting is limited. We conducted a systematic review of the literature to identify studies reporting ViV TAVI in degenerated stentless surgical bioprostheses. Material(s) and Method(s): Case reports and case series were included when patient-level or clearly identifiable data were available. Baseline characteristics, anatomical features, procedural strategies, and clinical outcomes were extracted and analyzed using a descriptive approach. A total of 54 studies were included, encompassing 294 ViV TAVI procedures performed in failed stentless aortic valves. Result(s): The mean patient age was 73.9 years, and the average STS-PROM score was 13.45%, reflecting a high-risk population. The most frequently treated prosthesis was the Medtronic Freestyle valve, and the predominant mechanism of failure was regurgitation. Transfemoral access represented the most common approach, while balloon-expandable and self-expanding transcatheter valves were used with similar frequency. Coronary protection strategies were adopted in a minority of procedures, whereas adjunctive procedural techniques such as pre- or post-dilation were relatively common. Device-related complications were mainly driven by coronary obstruction, while cardiac complications included myocardial infarction and unplanned coronary intervention. Overall, VARC-3 device success was achieved in the majority of procedures, with acceptable short-term mortality despite the complexity of the treated population. Conclusion(s): ViV TAVR in degenerated stentless bioprostheses appears feasible and generally effective but remains associated with specific procedural challenges, particularly related to coronary obstruction risk. Careful anatomical assessment and tailored procedural planning are essential, and larger contemporary studies are needed to better define optimal management strategies in this complex setting. Copyright © 2026 by the authors. <42> Accession Number 2046033297 Title Does beta-hydroxy-beta-methylbutyrate (HMB) have an anti-inflammatory impact in critically ill patients? A secondary post hoc analysis of an RCT. Source Clinical Nutrition. 62 (no pagination), 2026. Article Number: 106690. Date of Publication: 01 Jul 2026. Author Berger M.M.; Viana M.V.; Engelen P.K.J.; Deutz N.E.P. Institution (Berger) Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland (Berger, Viana) Dept of Adult Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland (Engelen, Deutz) Center for Translational Research in Aging & Longevity, Texas A&M University, United States Publisher Churchill Livingstone Abstract Background and aims: Beta-hydroxy-beta-methylbutyrate (HMB), a natural breakdown product of the amino acid leucine, has been shown to increase protein synthesis in human skeletal muscle. After demonstrating in a randomised 10-day supplementation trial using isotopes, a significant reduction of net protein breakdown in critically ill patients, this post-hoc study aimed to investigate the global, extra-, and intracellular protein synthesis pathways impacted by HMB, and its influence on the inflammatory response. Method(s): This secondary post-hoc analysis used data from the previously published randomized trial, where critically ill patients were supplied with 3 g of HMB/day or placebo for at least 10 days. The study procedures were conducted in the postabsorptive state on days 4 and 15 after ICU admission. Blood analysis included cytokines (by Luminex), C-reactive protein (CRP), amino acids (AA), urea and creatinine. Amino acid whole body productions and plasma concentrations were measured after pulse administrations of an 8 mL solution containing 18 stable AA tracers. Data are presented as means [95%CI]. Result(s): Altogether 37 patients were included (aged 65 [56, 74] years, SAPS2 48 [40, 52], and APACHEII 23 [19, 26]): baseline characteristics did not differ between the groups. Among the 37 measured cytokines, most declined by day 15, except for some specific growth factors. Twelve cytokines differed significantly between groups post-intervention, with levels being higher in HMB group (including 7 proinflammatory cytokines) (p < 0.05). Whole body production of AA and extracellular pool sizes did not differ significantly by day 15. In the HMB group (vs. placebo), the intracellular pool sizes of citrulline, glutamine, HMB, KMV (alpha-keto-beta-methylvaleric acid), taurine, and tau-methyhistidine increased and were significantly higher post-intervention. Taurine production increased significantly and similarly in both groups (p < 0.05) but glutamine and HMB production increased significantly more in the HMB group. In parallel, the urea to creatinine ratio decreased significantly (125 vs 181, p = 0.002) by day 15 in the HMB group. Conclusion(s): The present study shows that HMB supplementation is associated with a different inflammatory pattern, suggesting a more efficient immune response. Furthermore, HMB has a significant impact on intracellular synthesis of selected AA, particularly glutamine.(NCT03628365: https://clinicaltrials.gov/ct2/show/NCT03628365). Copyright © 2026 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <43> Accession Number 2045791425 Title Beyond the Maze: Hybrid Ablation and Left Atrial Appendage Occlusion in Cardiac Surgery: Evidence Synthesis and the MESAGE Study Protocol. Source Medicina (Lithuania). 62(5) (no pagination), 2026. Article Number: 890. Date of Publication: 01 May 2026. Author Kotoulas S.C.; Kolovos V.; Tsiamis N.; Kotoulas A.; Georgiou C.; Tsipas P.; Panagiotou I.; Antoniadis D.; Kotoulas C. Institution (Kotoulas, Kotoulas, Georgiou, Tsipas, Panagiotou, Kotoulas) Department of Cardiothoracic Surgery, 401 General Military Hospital of Athens, Panagiotis Kanellopoulos Avenue, Athens, Greece (Kolovos, Antoniadis) Department of Cardiology and Electrophysiology, 401 General Military Hospital of Athens, Athens, Greece (Tsiamis) Department of Cardiology, Sismanoglio General Hospital, Athens, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia, present in up to 14-20% of patients undergoing cardiac surgery, with the number of patients expected to double within the next decade. Despite a Class I recommendation for concomitant surgical ablation and a Class I-B recommendation for left atrial appendage (LAA) occlusion in patients with AF undergoing cardiac surgery (Class IIa for endoscopic or hybrid AF ablation), both procedures remain substantially underutilized in clinical practice. The design of the Mapping atrial fibrillation after Epicardial Surgical Ablation plus AtriClip to Guide Endocardial ablation (MESAGE) prospective study is presented. Material(s) and Method(s): A narrative literature review was conducted using PubMed through March 2025. Randomized controlled trials, multicenter registries, meta-analyses and current clinical guidelines were prioritized. The MESAGE study protocol is presented in accordance with the SPIRIT recommendations. Result(s): Randomized evidence demonstrates that hybrid ablation achieves 32-48% greater arrhythmia freedom than catheter ablation (CA) alone in persistent and long-standing persistent AF, with comparable safety and significantly fewer interventions at two-year follow-up. Epicardial LAA occlusion with the AtriClip device achieves complete occlusion in all patients with an 87.5% relative reduction in ischemic stroke risk in anticoagulation-free follow-up. Continuous implantable loop recorder (ILR)-based monitoring reveals AF recurrence in substantially more patients than conventional monitoring, with AF burden emerging as a more meaningful endpoint than arrhythmia freedom. The MESAGE study enrolls 40 patients undergoing cardiac surgery who have pre-existing AF, pre-randomized 1:1 to pulmonary vein isolation (PVI) alone versus PVI-BOX, with mandatory pre-operative ILR implantation, intra-operative AtriClip LAA exclusion, and systematic Day-60 endocardial mapping and supplementary ablation using the Affera dual-energy system. Conclusion(s): Hybrid epicardial-endocardial ablation combined with LAA exclusion and continuous ILR monitoring represents a comprehensive, mechanistically rational and evidence-informed approach to AF management in patients undergoing cardiac surgery, although current evidence remains heterogeneous, and the benefits depend on the AF phenotype and monitoring strategy. The MESAGE pilot study will generate hypothesis-generating prospective comparative data on epicardial PVI versus PVI-BOX in the concomitant surgical setting, assessed through systematic post-surgical endocardial mapping and continuous rhythm monitoring. Copyright © 2026 by the authors. <44> Accession Number 2046326102 Title Risk factors for postoperative acute kidney injury and development of a predictive model in patients undergoing cardiac surgery. Source Chinese Journal of Anesthesiology. 46(4) (pp 414-418), 2026. Date of Publication: 20 Apr 2026. Author Duan X.; Gao R.; Gao Y.; Deng T.; Wang Y.; Han J.; Liu H. Institution (Duan, Han, Deng, Liu) Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China (Gao, Han) Department of Anesthesiology, Tianjin Chest Hospital, Tianjin, China (Gao) Department of Anesthesiology, National Centre of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Wang) Department of Surgical Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China Publisher Chinese Medical Journals Publishing House Co.Ltd Abstract Objective To identify the risk factors for postoperative acute kidney injury (AKI) and to develop a predictive model in patients undergoing cardiac surgery. Methods This study was a secondary analysis based on a prospective multicenter randomized controlled trial entitled Effects of Precise Cardiac Anesthesia on Postoperative Neurological Outcomes and Delirium in Adult Surgical Patients. Patients who underwent elective cardiac surgery at 3 centers from September 2020 to December 2021 were included. The concentrations of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and serum creatinine (Cr) were measured within 24 h before surgery. Postoperative AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. Multivariable logistic regression analysis was used to identify the independent risk factors for postoperative AKI, a predictive model of risk factors was constructed, and the predictive performance of different models was evaluated using the receiver operating characteristic (ROC) analysis. Results Multivariable logistic regression analysis showed that old age, elevated preoperative concentration of Cr, elevated preoperative concentration of NT-proBNP, intraoperative use of epinephrine, and longer cardiopulmonary bypass time were independent risk factors for postoperative AKI (P<0.05). The areas under the receiver operating characteristic curve for the basic model, the basic model plus NT-proBNP, the basic model plus Cr, and the basic model plus both NT-proBNP and Cr were 0.700, 0.777, 0.788 and 0.805, respectively. Conclusions Old age, elevated preoperative concentrations of Cr and NT-proBNP, intraoperative use of epinephrine, and prolonged cardiopulmonary bypass time are independent risk factors for postoperative AKI in patients undergoing cardiac surgery. On the basis of the basic model, the combination of preoperative NT-proBNP and Cr can further improve the accuracy of the predictive model. Copyright 2026, Chinese Medical Association <45> Accession Number 2046020030 Title A randomized controlled trial of electrical cardiometry-guided perioperative hemodynamic management in children undergoing cardiac surgery. Source Annals of Pediatric Cardiology. 19(2) (pp 139-146), 2026. Date of Publication: 01 Mar 2026. Author Thottan R.S.; Das S.; Makhija N.; Hasija S.; Chauhan S. Institution (Thottan, Das, Makhija, Hasija, Chauhan) Department of Cardiac Anaesthesia and Critical Care, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India Publisher Wolters Kluwer Medknow Publications Abstract Background and Aims: Children undergoing corrective surgery for congenital heart disease (CHD) are at risk of perioperative hemodynamic instability and low cardiac output syndrome (LCOS). Conventional monitoring relies on static parameters that may inadequately reflect real-time cardiac performance. Electrical cardiometry (EC) provides continuous, noninvasive assessment of cardiac output and related indices. This study evaluated whether EC-guided perioperative management improves early postoperative outcomes compared with conventional monitoring in pediatric CHD surgery. Method(s): In this prospective randomized controlled trial, 60 children (0-15 years) undergoing elective corrective CHD surgery were randomized to EC-guided management (Group 1, n = 30) or conventional monitoring (Group 2, n = 30). In Group 1, perioperative fluid and vasoactive therapy were guided by EC-derived parameters, including cardiac index (CI), stroke volume, thoracic fluid content, and stroke volume variation. Group 2 was managed using standard clinical and invasive parameters. The primary outcome was the incidence of LCOS within 48 h postoperatively. The secondary outcomes included vasoactive inotropic score (VIS), major adverse cardiac events, and in-hospital mortality. Result(s): Baseline characteristics were comparable. Group 1 demonstrated significantly higher mean arterial pressure (MAP) at 8, 16, and 24 h postoperatively, faster lactate clearance, and lower VIS during the early postoperative period. CI correlated positively with MAP and urine output and inversely with lactate levels. No mortality occurred. Conclusion(s): EC-guided perioperative management aids in achieving early postoperative hemodynamic stability and metabolic recovery in children undergoing corrective CHD surgery and represents a valuable noninvasive adjunct to conventional monitoring. Copyright © 2026 Annals of Pediatric Cardiology. <46> [Use Link to view the full text] Accession Number 650779070 Title Left Atrial Appendage Closure or Anticoagulation for Atrial Fibrillation. Source The New England journal of medicine. 394(21) (pp 2083-2094), 2026. Date of Publication: 04 Jun 2026. Author Doshi S.K.; Kar S.; Nair D.G.; Waggoner T.; Agarwal H.; Moussavian M.; Kashani A.; Oza S.; Feldman L.; Sadhu A.; DeLurgio D.; Alli O.; Nielsen-Kudsk J.E.; Yamamoto M.; Alkhouli M.; Camm A.J.; Coylewright M.; Gibson C.M.; Granger C.B.; Gurol M.E.; Huber K.C.; Mansour M.; Natale A.; Pocock S.J.; Reddy V.Y.; Saliba W.I.; Asch F.M.; Wehrenberg S.; Frost K.; Christen T.; Sutton B.S.; Stein K.M.; Leon M.B.; Ellenbogen K.A. Institution (Doshi) Los AngelesMexico (Doshi) Pacific Heart Institute, Santa Monica, CA, United States (Kar) Los Robles Hospital and Medical Center, Thousand Oaks, CA, United States (Nair) Arrhythmia Research Group, Jonesboro, AR, United States (Waggoner) U.S. Heart and Vascular, Tucson, AZ, United States (Agarwal) Bergan Cardiology, Omaha, NE, United States (Moussavian) Cardiovascular Institute of San Diego, Chula Vista, CA, United States (Kashani) Memorial Hermann Memorial City Medical Center, Houston, United States (Oza) Ascension St. Vincent's, Jacksonville, FL, Puerto Rico (Feldman) Eisenhower Medical Center, Rancho Mirage, CA, United States (Sadhu) Phoenix Cardiovascular Research Group, Phoenix, AZ, United States (DeLurgio) Emory University Hospital, Atlanta, United States (Alli) Novant Health Presbyterian Medical Center, Charlotte, NC (Nielsen-Kudsk) Aarhus University Hospital, Aarhus, Denmark (Yamamoto) Toyohashi Heart Center, Toyohashi, Japan (Alkhouli) Mayo Clinic Foundation, Rochester, MN, United States (Camm) Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, City St. George's University of London, London, United Kingdom (Coylewright) Heart and Vascular Center, Essentia Health-St. Mary's Medical Center, Duluth, MN, United States (Gibson) Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, United States (Granger) Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States (Gurol, Mansour) Massachusetts General Hospital, Boston, United States (Huber) Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, United States (Natale) Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, United States (Natale) Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, United States (Pocock) Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom (Reddy) Helmsley Trust Electrophysiology Center, Icahn School of Medicine at Mount Sinai, NY, United States (Saliba) Cleveland Clinic Foundation, Cleveland, United States (Asch) MedStar Health Research Institute, MedStar Washington Hospital Center, WA, United States (Wehrenberg, Frost, Christen, Sutton, Stein) Boston Scientific, Marlborough, MA (Leon) Columbia University Medical Center, NY, United States (Ellenbogen) Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, United Kingdom Abstract BACKGROUND: For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. METHOD(S): In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-related bleeding, was tested for superiority. RESULT(S): Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (+/-SD) age of the patients was 71.7+/-7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5+/-1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). CONCLUSION(S): Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.). Copyright © 2026 Massachusetts Medical Society. <47> Accession Number 2033928252 Title Antithrombotic strategy following valve-in-valve transcatheter aortic valve replacement. A German Statutory Health Claims data analysis. Source Clinical Research in Cardiology. 115(7) (pp 1099-1106), 2026. Date of Publication: 01 Jul 2026. Author Heyne S.; Hohmann C.; Macherey-Meyer S.; Meertens M.M.; Kuhn E.; Marschall U.; Wienemann H.; Mauri V.; Adam M.; Baldus S.; Lee S. Institution (Heyne, Hohmann, Macherey-Meyer, Meertens, Wienemann, Mauri, Adam, Baldus, Lee) Clinic III for Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Str. 62, Cologne, Germany (Kuhn) Department of Cardiac Surgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany (Marschall) BARMER, Wuppertal, Germany Publisher Springer Science and Business Media Deutschland GmbH Abstract Aims: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) procedures are increasingly used. Specific recommendations on antithrombotic strategies following ViV-TAVR are lacking. We aimed to assess the efficacy of different antithrombotic strategies following ViV-TAVR. Methods and Results: We performed a retrospective analysis of German Statutory Health Claims data following ViV-TAVR stratified by antithrombotic strategies according to prescription within 90 days. Antithrombotic regimens included antiplatelet therapy (APT), direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). The composite endpoint was all-cause mortality, stroke and/or systemic embolism (SSE) and mechanical complication of heart valve prosthesis at 12 months. Cox proportional hazard regression models were used to compare outcomes. In total, 908 patients between 2005 and 2022 were identified. Of these, 286 received DOACs, 99 received VKAs, 351 received APT exclusively and 172 had no prescription. The incidence of the composite endpoint was 20.8% in the APT group, 20.3% in the DOAC group and 25.3% in the VKA group which was not statistically significantly different. The rate of SSE in the acetylsalicylic acid (ASA) mono group was higher compared to the dual antiplatelet therapy (DAPT) group (27.3% vs. 12.4%, univariable HR 0.42, 95% CI [0.19, 0.95], p = 0.03). Conclusion(s): In this analysis of German Health Claims data, DOACs seemed to be a safe alternative to VKAs and APT. ASA monotherapy was associated with higher rates of SSE compared to DAPT. Given the high risk of bias of this retrospective analysis and the growing use of valve-in-valve procedures, randomized controlled trials are needed to confirm these findings. Copyright © The Author(s) 2025. <48> Accession Number 2045565207 Title Induction strategies for preventing hemodynamic changes after intubation in non-cardiac surgery patients: a network meta-analysis of randomized controlled trials. Source Frontiers in Medicine. 12 (no pagination), 2026. Article Number: 1694700. Date of Publication: 22 Jan 2026. Author Gan Y.; Yang X.; Wang W.; Zhang H.; Luo X.; Wang M.; Xu Z.; Su S.; Wu J. Institution (Gan, Yang, Wang, Zhang, Wang, Xu, Wu) Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China (Luo, Su) Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China Publisher Frontiers Media SA Abstract Background - Tracheal intubation and laryngoscopy during general anesthesia induce significant hemodynamic changes. Although generally transient, these physiological perturbations may precipitate critical cardiovascular events in high-risk populations. Anesthesiologists have used various drug combinations to suppress this response. This network meta-analysis (NMA) aimed to identify a drug combination that can better suppress hemodynamic fluctuations caused by tracheal intubation in non-cardiac surgical patients. Methods - We searched 3 different medical literature databases. A NMA was performed on the included randomized controlled trials (RCTs). RCTs were evaluated using the Cochrane risk of bias tool. A random effects network meta-analysis was performed within a frequentist framework. The effects of each pharmacological strategy on intraoperative hemodynamics in patients undergoing non-cardiac surgery were compared. Endpoints included DELTAMean Arterial Pressure (DELTAMAP) and DELTAHeart Rate (DELTAHR). Results - The network meta-analysis included 10 studies and 791 patients. According to the surface under the cumulative ranking curve, Oxycodone-Propofol-Lidocaine (87.4%) demonstrated superior efficacy in controlling fluctuations in MAP, followed by Fentanyl-Propofol-Dexmedetomidine (82.9%) and Fentanyl-Propofol-Clonidine (81.6%). Fen-Pro-Dex (94.8%) demonstrated superior efficacy in controlling fluctuations in HR, followed by Fentanyl-Propofol-Lidocaine (Epidural) (83.3%), Fentanyl-Propofol-Remifentanil (79.1%). Conclusion - Among patients undergoing non-cardiac surgery, Oxy-Pro-Lid was preferred for attenuating post-intubation changes in MAP, whereas Fen-Pro-Dex provided superior control of HR fluctuations. These findings may help guide the selection of induction pharmacological strategies, although more randomized controlled trials are needed to confirm these results and clarify optimal dosing. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD42024591333, identifier CRD42024591333. Copyright © 2026 Gan, Yang, Wang, Zhang, Luo, Wang, Xu, Su and Wu. <49> Accession Number 2046079871 Title Incidence and predictors of postoperative atrial fibrillation following coronary artery bypass graft surgery: a meta-analysis of 207 studies. Source Acta Cardiologica. (no pagination), 2026. Date of Publication: 2026. Author Farzaneh A.; Zameni N.; Masoum A.; Karamian A. Institution (Farzaneh) School of Medicine, Department of Cardiology, Hamadan University of Medical Sciences, Hamadan, Iran, Islamic Republic of (Zameni) Department of Anesthesiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, Islamic Republic of (Masoum) Faculty of Medicine, Mashhad Islamic Azad University, Mashhad, Iran, Islamic Republic of (Karamian) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher Taylor and Francis Ltd. Abstract Background: Postoperative atrial fibrillation (POAF) is one of the most common tachyarrhythmias after coronary artery bypass graft (CABG) surgery. This study aimed to determine the overall incidence and predictors of POAF after CABG surgery through a systematic review of existing research findings. Method(s): The protocol of this study was registered in PROSPERO (CRD420251023423) and written under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Result(s): 207 articles with a total sample size of 180,223 participants were included in our meta-analysis. The overall incidence of POAF following CABG surgery was 24% (95% CI 23%-26%). Increased age and male gender were associated with higher odds of developing POAF (ORs of 1.06 and 1.28, respectively, p < 0.01). Comorbidities, including congestive heart failure (CHF), hypertension, COPD, renal failure, and chronic kidney disease (CKD), were shown to be predictors of POAF. Those who do not use beta-blocker or have withdrawn from it were more likely to experience POAF (OR = 2.26, 95% CI 1.35-3.78, p < 0.01). Preoperative use of statins significantly reduced the odds of POAF (OR = 0.57, 95% CI 0.42-0.78, p < 0.01). On-pump surgery, grafting >= 3 vessels, longer length of stay in hospital, use of intra-aortic balloon pump (IABP), prolonged cross-clamp time, use of inotropic medications, and higher left atrial volume index (LAVI), and LA diameter were also predictors of POAF. Higher preoperative left ventricular ejection fraction (LVEF) was another factor that was associated with lower odds of developing POAF. Conclusion(s): Recognising the risk factors for POAF helps us to identify high-risk patients to provide better preventive measures and management strategies for POAF after CABG. Copyright © 2026 Belgian Society of Cardiology. <50> Accession Number 2044606404 Title ADAPT AF-DES and the Limits of Non-inferiority in Long-term Antithrombotic Therapy. Source European Cardiology Review. 21 (no pagination), 2026. Article Number: e09. Date of Publication: 01 Jan 2026. Author Grimaldi M.; Rocca B. Institution (Grimaldi) Ecclesiastical Entity Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Italy (Grimaldi, Rocca) Department of Medicine and Surgery, LUM University, Casamassima, Italy Publisher Radcliffe Medical Media <51> Accession Number 2045520952 Title Efficacy of positive expiratory pressure in the prevention and treatment of postoperative pulmonary complications following thoracic and abdominal surgery. A systematic review and meta-analysis. Source Monaldi Archives for Chest Disease. 96(2) (no pagination), 2026. Article Number: 3735. Date of Publication: 2026. Author Dolic D.; Salvitti S. Institution (Dolic, Salvitti) Department of Medicine, University of Udine, Italy (Salvitti) Unit of Cardiorespiratory Physiotherapy, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy Publisher Page Press Publications Abstract Postoperative pulmonary complications (PPCs), including atelectasis, pneumonia, and respiratory failure, are common after thoracic and upper abdominal surgery and are associated with increased morbidity, longer hospital stays, and higher costs. This systematic review and meta-analysis investigated whether positive expiratory pressure (PEP) devices reduce PPCs after thoracic or upper abdominal surgery compared with continuous positive airway pressure (CPAP), usual care/no intervention, or other non-CPAP respiratory treatments. We searched major databases and included randomized controlled trials. A total of 12 studies were included, and 7 contributed to the meta-analysis. Across comparator-stratified analyses, PEP did not demonstrate a consistent reduction in PPCs. Compared with usual care/no intervention, pooled estimates showed no significant benefit, and results were similarly inconclusive when PEP was compared with other non-CPAP treatments; evidence vs. CPAP was limited to a single small trial. The overall certainty of evidence was low due to methodological limitations and heterogeneity in outcome definitions and intervention protocols. Overall, current evidence does not support routine use of PEP devices as a primary strategy to prevent PPCs after thoracic or upper abdominal surgery. Further well-designed trials are needed to clarify whether specific patient subgroups or standardized protocols may benefit. ©Copyright: the Author(s), 2026. <52> Accession Number 2044945185 Title Impact of SGLT2 Inhibitors on Clinical Outcomes in Patients with Diabetes Mellitus Following Heart Transplantation: A Meta-analysis. Source Diabetes Therapy. 17(6) (pp 839-852), 2026. Date of Publication: 01 Jun 2026. Author Wang H.; Xie X.; Gong G.; Huang L.; Tang Z. Institution (Wang) Department of Cardiology, The Peoples Hospital of Guangxi Zhuang Autonomous Region, Guangxi, Nanning, China (Xie) Macau University of Science and Technology, Macao (Gong) Department of Cardiology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Guangxi, Nanning, China (Huang) Wuming Hospital of Guangxi Medical University, Guangxi, Nanning, China (Tang) Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China Publisher Adis Abstract Introduction: In this new era, heart transplantation (HT) is rapidly gaining popularity worldwide. Patients with end-stage heart disease are often candidates for HT. However, studies have shown that more than 30% of patients who undergo HT have pre-existing diabetes mellitus (DM), which is associated with a higher risk of graft failure and death. In this analysis, we aimed to assess the impact of sodium-glucose co-transporter 2 (SGLT2) inhibitors on clinical outcomes in patients with DM following HT. Method(s): Online databases were searched for relevant publications. The statistical analysis was performed using the RevMan software version 5.4. The clinical outcomes included rejection post-HT, mortality, sepsis, weight reduction, change in body mass index (BMI), change in serum creatinine level, glomerular filtration rate (eGFR), and improvement in glycated hemoglobin (HbA1c). For dichotomous data, risk ratios (RR) with 95% confidence intervals (CI) were used to summarize the analysis. However, for continuous data, weight mean difference (WMD) with 95% CI was used. Result(s): Eight studies with a total number of 2755 participants were included in this analysis. Our current results showed that rejection risk post HT was significantly lower in the SGLT2 inhibitor group (RR: 0.85, 95% CI: 0.78-0.93; P = 0.0001). The mortality risk was not significantly different (RR: 0.64, 95% CI: 0.32-1.29; P = 0.21). Similarly, sepsis following HT was similar in both groups (RR: 1.62, 95% CI: 0.13-20.11; P = 0.71). No significant differences were observed in weight reduction, BMI, change in serum creatinine level, change in eGFR, or improvement in HbA1c following HT. Conclusion(s): In participants with DM following HT, SGLT2 inhibitors significantly reduced rejection post transplantation. However, its impact on other important clinical outcomes, including mortality, should be further assessed with more data in future studies. Copyright © The Author(s) 2026. <53> Accession Number 2046311735 Title Comparison of Paravertebral Block and Erector Spinae Plane Block in Thoracotomy Using Nociception Level Index Monitoring: A Prospective Randomized Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Yorukoglu H.U.; Cesur S.; Alparslan V.; Bulut M.; Aksu C.; Kus A. Institution (Yorukoglu, Cesur, Alparslan, Bulut, Aksu, Kus) Department of Anesthesiology and Reanimation, Kocaeli University, School of Medicine, Kocaeli, Turkey Publisher W.B. Saunders Abstract Objective: Paravertebral block (PVB) is considered the gold-standard regional technique for thoracotomy analgesia, whereas the erector spinae plane block (ESPB) has gained popularity. However, evidence comparing these 2 techniques in open thoracotomy remains inconsistent. The nociception level (NOL) index provides a more objective assessment of intraoperative nociception. This study aimed to compare the analgesic efficacy of preoperative PVB and ESPB during thoracotomy using NOL-guided opioid administration. Design(s): Prospective randomized clinical trial. Setting(s): Single tertiary-care university hospital. Participant(s): Fifty-seven patients who underwent elective thoracotomy surgeries were included in this study. Intervention(s): Patients were randomized to receive preoperative ultrasound-guided PVB or ESPB at the T5 level using 20 mL of 0.25% bupivacaine. Measurements and Main Results: Intraoperative opioid infusion rate was titrated with the NOL index. Intraoperative remifentanil and postoperative morphine consumptions, pain scores at rest and during coughing, rescue analgesic need, and adverse events were recorded. Intraoperative remifentanil consumption was significantly lower in the PVB group than in the ESPB group (431.4 +/- 287.7 mcg vs 863.6 +/- 385.5 mcg, p < 0.001). Total 24-hour postoperative morphine use was also lower in the PVB group (15.2 +/- 6.6 mg vs 20.1 +/- 6.6 mg, p = 0.002). Numeric rating scale (NRS) scores at rest were significantly lower in the PVB group at 9 and 12 hours, while NRS scores during coughing were significantly lower at all postoperative time points. Conclusion(s): In patients undergoing thoracotomy, PVB provided superior intraoperative and postoperative analgesia compared with ESPB, with significantly reduced opioid requirements and lower pain scores. Objective nociception monitoring with the NOL index demonstrated that ESPB may be insufficient for major thoracic surgery. Copyright © 2026 Elsevier Inc. <54> Accession Number 2040764849 Title A Bayesian meta-analysis of transcatheter versus surgical aortic valve replacement in patients with small aortic annulus. Source Cardiovascular Revascularization Medicine. 87 (pp 16-24), 2026. Date of Publication: 01 Jun 2026. Author Oliveira V.M.R.; Nishikubo M.E.P.; Antunes A.G.O.; Barbosa L.M.; de Sousa P.A.; Lopes L.; Tartuce L.P.; Rassi D.D.C.; Moreira H.G. Institution (Oliveira, Nishikubo, Antunes, Rassi, Moreira) Department of Medicine, Federal University of Goias, Goiania, Brazil (Barbosa) Department of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil (de Sousa) Department of Medicine, Federal University of Uberlandia, Uberlandia, Brazil (Lopes) Johns Hopkins Bloomberg School of Public Health, Baltimore, United States (Tartuce) Instituto de Cardiologia e Radiologia Intervencionista de Rio Verde, Rio Verde, Brazil (Moreira) Einstein Hospital Israelita, Sao Paulo, Brazil Publisher Elsevier Inc. Abstract Background Small aortic annulus (SAA) is associated to suboptimal results after aortic valve replacement. The optimal treatment for aortic disease in SAA remains unclear. Methods We conducted a systematic review and Bayesian random-effects meta-analysis to compare transcatheter (TAVR) versus surgical aortic valve replacement (SAVR) in patients with small aortic annulus. A comprehensive search of PubMed, Scopus, and Cochrane Library was performed through May 2024. Binary outcomes were synthesized using a binomial-normal hierarchical model to estimate posterior distributions of log odds ratios (log OR) and corresponding 95 % credible intervals (CrIs). Posterior probabilities of treatment effects were calculated to assess the certainty of benefit or harm. All statistical analyses were performed using R version 4.5.0. Results Nine studies comprising 2548 patients (50.9 % TAVR) were included. TAVR was associated with reduced risk of severe patient-prosthesis mismatch (OR 0.47; 95 % CrI 0.31-0.72; posterior probability of benefit 99.8 %) and moderate mismatch (OR 0.56; 95 % CrI 0.40-0.79; posterior probability 99.7 %). In contrast, SAVR was associated with lower risk of moderate/severe aortic regurgitation (OR 4.74; 95 % CrI 2.43-9.27; posterior probability of harm with TAVR 98.1 %) and permanent pacemaker implantation (OR 2.66; 95 % CrI 1.69-4.20; posterior probability of harm with TAVR 98.5 %). No meaningful differences were observed for stroke at 30 days (OR 1.51; 95 % CrI 0.69-3.36) or all-cause mortality at 1 year (OR 0.78; 95 % CrI 0.51-1.17). Conclusions TAVR is superior to SAVR regarding severe and moderate PPM in SAA patients. SAVR is associated with lower risk of aortic regurgitation and new pacemaker implant, with no significant differences in mortality and stroke. Copyright © 2025 Elsevier Inc. <55> Accession Number 2039162491 Title Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients: The ALBICS AKI Randomized Clinical Trial. Source JAMA Surgery. 160(8) (pp 835-844), 2025. Date of Publication: 13 Aug 2025. Author Shehabi Y.; Balachandran M.; Al-Bassam W.; Bailey M.; Bellomo R.; Bihari S.; Brown A.; Collins D.; Darlison P.R.; Li M.; Mandarano R.; Sarode V.; Pakavakis A. Institution (Shehabi, Al-Bassam, Brown, Li, Pakavakis) Monash Health School of Clinical Sciences, Clayton, VIC, Australia (Shehabi, Balachandran, Al-Bassam, Brown, Li, Pakavakis) The Victorian Heart Hospital, Clayton, VIC, Australia (Shehabi) Clinical School of Medicine, University of New South Wales, Prince of Wales Hospital, Randwick, NSW, Australia (Balachandran, Al-Bassam, Pakavakis) Department of Intensive Care, Monash Health, Clayton, VIC, Australia (Bailey, Brown) Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Bellomo) Department of Critical Care, The University of Melbourne, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (Bellomo) Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia (Bihari) Department of ICU, Flinders Medical Centre, Bedford Park, SA, Australia (Bihari) College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia (Brown, Darlison) Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia (Collins) Prince of Wales and Prince of Wales Private Hospital, Randwick, NSW, Australia (Mandarano) Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy (Sarode) Department of Intensive Care, Cabrini Health, Malvern, VIC, Australia (Sarode) School of Translational Medicine, Monash University, Melbourne, VIC, Australia Publisher American Medical Association Abstract Importance: Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Protein loading appears nephroprotective; thus, continuous hyperoncotic albumin infusion may impact AKI following high-risk cardiac surgery. Objective(s): To evaluate the effect of postoperative 20% albumin infusion compared with usual care on the occurrence of AKI in high-risk cardiac surgery patients. Design, Setting, and Participant(s): This was an investigator-initiated randomized multicenter open-label pragmatic clinical trial. Participants were stratified by site and estimated glomerular filtration rate (eGFR) above and below 60 mL/min/1.73 m2. The study was conducted at 7 cardiac centers in Australia and Italy between July 2019 and August 2024. Patients undergoing on-pump cardiac surgery with a preoperative eGFR of greater than 15 mL/min/1.73 m2 and less than 60 mL/min/1.73 m2 or undergoing a combined cardiac surgical procedure or major aortic surgery were included, excluding those who were in intensive care for longer than 6 hours following the index surgery, had a serum albumin level less than 20 g/L, were dialysis dependent, had a previous kidney transplant, were receiving extracorporeal life support or ventricular assist device, or had an objection to receiving albumin or blood products. Intervention(s): Participants were randomized 1:1 within 6 hours after surgery to receive a 300-mL infusion of 20% albumin over 15 hours or usual care, as per clinician discretion. All patients received volume resuscitation and hemodynamic treatment according to participating centers' protocols. Main Outcomes and Measures: The primary outcome was stage 1-3 AKI according to the creatinine-based Kidney Disease Improving Global Outcomes definition. The main secondary outcomes included major adverse kidney events and mortality at hospital discharge or day 28 following randomization. Result(s): The primary analysis included 307 patients randomized to the 20% albumin group and 304 to usual care. The mean (SD) age was 69 (10.8) years, and 281 patients (45.8%) had an eGFR less than 60 mL/min/1.73 m2. The median (IQR) European System for Cardiac Operative Risk Evaluation score-II was 3.23 (1.91-5.30). AKI occurred in 150 of 307 patients in the albumin group (48.9%) vs 132 of 304 in usual care (43.4%) (unadjusted relative risk, 1.13; 95% CI, 0.95-1.34; P =.18; strata-adjusted relative risk, 1.12; 95% CI, 1.04-1.21; P =.003). This effect was more pronounced in patients with an eGFR of <60 mL/min/1.73 m2 (adjusted relative risk, 1.14; 95% CI; 1.07-1.22; P <.001). There were more blood transfusions given in the albumin group (116 [37.8%] vs 91 [29.9%]; P =.04) but no other significant differences in secondary outcomes. Conclusions and Relevance: In this study of cardiac surgery patients at high risk of AKI, an infusion of 20% albumin increased the risk of AKI. These findings do not support the routine use of hyperoncotic albumin infusion in patients undergoing high-risk cardiac surgery. Copyright © 2025 American Medical Association. All rights reserved. <56> Accession Number 2045791872 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. 15(9) (no pagination), 2026. Article Number: e044431. Date of Publication: 2026. Author Moghadam A.S.; Kazemian S.; Moghadam S.S.; Nasiri P.; Mojahedi A.; Geraiely B.; Larti F.; Latib A.; Scotti A.; Kuno T.; Kolte D. Institution (Moghadam, Kazemian, Moghadam) Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Nasiri) School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Islamic Republic of (Mojahedi) Department of Internal Medicine, Stony Brook University Hospital, Stony Brook, NY, United States (Geraiely, Larti) Cardiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Latib, Scotti) Division of Cardiology, Montefiore Medical Center, The Bronx, NY, United States (Kuno, Kolte) Cardiology Division, Massachusetts General Hospital, Beth Israel Deaconess Medical CenterHarvard Medical School, Boston, MA, United States (Kuno) Division of Cardiology, Beth Israel Deaconess Medical CenterHarvard Medical School, Boston, MA, United States Publisher American Heart Association Inc. 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 highgradient (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 allcause 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. Copyright © 2026 The Author(s). <57> Accession Number 2046077464 Title Global Sensitivity Analysis for Studies Extending Inferences From a Randomized Trial to a Target Population. Source Statistics in Medicine. 45(13-14) (no pagination), 2026. Article Number: e70083. Date of Publication: 01 Jun 2026. Author Dahabreh I.J.; Robins J.M.; Haneuse S.J.-P.A.; Robertson S.E.; Steingrimsson J.A.; Hernan M.A. Institution (Dahabreh, Robins, Robertson, Hernan) CAUSALab, Harvard T.H. Chan School of Public Health, Boston, MA, United States (Dahabreh, Robins, Haneuse, Robertson, Hernan) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States (Dahabreh, Robins, Haneuse, Hernan) Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States (Steingrimsson) Department of Biostatistics, School of Public Health, Brown University, Providence, RI, United States Publisher John Wiley and Sons Ltd Abstract When individuals participating in a randomized trial differ with respect to the distribution of effect modifiers compared with the target population where the trial results will be used, treatment effect estimates from the trial may not directly apply to target population. Methods for extending-generalizing or transporting-causal inferences from the trial to the target population rely on conditional exchangeability assumptions between randomized and non-randomized individuals. The validity of these assumptions is often uncertain or controversial and investigators need to examine how violation of the assumptions would impact study conclusions. We describe methods for global sensitivity analysis that directly parameterize violations of the assumptions in terms of potential (counterfactual) outcome distributions. Our approach does not require detailed knowledge about the distribution of specific unmeasured effect modifiers or their relationship with the observed variables. We illustrate the methods using data from a trial nested within a cohort of trial-eligible individuals to compare coronary artery surgery plus medical therapy versus medical therapy alone for stable ischemic heart disease. Copyright © 2026 John Wiley & Sons Ltd. <58> Accession Number 2046332118 Title TAVR in Low-Risk Patients at Long-Term Follow-Up: Promising Outcomes With Remaining Uncertainties from an Updated Meta-Analysis. Source American Journal of Cardiology. 272 (pp 66-67), 2026. Date of Publication: 01 Aug 2026. Author Di Pietro G.; Improta R.; Tocci M.; Bruno E.; Colantonio R.; Mancone M. Institution (Di Pietro, Improta, Tocci, Bruno, Colantonio, Mancone) Department of Clinical and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy Publisher Elsevier Inc. <59> Accession Number 2045791540 Title Comparison of Cardiac Troponin T and I: Impact on Definitions of Perioperative Myocardial Infarction After Coronary Artery Bypass Grafting. Source Journal of the American Heart Association. 15(9) (no pagination), 2026. Article Number: e045234. Date of Publication: 01 Jan 2026. Author Koechlin L.; Salikhanov I.; Strebel I.; Gahl B.; Mawad B.; Landert N.; Vohringer L.; Reuthebuch O.; Haaf P.; Zellweger M.; Siegemund M.; Mueller C.; Berdajs D. Institution (Koechlin, Strebel, Gahl, Mawad, Landert, Vohringer, Reuthebuch, Berdajs) Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland (Koechlin, Salikhanov, Haaf, Zellweger, Mueller) Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland (Koechlin) Department of Cardiac Surgery, University Hospital Zurich, Zurich, Czechia (Gahl) Surgical Outcome Research Centre Basel, University Hospital Basel, University Basel, Basel, Switzerland (Siegemund) Intensive Care Unit, Department of Acute MedicineUniversity Hospital Basel, Basel, Switzerland Publisher American Heart Association Inc. Abstract BACKGROUND: We aimed to directly compare the postoperative release dynamics of cTn (cardiac troponin) T and I after uneventful coronary artery bypass graft surgery and analyze differences between cTnT and cTnI regarding biomarker thresholds across various definitions of perioperative myocardial infarction. METHOD(S): Patients >18 years of age undergoing isolated coronary artery bypass graft surgery were included. Measurements of cTnT/I were performed in the same patients from the same blood samples. Patients with patent bypass grafts on postoperative computed tomography and without a 10% decrease in left ventricular ejection fraction, indicating an uneventful postoperative course, were included. Criteria for perioperative myocardial infarction were applied according to current guidelines and recommendations (Universal Definition of Myocardial Infarction, the Academic Research Consortium-2, VISION [Vascular Events in Surgery Patients Cohort Evaluation]). RESULT(S): The study included 258 patients (median 69 [interquartile range, 62-75] years). Median postoperative peak values were 349 ng/L (interquartile range, 206-547) for cTnT and 1517 ng/L (interquartile range, 752-2897) for cTnl and were seen on the first postoperative day most frequently. The required biomarker cutoffs according to Universal Definition of Myocardial Infarction, Academic Research Consortium-2, and VISION trial were exceeded more often for cTnI compared with cTnT (eg, Universal Definition of Myocardial Infarction: n=181 [72.4%; 95% CI, 67%-78%] for cTnI versus n=150 [60.0%; 95% CI, 54%-66%] for cTnT; P<0.001; Academic Research Consortium-2: n=173 [69.2%; 95% CI, 63%-75%] for cTnI versus n=75 [30.0%; 95% CI, 25%-36%] for cTnT; P<0.001). Including echocardiogram and ECG criteria for perioperative myocardial infarction, differences between cTnT and I were lower but remained. CONCLUSION(S): cTnT and I differ in their postoperative concentrations after coronary artery bypass graft with impact on current criteria for perioperative myocardial infarction. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. JAHA is available at: www.ahajournals.org/journal/jaha <60> Accession Number 2046313471 Title Simulation-Based Training for Coronary Artery Bypass Grafting: Systematic Review and Meta-analysis. Source Journal of Surgical Education. (no pagination), 2026. Article Number: 104010. Date of Publication: 2026. Author Sidik A.I.; Entsua-Mensah K.; Dontsov V.V.; Ruchkin M.G.; Karpenko I.G.; Sobolev D.; D'Oria M. Institution (Sidik) Department of Cardiovascular Surgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation (Entsua-Mensah) National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana (Dontsov) Moscow Regional Research, Clinical Institute named after M.F. Vladimirsky, Moscow, Russian Federation (Ruchkin) Department of Cardiac Surgery, Research Institute for Emergency Medicine named after N.V. Sklifosovsky, Moscow, Russian Federation (Karpenko) Department of Cardiothoracic Surgery, A.A. Vishnevskiy Hospital, Moscow, Russian Federation (Sobolev) European Medical Center, Moscow, Russian Federation (D'Oria) Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy Publisher Elsevier Inc. Abstract BACKGROUND: Declining operative exposure and increasing procedural complexity have challenged traditional apprenticeship models in coronary artery bypass grafting (CABG) training. Simulation-based training (SBT) has emerged as a strategy to support technical skill acquisition outside the operating room. This systematic review and meta-analysis evaluated the effectiveness of SBT in improving technical performance and procedural efficiency for CABG anastomosis. METHOD(S): A comprehensive search of PubMed, Scopus, and Web of Science identified studies published between 2000 and 2025 that reported quantitative outcomes following SBT for CABG. Randomized controlled trials, quasi-experimental studies, and pre-post designs were eligible. RESULT(S): Eleven studies with 372 participants met the inclusion criteria. Pooled analysis showed a large improvement in overall technical performance (standardized mean difference 2.18, 95% CI 1.73-2.63; p < 0.00001) and a substantial reduction in anastomosis completion time (standardized mean difference 2.00, 95% CI 0.92-3.08; p = 0.0003). Subgroup analyses demonstrated significant benefits across simulator categories (tissue-based, hybrid, and synthetic) and fidelity levels, with no statistically significant differences between trainee levels. Most studies had low to moderate overall risk of bias. CONCLUSION(S): This review indicates that SBT meaningfully accelerates technical skill acquisition and improves procedural efficiency in CABG anastomosis across trainee levels and simulator types. These findings support the integration of structured simulation into cardiothoracic surgery training curricula. Future research should evaluate long-term skill retention, transferability to real patient surgery, and cost-effectiveness to guide optimal implementation. Copyright © 2026 The Author(s) <61> Accession Number 2045727144 Title Determinants of Healthcare Costs in Individuals With Down Syndrome: A Systematic Review. Source Health Science Reports. 9(6) (no pagination), 2026. Article Number: e72297. Date of Publication: 01 Jun 2026. Author Rakhshan S.T.; Byford S.; Razimoghadam M.; Moradi F.; Soltani S. Institution (Rakhshan, Razimoghadam) Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Byford) King's Health Economics, King's College London, London, United Kingdom (Razimoghadam) National Center for Health Insurance Research, Tehran, Iran, Islamic Republic of (Moradi) Medical Education Department Center (EDC), Kurdistan University of Medical Sciences, Sanandaj, Iran, Islamic Republic of (Soltani) Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran, Islamic Republic of Publisher John Wiley and Sons Inc Abstract Background: Individuals with Down syndrome (DS) require specialized medical follow-up and services more frequently than the general population, resulting in substantial healthcare costs for families and health systems. This systematic review aimed to synthesize evidence on the magnitude and determinants of direct healthcare and indirect costs associated with DS. Method(s): We searched Web of Science, PubMed, and Scopus for observational and experimental studies published in English between January 1, 2000, and December 31, 2022 (updated June 15, 2024), that reported healthcare costs or cost determinants for individuals with DS. Reference lists were also screened. We excluded non-English papers, qualitative studies, reviews, protocols, editorials, and gray literature. Result(s): The search identified 625 unique citations, of which 14 matched the inclusion criteria. Half were conducted in the USA. Inpatient services constituted the largest share of direct healthcare costs in 58% of studies. Indirect costs, mainly productivity losses among families, were reported in 25% of studies. Healthcare costs were highest during infancy (driven primarily by congenital heart defects and early hospitalizations), decreased throughout childhood and adolescence, and increased again in adulthood, particularly after age 40, due to age-related comorbidities such as dementia and multimorbidity. Associated morbidities, greater functional limitations, and lower socioeconomic status were consistently associated with higher costs. Conclusion(s): Age, comorbidities, functional ability, and socioeconomic factors are key drivers of healthcare costs in DS. Long-term, comprehensive policies integrating medical, social, and educational support are needed. Priority should be given to early cardiac surgery coverage, multidisciplinary adult transition clinics, subsidized respite care, and financial assistance schemes to reduce both inpatient utilization and family productivity losses. Copyright © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC. <62> Accession Number 2045836462 Title Right heart failure: lights and shadows. Source Minerva Cardiology and Angiology. 74(3) (pp 347-364), 2026. Date of Publication: 01 Jun 2026. Author Giordana F.; Cinconze S.; Coppini L.; Bernelli C. Institution (Giordana, Cinconze, Coppini) Division of Cardiology, ASO S. Croce and Carle Hospital, Cuneo, Italy (Bernelli) Division of Cardiology, Santa Corona Hospital, ASL2, Savona, Pietra Ligure, Italy Publisher Edizioni Minerva Medica Abstract Right heart function is essential for overall heart health and plays a crucial role in the prognosis of patients with heart failure. A comprehensive assessment of the right ventricle (RV) that includes various clinical and hemodynamic parameters, as well as imaging techniques, provides important insights into the structure and function of the right heart. Advanced imaging methods, such as cardiac MRI, offer further clarity regarding the morphology and performance of the right heart. Interventional therapies have transformed treatment options and the prognosis for patients with advanced RV failure, and these therapies should be integrated into a comprehensive care plan. Ongoing research into the molecular and genetic factors contributing to right heart dysfunction is expected to reveal new therapeutic targets. Continued advancements in imaging and treatment options are vital for enhancing patient outcomes. In this review, we provide a detailed analysis of RV function, diagnosis, and therapy for RV failure. Copyright © 2025 EDIZIONI MINERVA MEDICA. <63> Accession Number 2046065361 Title Investigation of Esketamine Administration During Surgical Procedures for the Alleviation of Postoperative Anxiety and Depression in Adolescent Patients: A Randomized Controlled Trial. Source Drug Design, Development and Therapy. 20 (no pagination), 2026. Article Number: 587626. Date of Publication: 2026. Author Li Y.; Zhao K.; Cao P.; Wang Q.; Li K.; Zhou J. Institution (Li) Department of Anaesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, Henan, Zhengzhou, China (Zhao, Cao, Wang, Li, Zhou) Department of Anaesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, Henan, Zhengzhou, China Publisher Dove Medical Press Ltd Abstract Background: Surgical stress can lead to postoperative anxiety and depression, especially in adolescents. These complications reduce quality of life and increase medical burdens, but perioperative psychological interventions for adolescents are limited, and related mechanisms remain unclear. Esketamine (S-ketamine), an N-methyl-D-aspartate receptor (NMDAR) antagonist, has analgesic, sedative, antidepressant, and anxiolytic effects, yet its efficacy and safety in adolescent surgical patients have not been systematically studied. Purpose(s): This study seeks to investigate the prophylactic efficacy of subanesthetic-dose S-ketamine in mitigating postoperative anxiety and depression among adolescent patients. Method(s): In this prospective double-blind randomized placebo-controlled trial, 92 American Society of Anesthesiologists (ASA) I-II adolescents aged 13-18 years undergoing elective surgery were randomly assigned to receive intravenous esketamine (0.25 mg/kg) or normal saline at skin incision. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS); serum C-reactive protein (CRP) and interleukin-6 (IL-6) were measured; pain was evaluated using the NRS. Adverse events were recorded. Result(s): Eighty patients completed the study. The esketamine group had significantly lower anxiety scores on postoperative days 1, 3, 7, and 14 (P < 0.05). Depression scores differed significantly only on day 14 (P = 0.043). There were no significant between-group differences in inflammatory markers or adverse events. Esketamine was a protective factor against postoperative anxiety (OR = 0.38, P < 0.05). Conclusion(s): Subanesthetic-dose esketamine during surgery effectively reduces postoperative anxiety and partially alleviates depressive symptoms in adolescents with acceptable safety. Limited by sample size and single-center design, multicenter studies with longer follow-up are warranted. Copyright © 2026 Li et al. <64> [Use Link to view the full text] Accession Number 2044254852 Title Balloon-expandable versus self-expanding valves in severe aortic stenosis with small aortic annulus: an updated meta-analysis. Source Coronary Artery Disease. Publish Ahead of Print (no pagination), 2026. Article Number: 10.1097/MCA.0000000000001618. Date of Publication: 04 Feb 2026. Author Narciso I.A.T.; Krishna M.M.; Joseph M.; Puglla Sanchez L.R.; Ezenna C.; Ayesha A.; Pereira V.; Lajczak P.; Mendes B.S.; Schincariol M. Institution (Narciso) University Center UNIFIPMOC, Montes Claros, Brazil (Krishna, Joseph) Department of Medicine, Medical College Thiruvananthapuram, Kerala, India (Puglla Sanchez) Clinico Lozano Blesa University Hospital, Zaragoza, Spain (Ezenna) Department of Medicine, University of Massachusetts, Baystate Medical Center, Springfield, United States (Ayesha) Shifa College of Medicine, Islamabad, Pakistan (Pereira) Faculty of Biomedical Sciences Austral University, Pilar, Argentina (Lajczak) Medical University of Silesia, Katowice, Poland (Mendes) University Center UNIFIPMOC, Montes Claros, Brazil (Schincariol) Klinikum Furth, Academic Teaching Hospital of Friedrich-Alexander-Universitat Erlangen-Nurnberg, Furth, Germany Publisher Lippincott Williams and Wilkins Abstract Background - Balloon-expandable valve (BEV) and self-expanding valve (SEV) are used in transcatheter aortic valve replacement (TAVR). Patients with a small aortic annulus (SAA) make up to one-third of the cases and face higher risks of prosthesis-patient mismatch and high valvular gradients. Objectives - This meta-analysis aimed to compare balloon-expandable and self-expanding valves used in TAVR in patients with a SAA, focusing on hemodynamic and clinical outcomes. Methods - We systematically searched Cochrane Central, PubMed, and EMBASE for studies comparing balloon-expandable and self-expanding valves in patients with SAA undergoing TAVR. Random effects models were applied to generate odds ratios (ORs) and mean differences with 95% confidence interval (CI). Results - Fifteen studies (two randomized controlled trials and 13 propensity-matched studies) with 5149 patients (48.4% balloon-expandable valves) were identified. BEVs were associated with a lower indexed effective orifice area (mean difference: -0.18, 95% CI: -0.25 to -0.10; P < 0.00001) and higher transvalvular mean pressure gradient (mean difference: 4.32, 95% CI: 3.39-5.24; P < 0.00001) and peak pressure gradients (mean difference: 4.87, 95% CI: 1.23-8.51; P = 0.009). Permanent pacemaker implantation (OR: 0.57, 95% CI: 0.44-0.73; P < 0.0001) and major bleeding (OR: 0.67, 95% CI: 0.47-0.96; P = 0.03) were lower in balloon-expandable valves. BEVs increased the odds of any prosthesis-patient mismatch (OR: 2.28, 95% CI: 1.61-3.22; P < 0.00001) and severe prosthesis-patient mismatch (OR: 3.16, 95% CI: 2.19-4.58; P < 0.00001). Conclusion - In patients with SAA undergoing TAVR, SEVs offer superior hemodynamic performance, whereas BEVs are associated with fewer conduction disturbances and bleeding events. Both valve platforms yielded similar clinical outcomes, underscoring the need for individualized device selection. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <65> Accession Number 2041671046 Title Thoracic pedicle Subtraction osteotomies: a systematic review of indications, correction magnitudes, and safety profile. Source European Spine Journal. 35(5) (pp 2275-2289), 2026. Date of Publication: 01 May 2026. Author Hoang R.; Cowman A.W.; Jin H.; Tummala P.; Liu L.; Song J.; Theologis A.A. Institution (Hoang, Cowman, Jin, Tummala, Liu) University of California - Irvine, Irvine, United States (Song) Icahn School of Medicine at Mount Sinai, New York, United States (Theologis) University of California - San Francisco, San Francisco, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: Thoracic pedicle subtraction osteotomies (T-PSO) are used to correct severe primary and revision thoracic spinal deformities. While lumbar PSOs are well established, literature describing the efficacy and safety of T-PSOs remains limited. This systematic review aims to characterize indications, correction magnitudes, and complications associated with T-PSO. Method(s): A systematic review was conducted across PubMed, Web of Science, and Scopus in accordance with PRISMA guidelines. Studies were included if they reported outcomes specific to T-PSO in either primary or revision surgeries. Surgical correction characteristics, thoracic region sub-analyses, and adverse events were summarized. Result(s): Data were extracted from 52 studies, including 38 case reports/series and 14 retrospective chart reviews. Among 404 T-PSO patients, 167 patients had the level of procedure reported. Most procedures were single-level osteotomies (n = 161, 96.4%), with the most frequent levels at T11 and T12. The most common indications for T-PSO based on thoracic region were postoperative kyphosis (n = 15, 32.6%) for the upper thoracic spine, thoracic kyphosis (n = 3, 37.5%) alongside thoracic kyphoscoliosis (n = 3, 37.5%) for the middle thoracic spine, and thoracolumbar kyphosis (n = 54, 50.5%) for the lower thoracic spine. Mean magnitude of thoracic kyphosis correction was 25.8degree and correction at the T-PSO level was 25.5degree. Adverse events occurred in 48.5% of patients, including structural complications (22.5%), instrumentation failures (11.8%), infections (10.8%), and neurologic deficits (9.8%). Three deaths were reported. Complication rates were similar between primary and revision procedures. Conclusion(s): T-PSO achieves meaningful sagittal plane correction in appropriately selected patients with severe and/or rigid primary and revision thoracic spinal deformities. However, high complication rates emphasize the importance of careful patient selection and surgical planning. Standardization of outcome reporting is critical to optimize future clinical guidance. Copyright © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025. <66> [Use Link to view the full text] Accession Number 2043635052 Title Impaired Cognitive Domains in Surgical Patients: A Systematic Review and Meta-Analysis. Source Anesthesia and Analgesia. (no pagination), 2026. Date of Publication: 16 Feb 2026. Author Park S.; Yan E.; Martinez-Rodriguez R.; Desai B.; Chung J.; Saripella A.; Englesakis M.; Fishman K.N.; Chung F. Institution (Park, Martinez-Rodriguez, Desai, Chung) Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Yan, Saripella, Chung) Department of Anesthesia and Pain Medicine, Krembil Research Institute, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada (Yan, Chung) Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Englesakis) Library & Information Services, University Health Network, Toronto, Ontario, Canada (Fishman) Neuropsychology & Cognitive Health, Baycrest Hospital, Toronto, Ontario, Canada (Fishman) Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Cognitive impairment is a highly prevalent but frequently overlooked issue among surgical patients preoperatively. This systematic review and meta-analysis aimed to (1) determine the perioperative prevalence of impaired cognitive domains in surgical patients, (2) explore perioperative changes in the different domains, and (3) examine postoperative outcomes associated with preoperatively impaired cognitive domains. METHOD(S): - Five electronic databases were searched from inception to March 19, 2024. Inclusion criteria were (1) surgical patients >=18 years of age; (2) preoperative cognitive assessments using a neuropsychological battery; (3) reported the prevalence of impairment in specific cognitive domains or changes perioperatively; and (4) sample size of >=100 surgical patients. The exclusion criteria included studies involving neurological surgery; cross-sectional, case-control, and case series studies; non-English articles; and studies with overlapping data. RESULT(S): - In total, of the 12, 082 articles identified from 5 databases, 21 studies (5725 patients, 11 non-cardiac surgery studies, and 10 cardiac surgery studies) were included. Among the 6 cognitive domains assessed preoperatively, the pooled prevalence of impairment was highest in executive function (18%; 95% CI, 13%-24%), visuospatial function (16%; 95% CI, 6%-26%), and attention/working memory/processing speed (14%; 95% CI, 9%-18%). Perceptual-motor control (13%; 95% CI, 9%-36%), language (13%; 95% CI, 8%-17%), and learning/memory (12%; 95% CI, 8%-16%) had lower pooled prevalence. The cognitive domains that were assessed postoperatively showed a high prevalence of impairment at 1 week, with 35% (95% CI, 4%-66%) in attention/working memory/processing speed, 34% (95% CI, 16%-51%) in executive function, and 28% (95% CI, 16%-40%) in learning/memory. The pooled prevalence subsequently decreased within 3 months to 16% (95% CI, 3%-35%) in attention/working memory/processing speed, 15% (95% CI, 6%-24%) in executive function, and 12% (95% CI, -2% to 25%) in learning/memory. CONCLUSION(S): - The prevalence of preoperatively impaired cognitive domains was the highest in executive function, followed by visuospatial function and attention/working memory/processing speed. Identifying commonly impaired cognitive domains may help optimize cognitive assessments in the perioperative setting. Further research is needed to clarify the clinical utility of assessing specific cognitive domains in surgical populations to improve postoperative outcomes and reduce cognitive deterioration. Copyright © 2026 Emerald Publishing Limited <67> Accession Number 2046128006 Title Low-dose levosimendan infusions in advanced heart failure: efficacy, safety, and factors associated with outcomes. Source Clinical Research in Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Barras N.; Kikoine J.; Liaudet L.; Sotiropoulos K.; Regamey J.; Godinho R.; Hullin R.; Yerly P. Institution (Barras, Godinho, Hullin, Yerly) Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland (Kikoine) Department of Cardiology, Centre Hospitalier du Valais Romand, Sion, Switzerland (Liaudet) Department of Intensive Care Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland (Sotiropoulos) Department of Cardiology, Spital Muri, Muri, Switzerland (Regamey) Department of Cardiology, Hopital Riviera-Chablais, Rennaz, Switzerland Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: In advanced heart failure (AdHF), repeated levosimendan infusions between 0.1 and 0.2 mug/kg/min for 6-24 h every 2-4 weeks were associated with inconsistent outcomes and trends towards worse prognosis. Treatment effect with lower dosing is however unknown. The aims of this retrospective study were to assess the impact of 24-h levosimendan cycles at 0.05 mug/kg/min every 4 weeks on HF therapy, outcomes, and safety and to identify predictors of treatment efficacy. Method(s): Among 286 AdHF patients, 39 levosimendan-treated subjects (4.19 +/- 2.6 infusions) and 39 standard-of-care (SOC) subjects matched 1:1 based on a propensity score accounting for age, sex, ischemic heart disease, left ventricular (LV) ejection fraction, creatinine, heart rhythm, and heart transplantation (HTx) listing underwent comparison of their outcome. Efficacy was defined as 1-year survival without LV-assist-device, urgent HTx and urgent hospitalization for HF. Adverse events (AE) included permanent levosimendan interruption, sustained arrhythmias, or hypotension occasioning permanent infusion hold. Result(s): Beta-blocker (BB) dose increased with levosimendan [34.7% (18.4-50%) of target-dose at 6-months vs. 21.9% (6.25-25%) at baseline (P = 0.022)]. At 1 year, 26 patients reached the efficacy endpoint in the levosimendan group vs. 14 in the SOC group (HR = 0.42; 95% CI = 0.22-0.83; P = 0.01). The benefit of levosimendan was essentially driven by the reduction of HF hospitalization (HR = 0.367; 95% CI = 0.16-0.85; P = 0.014), with no difference in the reduction of death, LVAD or SU-HTx (HR = 0.8; 95% CI = 0.3-21.4; P = 0.65). No AE occurred. We found no prognostic factor at baseline but BB therapy (95.6% vs. 50%; P = 0.005), higher BB dosing (33 +/- 20% vs. 9 +/- 20% of target-dose; P = 0.036), and lower heart rate (71 +/- 10.4 vs. 81 +/- 14 bpm; P = 0.039) at 3 months were associated with treatment efficacy. Conclusion(s): Our findings raise the hypotheses that low-dose levosimendan is safe, enables BB up-titration, and is associated with improved outcomes. Heart rate, BB therapy, and BB dosing at 3 months may predict event-free survival. Copyright © Springer-Verlag GmbH Germany, part of Springer Nature 2026. <68> Accession Number 2042210644 Title Efficacy and safety of anticoagulant therapy for hypoattenuated leaflet thickening Post-TAVR: A systematic review and meta-analysis. Source Journal of Thrombosis and Thrombolysis. 59(3) (pp 587-597), 2026. Date of Publication: 01 Mar 2026. Author Tudella G.C.N.; Fagundes C.S.; De Conto T.; Marques M.D.; Chemello D. Institution (Tudella, Fagundes, De Conto) Department of Medicine, Federal University of Santa Maria, RS, Santa Maria, Brazil (Marques, Chemello) Department of Clinical Medicine, Federal University of Santa Maria, RS, Santa Maria, Brazil Publisher Springer Abstract Hypoattenuated leaflet thickening (HALT), a subclinical form of valve thrombosis, is a common finding after transcatheter aortic valve replacement (TAVR). While anticoagulant therapy has been associated with HALT resolution, the efficacy and safety of this approach remain uncertain. To evaluate the effectiveness and safety of oral anticoagulant (OAC) therapy in resolving HALT after TAVR. A systematic review and meta-analysis was performed in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251045514). Studies including adult TAVR patients with imaging-confirmed HALT treated with anticoagulants were included. Outcomes assessed included HALT resolution, valve dysfunction, and major bleeding. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was evaluated via GRADE. Summary estimates were calculated using a random-effects model. Nine observational studies involving 369 patients were included, with a follow-up ranging from 78 to 217.6 days, and ranging from 5 days to 9.6 months of interval between TAVR and imaging. The overall pooled HALT resolution rate in imaging follow-up was 90% (95% CI: 0.84-0.95; I2 = 15.0%). Otherwise, when discontinuation of OAC had a recurrence rate of 69% (95% CI: 0.49-0.84, I2=0). The bleeding event proportion was 0.05 (95% CI: 0.01-0.18, I2 = 0.0%). Sensitivity analyses excluding influential studies suggest the robustness of findings. Anticoagulant therapy is associated with high rates of HALT resolution and appears superior to antiplatelet therapy. These findings support the role of anticoagulation in selected post-TAVR patients with HALT, though randomized trials are needed to confirm efficacy and assess bleeding risk. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025. <69> Accession Number 2045562187 Title Robotic surgery in acute care, trauma, and critical care settings: a dual-dataset, data-driven bibliometric analysis of global research trends, emerging themes, and future directions. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 509. Date of Publication: 01 Dec 2026. Author Talib M.A.; Alomary F.O.; Alshuhri S.; Alomran A.; Alsahli A.; Alshammari A.; Abdelrahman S.M.; Alhathli M.A.; Abdelwahab S.I.; Taha M.M.E. Institution (Talib, Alomary, Alshuhri, Alomran, Alsahli, Alshammari, Abdelrahman) College of Computer and Information Sciences (CCIS), Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia (Alhathli) Department of Computer Science, College of Computer and Information Science, Prince Nourah Bint Abdulrahman University (PNU), Riyadh, Saudi Arabia (Abdelwahab, Taha) Health Research Centre, Jazan University, Jazan, Saudi Arabia Publisher Springer Nature Abstract Background: Robotic technologies are increasingly explored in acute and emergency surgical contexts, offering potential advantages in precision, minimally invasive access, and perioperative management. Despite rapid growth, research addressing robotic acute care surgery (RACS) remains dispersed across specialties, methodological designs, and geographic regions. A comprehensive, data-driven synthesis of its intellectual structure, collaboration patterns, and thematic evolution has not been systematically undertaken. This study aimed to map global research activity in RACS, identify leading contributors, characterize dominant and emerging themes, and delineate conceptual transitions within the field. Method(s): A bibliometric analysis was conducted using Scopus-indexed publications (1997-2025). Descriptive, collaboration, and thematic analyses were performed using Bibliometrix, VOSviewer, and CiteSpace to evaluate productivity trends, knowledge networks, thematic development, and emerging research fronts. Result(s): A total of 1,172 publications demonstrated sustained growth, particularly after 2020. The United States, China, and Italy emerged as leading contributors, with Europe and North America accounting for the majority of productivity and citation impact. Collaboration networks revealed concentrated institutional hubs with relatively limited transnational integration. Bradford's Law identified a small core of specialized surgical journals responsible for approximately one-third of total output. Keyword co-occurrence analysis highlighted central themes around robot-assisted surgery, minimally invasive techniques, and perioperative outcomes, with bridging roles played by laparoscopy and comparative study designs. Thematic evolution analysis suggested a gradual shift from technology-focused foundations toward outcome-oriented evaluation, cost analysis, and acute-context applications. CiteSpace identified active research fronts in emergency surgery, risk assessment, propensity score matching, and randomized controlled trials, indicating increasing methodological sophistication. Conclusion(s): Research intersecting robotic surgery and acute care contexts has expanded substantially over the past decade, with growing emphasis on outcomes, comparative effectiveness, and economic evaluation. This study provides a structured intellectual and thematic framework, identifies gaps in international collaboration and high-level evidence generation, and outlines strategic directions for future multicenter and methodologically rigorous investigations. Copyright © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2026. <70> Accession Number 2045596612 Title Association of Platelet Count, Mean Platelet Volume, Platelet Distribution Width, Plateletcrit, and Platelet-Lymphocyte Ratio With Postoperative Cardiac Surgery-Associated Atrial Fibrillation: A Systematic Review and Meta-Analysis. Source Journal of Cardiac Surgery. 2026(1) (no pagination), 2026. Article Number: 2799748. Date of Publication: 2026. Author Mao K.; Caruana C.B.; Frentiu A.; Raveendran D.; Perry L.A.; Penny-Dimri J.C.; Ramson D.M.; Segal R.; Bellomo R.; Smith J.A.; Plummer M.; Liu Z. Institution (Mao, Raveendran, Perry, Segal, Bellomo, Liu) Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia (Caruana, Penny-Dimri) Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia (Frentiu, Ramson, Smith) Department of Surgery, Monash University, Melbourne, VIC, Australia (Perry, Segal) Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia (Bellomo) Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia (Bellomo) Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia (Bellomo) School and Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Bellomo) Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital, Melbourne, VIC, Australia (Smith) Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia (Plummer) Department of Intensive Care, Royal Adelaide Hospital, Adelaide, SA, Australia Publisher John Wiley and Sons Inc Abstract Background: The predictive value of platelet indices, including the platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet-lymphocyte ratio (PLR) for postoperative atrial fibrillation (POAF) following cardiac surgery remains undetermined. Method(s): MEDLINE, Embase, and the Cochrane Library were searched from inception to October 2024. For each included study, median differences (MDs) and odds ratios (ORs) were tabulated with 95% confidence intervals (CIs). Pooled estimates were generated using random-effects inverse-variance modeling. Statistical analysis focused on cases of POAF. Result(s): Six thousand five hundred and seventeen unique studies were screened and included 23 studies involving 12,375 patients in the subsequent analysis. Compared with patients who did not develop POAF, patients with POAF had higher preoperative MPV (MD: 0.30 fL, 95% CI: 0.07-0.53, and p = 0.0112) and PLR (MD: 40.42, 95% CI: 7.49-73.33, and p = 0.0161). Preoperative PLT (MD: 3.32, 95% CI: -5.87-12.51, and p = 0.4785) was not significantly different between groups. Study numbers were insufficient to assess the association between PCT with POAF. Conclusion(s): Elevated preoperative MPV and PLR were associated with POAF after cardiac surgery. Further research is required to investigate the roles of these indices in the risk stratification of POAF in patients undergoing cardiac surgery. Copyright © 2026 Kevin Mao et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd. <71> Accession Number 2046264214 Title Six-Year Outcomes After Transcatheter vs Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. Source Journal of the American College of Cardiology. 87(23) (pp 3210-3221), 2026. Date of Publication: 16 Jun 2026. Author Forrest J.K.; Yakubov S.J.; Sorajja P.; Byrne T.; Kirshner M.; Bajwa T.; Crouch J.; Coselli J.; Silva G.; Stoler R.; Islam A.; Rousou A.; Poulin M.-F.; Khabbaz K.; Bladergroen M.; Fail P.; Netherland D.; Lam K.Y.; Tonino W.A.L.; Sudre A.; Berthoumieu P.; Tchetche D.; Newman J.; Hughes G.C.; Harrison J.K.; De A.; van Mieghem N.M.; Yong G.; Agarwal S.; Park S.; Rapp J.; Kleiman N.; Reardon M.; Mohammadi S.; Rodes-Cabau J.; Sparling J.; Elkins C.C.; Gallo M.; Matthews R.V.; Starnes V.A.; Ando K.; Farge A.; Hovasse T.; DeFrain M.; Muppala M.; Vyas A.; Bagur R.; Chu M.; Fontana G.; Dev V.; Tuchek J.M.; Azuaje I.I.; Melnitchouk S.; Piazza N.; Lacappelle K.; Steinberg D.; Katz M.; Wang J.; Kozina J.; Merritt R.; Chawla A.; Jensen B.; Alvarez J.; Gooley R.; Smith J.; Ibrahim R.; Cartier R.; Rovin J.; Fukushima S.; Rutkin B.; Yakubov S.; Song H.; Zahr F.; Miyagawa S.; Rajagopal V.; Kanmanthareddy A.; Mumtaz M.; Bhindi R.; Brady P.; Batra S.; Davis T.; Iskander A.; Heimansohn D.; Hermiller J.; Takamisawa I.; Haldis T.; Yamazaki S.; Teirstein P.; Tada N.; Saito S.; Merhi W.; Leung S.; Muller D.; Timmers L.; Petrossian G.; Robinson N.; Knight P.; Ling F.; Radhakrishnan S.; Fremes S.; Lehr E.; Gafoor S.; Noel T.; Kozuma K.; Walton A.; Resar J.; Adams D.; Sharma S.; Lilly S.; Tadros P.; Zorn G.; Dauerman H.; Ittleman F.; Horlick E.; Welt F.; Sharma V.; Rushing G.; Fullerton D.; Messenger J.; Griffith B.; Gupta A.; de Marchena E.; Salerno T.; Chetcuti S.; Deeb G.M.; Sultan I.; Goel K.; Pasupati S.; Kon N.; Zhao D.; Ramlawi B.; Forrest J.; Reardon M.J. Institution (Forrest, Sorajja, Byrne, Kirshner, Bajwa, Crouch, Coselli, Silva, Stoler, Islam, Rousou, Poulin, Khabbaz, Bladergroen, Fail, Netherland, Lam, Tonino, Sudre, Berthoumieu, Tchetche, Newman, Hughes, Harrison, De, van Mieghem, Yong, Agarwal, Park, Rapp, Kleiman, Reardon, Mohammadi, Rodes-Cabau, Sparling, Elkins, Gallo, Matthews, Starnes, Ando, Farge, Hovasse, DeFrain, Muppala, Vyas, Bagur, Chu, Fontana, Dev, Tuchek, Azuaje, Melnitchouk, Piazza, Lacappelle, Steinberg, Katz, Wang, Kozina, Merritt, Chawla, Jensen, Alvarez, Gooley, Smith, Ibrahim, Cartier, Rovin, Fukushima, Rutkin, Yakubov, Song, Zahr, Miyagawa, Rajagopal, Kanmanthareddy, Mumtaz, Bhindi, Brady, Batra, Davis, Iskander, Heimansohn, Hermiller, Takamisawa, Haldis, Yamazaki, Teirstein, Tada, Saito, Merhi, Leung, Muller, Timmers, Petrossian, Robinson, Knight, Ling, Radhakrishnan, Fremes, Lehr, Gafoor, Noel, Kozuma, Walton, Resar, Adams, Sharma, Lilly, Tadros, Zorn, Dauerman, Ittleman, Horlick, Welt, Sharma, Rushing, Fullerton, Messenger, Griffith, Gupta, de Marchena, Salerno, Chetcuti, Deeb, Sultan, Goel, Pasupati, Kon, Zhao, Ramlawi, Forrest, Reardon) Yale University School of Medicine, New Haven, CT, United States (Yakubov, Sorajja, Byrne, Kirshner, Bajwa, Crouch, Coselli, Silva, Stoler, Islam, Rousou, Poulin, Khabbaz, Bladergroen, Fail, Netherland, Lam, Tonino, Sudre, Berthoumieu, Tchetche, Newman, Hughes, Harrison, De, van Mieghem, Yong, Agarwal, Park, Rapp, Kleiman, Reardon, Mohammadi, Rodes-Cabau, Sparling, Elkins, Gallo, Matthews, Starnes, Ando, Farge, Hovasse, DeFrain, Muppala, Vyas, Bagur, Chu, Fontana, Dev, Tuchek, Azuaje, Melnitchouk, Piazza, Lacappelle, Steinberg, Katz, Wang, Kozina, Merritt, Chawla, Jensen, Alvarez, Gooley, Smith, Ibrahim, Cartier, Rovin, Fukushima, Rutkin, Yakubov, Song, Zahr, Miyagawa, Rajagopal, Kanmanthareddy, Mumtaz, Bhindi, Brady, Batra, Davis, Iskander, Heimansohn, Hermiller, Takamisawa, Haldis, Yamazaki, Teirstein, Tada, Saito, Merhi, Leung, Muller, Timmers, Petrossian, Robinson, Knight, Ling, Radhakrishnan, Fremes, Lehr, Gafoor, Noel, Kozuma, Walton, Resar, Adams, Sharma, Lilly, Tadros, Zorn, Dauerman, Ittleman, Horlick, Welt, Sharma, Rushing, Fullerton, Messenger, Griffith, Gupta, de Marchena, Salerno, Chetcuti, Deeb, Sultan, Goel, Pasupati, Kon, Zhao, Ramlawi, Forrest, Reardon) OhioHealth Riverside Methodist Hospital, Columbus, OH, United States (Deeb, Sorajja, Byrne, Kirshner, Bajwa, Crouch, Coselli, Silva, Stoler, Islam, Rousou, Poulin, Khabbaz, Bladergroen, Fail, Netherland, Lam, Tonino, Sudre, Berthoumieu, Tchetche, Newman, Hughes, Harrison, De, van Mieghem, Yong, Agarwal, Park, Rapp, Kleiman, Reardon, Mohammadi, Rodes-Cabau, Sparling, Elkins, Gallo, Matthews, Starnes, Ando, Farge, Hovasse, DeFrain, Muppala, Vyas, Bagur, Chu, Fontana, Dev, Tuchek, Azuaje, Melnitchouk, Piazza, Lacappelle, Steinberg, Katz, Wang, Kozina, Merritt, Chawla, Jensen, Alvarez, Gooley, Smith, Ibrahim, Cartier, Rovin, Fukushima, Rutkin, Yakubov, Song, Zahr, Miyagawa, Rajagopal, Kanmanthareddy, Mumtaz, Bhindi, Brady, Batra, Davis, Iskander, Heimansohn, Hermiller, Takamisawa, Haldis, Yamazaki, Teirstein, Tada, Saito, Merhi, Leung, Muller, Timmers, Petrossian, Robinson, Knight, Ling, Radhakrishnan, Fremes, Lehr, Gafoor, Noel, Kozuma, Walton, Resar, Adams, Sharma, Lilly, Tadros, Zorn, Dauerman, Ittleman, Horlick, Welt, Sharma, Rushing, Fullerton, Messenger, Griffith, Gupta, de Marchena, Salerno, Chetcuti, Deeb, Sultan, Goel, Pasupati, Kon, Zhao, Ramlawi, Forrest, Reardon) University of Michigan Health Systems University Hospital, Ann Arbor, MI, United States (Reardon, Sorajja, Byrne, Kirshner, Bajwa, Crouch, Coselli, Silva, Stoler, Islam, Rousou, Poulin, Khabbaz, Bladergroen, Fail, Netherland, Lam, Tonino, Sudre, Berthoumieu, Tchetche, Newman, Hughes, Harrison, De, van Mieghem, Yong, Agarwal, Park, Rapp, Kleiman, Reardon, Mohammadi, Rodes-Cabau, Sparling, Elkins, Gallo, Matthews, Starnes, Ando, Farge, Hovasse, DeFrain, Muppala, Vyas, Bagur, Chu, Fontana, Dev, Tuchek, Azuaje, Melnitchouk, Piazza, Lacappelle, Steinberg, Katz, Wang, Kozina, Merritt, Chawla, Jensen, Alvarez, Gooley, Smith, Ibrahim, Cartier, Rovin, Fukushima, Rutkin, Yakubov, Song, Zahr, Miyagawa, Rajagopal, Kanmanthareddy, Mumtaz, Bhindi, Brady, Batra, Davis, Iskander, Heimansohn, Hermiller, Takamisawa, Haldis, Yamazaki, Teirstein, Tada, Saito, Merhi, Leung, Muller, Timmers, Petrossian, Robinson, Knight, Ling, Radhakrishnan, Fremes, Lehr, Gafoor, Noel, Kozuma, Walton, Resar, Adams, Sharma, Lilly, Tadros, Zorn, Dauerman, Ittleman, Horlick, Welt, Sharma, Rushing, Fullerton, Messenger, Griffith, Gupta, de Marchena, Salerno, Chetcuti, Deeb, Sultan, Goel, Pasupati, Kon, Zhao, Ramlawi, Forrest, Reardon) Houston Methodist-DeBakey Heart and Vascular Center, Houston, TX, United States Publisher Elsevier Inc. Abstract Background: The Evolut Low Risk trial enrolled patients with severe aortic stenosis at low surgical risk. Annual follow-up is planned for 10 years, evaluating the composite of all-cause mortality or disabling stroke and key secondary endpoints. Objective(s): Our prespecified objective was to report the 6-year clinical outcomes of transcatheter aortic valve replacement (TAVR) vs surgery from the Evolut Low Risk trial. Given an increase in reintervention rates at 6 years, we performed additional analyses in available 7-year data. Method(s): Low-risk patients with severe symptomatic aortic stenosis were randomized to TAVR or surgery from 2016-2019. Prespecified analyses at 6 years included annual follow-up of clinical outcomes reported as Kaplan-Meier estimates with log-rank test. Because the trial enrolled patients over several years, at the time of data lock, a majority of patients had completed 7-year follow-up. Given an increased reintervention rate at 6 years in the TAVR arm, we performed additional analysis of 7-year data available at the time of the database lock. Reintervention rates are reported as cumulative incidence. Result(s): A total of 1,414 patients underwent an attempted implantation (730 TAVR, 684 surgery). At 6 years, the composite endpoint of all-cause mortality or disabling stroke was 23.3% for TAVR and 20.4% for surgery (difference: 2.8% [95% CI: -1.9% to 7.6%]; P = 0.43). All-cause mortality with vital status sweep at 6 years was 23.3% (95% CI: 20.6%-26.4%) for TAVR and 20.2% (95% CI: 17.4%-23.3%) for surgery (P = 0.24). The reintervention rate at 6 years was 5.5% for TAVR and 3.3% for surgery (sHR: 1.66 [95% CI: 0.96-2.86]; P = 0.07). Using available 7-year follow-up (555 TAVR and 480 surgery), the reintervention rate for TAVR was 9.8% and for surgery was 6.0% (sHR: 1.68 [95% CI: 1.10-2.58]; P = 0.02). In the TAVR and surgery groups, the rate of reintervention for regurgitation was 5.6% vs 1.6% (sHR: 3.39 [95% CI: 1.62-7.07]; P < 0.001) and the rate of reintervention for stenosis was 3.6% vs 3.5% (sHR: 1.14 [95% CI: 0.61-2.15]; P = 0.70). Conclusion(s): The 6-year results from the Evolut Low Risk trial show no significant difference in the composite endpoint of all-cause mortality or disabling stroke. At 6 and 7 years, the TAVR arm had a higher reintervention rate compared with surgery, driven by an increased incidence of aortic regurgitation. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283). Copyright © 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <72> Accession Number 2046233996 Title Age and Procedural Timing for Asymptomatic Severe Aortic Stenosis: Analysis From the EARLY TAVR Trial. Source Circulation: Cardiovascular Interventions. (no pagination), 2026. Article Number: e016370. Date of Publication: 2026. Author Goel K.; Lindman B.R.; Schwartz A.; Cohen D.J.; Giustino G.; Oldemeyer J.B.; Strote J.; Babaliaros V.; Devireddy C.M.; Fischbein M.P.; Fearon W.F.; Daniels D.; Spies C.; Chhatriwalla A.K.; Suradi H.S.; Shah P.; Szerlip M.; Dahle T.; Apostolou D.; Makkar R.; Davidson C.J.; Sheth T.; Sorajja P.; DeVries J.T.; Southard J.; Depta J.P.; Pop A.; Rinaldi M.J.; Badr S.; Williams M.R.; Russo M.J.; Guerrero M.; McCabe J.M.; Pibarot P.; Wang Y.; Leon M.B.; Genereux P. Institution (Goel, Lindman) Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, United States (Lindman) Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN, United States (Schwartz, Cohen, Leon) Columbia University Medical Center/NewYork-Presbyterian Hospital, United States (Cohen, Leon) Cardiovascular Research Foundation, New York, NY, United States (Cohen) St. Francis Hospital and Heart Center, Roslyn, NY, United States (Giustino, Genereux) Gagnon Cardiovascular Institute, Morristown Medical Center, NJ, United States (Oldemeyer, Strote) University of Colorado Health, Loveland, United States (Babaliaros, Devireddy) Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, United States (Fischbein, Fearon) Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA, United States (Daniels, Spies) Division of Cardiology, California Pacific Medical Center, San Francisco, United States (Chhatriwalla) Saint Luke's Mid America Heart Institute, Kansas City, MO, United States (Suradi) Division of Cardiology, Rush University Medical Center, Chicago, IL, United States (Shah) Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States (Szerlip) Baylor Scott and White The Heart Hospital Plano, TX, United States (Dahle) CentraCare Heart & Vascular Center, St. Cloud, MN, United States (Apostolou) Center for Structural Heart Disease, Henry Ford Health System, Detroit, MI, United States (Makkar) Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States (Davidson) Northwestern University Feinberg School of Medicine, Chicago, IL, United States (Sheth) Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (Sorajja) Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, MN, United States (DeVries) Heart and Vascular Center, Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States (Southard) Division of Cardiovascular Medicine, UC Davis Health System, University of California-Davis, Sacramento, United States (Depta) Sands-Constellation Heart Institute, Rochester Regional Health, NY, United States (Pop) Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, IL, United States (Rinaldi) Atrium Health Sanger Heart & Vascular Institute, Charlotte, NC, United States (Badr) Prairie Education and Research Cooperative, Springfield, IL, United States (Williams) New York University Langone Medical Center, United States (Russo) Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, United States (Guerrero) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (McCabe) Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, United States (Pibarot) Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Wang) Edwards Lifesciences, Irvine, CA, United States Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - The EARLY TAVR trial demonstrated that early transcatheter aortic valve replacement (TAVR) was superior to clinical surveillance (CS) in asymptomatic severe aortic stenosis. The relative impact of early TAVR versus a CS strategy by age is unknown. METHOD(S): - The study population of the EARLY TAVR trial was stratified into 4 age groups: 65 to 69 years (n=141), 70 to 74 years (n=263), 75 to 79 years (n=250), and >=80 years (n=247). Associations between age and the trial primary end point of death, stroke, or unplanned cardiovascular hospitalization; the composite end point of death, stroke, or heart failure hospitalization; and its individual components were examined. Interaction tests evaluated whether the treatment effect of early TAVR versus CS differed by age. RESULT(S): - No interaction was detected between age and the treatment effect of early TAVR versus CS for the composite or individual outcomes. We observed lower stroke rates with early TAVR compared with CS in the youngest (65-69 years, absolute risk reduction, 13%; P=0.008) and oldest (>=80 years; absolute risk reduction, 12.3%; P=0.029) age groups. The absolute difference in heart failure hospitalization rates between the early TAVR and CS arms at 2 years was greatest in the oldest patients (>=80 years, 9.1%; 75-79 years, 5.9%; 70-74 years, 5.1%; 65-69 years, 4.4%). In the CS group, time to conversion to AVR was similar across all age groups (median, 11 months; P=0.73). Approximately one-third of younger patients (65-69 years) in the CS arm presented with acute valve syndrome at the time of conversion, and the frequency tended to increase with age (P=0.06). CONCLUSION(S): - In the EARLY TAVR trial, the relative benefit of early TAVR over CS was consistent among all age groups. The greatest absolute reduction in stroke rate with early TAVR compared with CS appeared in the youngest and oldest groups, whereas reduction in heart failure hospitalization was most pronounced in the oldest patients. These data suggest that early TAVR should be considered in all age groups above 65 years. REGISTRATION: - URL: https://www.clinicaltrials.gov; Unique identifier: NCT03042104. Copyright © 2026 The Authors. <73> Accession Number 2042350581 Title Secondary pneumomediastinum: A comprehensive review of its etiology, diagnosis and management. Source Asian Journal of Surgery. 49(6) (pp 3238-3243), 2026. Date of Publication: 01 Jun 2026. Author Zhou Y.; Jin L.-L.; Min W.-W.; Shen Q.-B. Institution (Zhou) Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, Zhejiang Province, Huzhou, China (Jin) Department of Central Laboratory, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang Province, Huzhou, China (Min, Shen) Department of Cardiothoracic Surgery, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang Province, Huzhou, China Publisher Elsevier (Singapore) Pte Ltd Abstract Pneumomediastinum arises from a diverse range of etiological factors. Its clinical manifestations are often variable and nonspecific, which frequently leads to misdiagnosis or oversight in clinical practice. While the majority of patients achieve favorable outcomes with conservative management, delays in diagnosis or treatment can lead to severe complications, including mediastinitis, respiratory failure, airway obstruction, and potentially life-threatening conditions. This study systematically reviews the etiology, clinical characteristics, and diagnostic-therapeutic strategies associated with secondary pneumomediastinum through an extensive analysis of the literature, aiming to provide evidence-based insights for clinical decision-making. Copyright © 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <74> Accession Number 2039379151 Title Intercostal or Paravertebral Block vs Thoracic Epidural in Lung Surgery: A Randomized Noninferiority Trial. Source JAMA Surgery. 160(8) (pp 855-864), 2025. Date of Publication: 13 Aug 2025. Author Spaans L.N.; Dijkgraaf M.G.W.; Susa D.; De Loos E.R.; Mourisse J.M.J.; Bouwman R.A.; Verhagen A.F.T.M.; Van Den Broek F.J.C.; Meijer P.; Kuut M.; Hanneman N.; Bousema J.; Franssen A.; Brokx H.; Van Duyn E.; Potters J.-W.; Van Den Broek R.; Van Brakel T.; Rijna H.; Boom A.; Noyez V.; Hendriks J.M.H.; Yogeswaran S.K.; Dickhoff C.; Van Dorp M. Institution (Spaans, Van Den Broek) Department of Surgery, Maxima Medical Center, Veldhoven, Netherlands (Spaans, Dijkgraaf) Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands (Dijkgraaf) Amsterdam Public Health, Methodology, Amsterdam, Netherlands (Susa, Brokx) Department of Surgery, Bravis Hospital, Bergen op Zoom, Roosendaal, Netherlands (De Loos, Franssen) Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, Netherlands (Mourisse, Kuut) Department of Anesthesia, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands (Bouwman, Van Den Broek) Department of Anesthesiology and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands (Bouwman) Department of Electrical Engineering, Signal Processing Systems, Eindhoven Technical University, Eindhoven, Netherlands (Verhagen) Department of Cardio-thoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands (Meijer) Department of Anaesthesiology, Maxima Medical Center, Veldhoven, Netherlands (Hanneman, Bousema) Department of Surgery, Ikazia Hospital, Rotterdam, Netherlands (Van Duyn) Department of Surgery, Medisch Spectrum Twente, Enschede, Netherlands (Potters) Department of Anesthesiology, Medisch Spectrum Twente, Enschede, Netherlands (Van Brakel) Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands (Rijna) Department of Surgery, Spaarne Gasthuis, Hoofddorp, Netherlands (Boom) Department of Anesthesiology, Spaarne Gasthuis, Hoofddorp, Netherlands (Noyez) Department of Surgery, Algemeen Ziekenhuis Sint-Maarten, Mechelen, Belgium (Hendriks, Yogeswaran) Department of Vascular and Thoracic Surgery, Antwerp University Hospital, Antwerp, Belgium (Dickhoff, Van Dorp) Department of Cardiothoracic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands Publisher American Medical Association Abstract Importance: Effective pain control after thoracic surgery is crucial for enhanced recovery. While thoracic epidural analgesia (TEA) traditionally ensures optimal analgesia, its adverse effects conflict with the principles of enhanced recovery after thoracic surgery. High-quality randomized data regarding less invasive alternative locoregional techniques are lacking. Objective(s): To evaluate the efficacy of continuous paravertebral block (PVB) and a single-shot intercostal nerve block (ICNB) as alternatives to TEA. Design, Setting, and Participant(s): This randomized clinical trial compared PVB and ICNB vs TEA (1:1:1) in patients undergoing thoracoscopic anatomical lung resection at 11 hospitals in the Netherlands and Belgium, enrolled from March 5, 2021, to September 5, 2023. The study used a noninferiority design for pain and a superiority design for quality of recovery (QoR). Intervention(s): Continuous PVB and single-shot ICNB. Main Outcomes and Measures: Primary outcomes were pain, defined as mean proportion of pain scores 4 or greater during postoperative days (POD) 0 through 2 (noninferiority margin for the upper limit [UL] 1-sided 98.65% CI, 17.5%), and QoR, assessed with the QoR-15 questionnaire at POD 1 and 2. Secondary measures included opioid consumption, mobilization, complications, and hospitalization. Result(s): A total of 450 patients were randomized, with 389 included in the intention-to-treat (ITT) analysis (mean [SD] age, 66 [9] years; 208 female patients [54%] and 181 male [46%]). Of these 389 patients, 131 received TEA, 134 received PVB, and 124 received ICNB. The mean proportions of pain scores 4 or greater were 20.7% (95% CI, 16.5%-24.9%) for TEA, 35.5% (95% CI, 30.1%-40.8%) for PVB, and 29.5% (95% CI, 24.6%-34.4%) for ICNB. While PVB was inferior to TEA regarding pain (ITT: UL, 22.4%; analysis per-protocol [PP]: UL, 23.1%), ICNB was noninferior to TEA (ITT: UL, 16.1%; PP: UL, 17.0%). The mean (SD) QoR-15 scores were similar across groups: 104.96 (20.47) for TEA, 106.06 (17.94; P =.641) for PVB (P =.64 for that comparison), and 106.85 (21.11) for ICNB (P =.47 for that comparison). Both ICNB and PVB significantly reduced opioid consumption and enhanced mobility compared with TEA, with no significant differences in complications. Hospitalization was shorter in the ICNB group. Conclusions and Relevance: After thoracoscopic anatomical lung resection, only ICNB provides noninferior pain relief compared with TEA. ICNB emerges as an alternative to TEA, although risks and benefits should be weighed for optimal personalized pain control. Copyright © 2025 American Medical Association. All rights reserved. <75> Accession Number 2045916671 Title Hypnosis on Perioperative Outcomes Among Patients Undergoing Non-Cardiovascular Surgeries: A Systematic Review of Randomized Trials. Source International Journal of Clinical and Experimental Hypnosis. 74(2) (pp 226-244), 2026. Date of Publication: 2026. Author El-Allam Y.; Hafiani Y.; Khalyfa M.; Bouzid J.; Mouhajir M.; Himmouche N. Institution (El-Allam, Khalyfa, Bouzid, Himmouche) Hassan First University, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco (Hafiani) Pedagogic Unit of Research in Anesthesia and Intensive Care, Faculty of Medicine and Pharmacy, Mohamed V University, Rabat, Morocco (Mouhajir) Higher Institute of Nursing Professions and Health Techniques of Rabat, Ministry of Health and Social Protection, Rabat, Morocco Publisher Routledge Abstract Surgery is a disturbing factor of perioperative outcomes in surgical patients. This study aims to explore the effects of clinical hypnosis in diverse perioperative disturbances among non-cardiovascular surgical patients. This is a systematic review according to PRISMA guidelines, using following databases: Cochrane trials, Scopus, Web of Science, Medline and Google Scholar with various keywords in English and French. Studies quality was assessed using Cochrane Rob 2 tool. Thirty randomized controlled trials published between 2012 and January 2025 were included in this review. Results showed that clinical hypnosis revealed a significant effect on decreasing pre and intraoperative anxiety, medication consumption especially opioids and hypnotics intra and postoperatively, risk of postoperative nausea and vomiting was also decreased in hypnosis group. A higher level of prolactin was also observed in women on post-cesarean section. Hypnosis is an interesting perioperative strategy, particularly in decreasing preoperative anxiety and medication consumption. Its impact on pain is uncertain and it can be related to techniques, patient hypnotic profile or type of surgery. Copyright © 2026 International Journal of Clinical and Experimental Hypnosis. <76> Accession Number 2045473165 Title Change in Frailty After Transcatheter and Surgical Aortic Valve Replacement for Aortic Stenosis-A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. 35(6) (pp 754-762), 2026. Date of Publication: 01 Jun 2026. Author Mohiaddin H.; Hayes J.; Chotalia R.; Sze S.; Squire I.B. Institution (Mohiaddin, Sze, Squire) NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom (Mohiaddin, Hayes, Chotalia, Sze) University Hospitals of Leicester NHS Trust, Leicester, United Kingdom Publisher Elsevier Ltd Abstract Background: Frailty is common among patients awaiting intervention for aortic stenosis (AS) by transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). Although the association between pre-procedure frailty and poor outcomes is well-established, it remains unclear whether aortic valve interventions can lead to changes in frailty. Method(s): Ovid MEDLINE, SCOPUS, CINAHL and Cochrane databases were searched for studies that reported frailty assessments before and after TAVI and/or SAVR. Data from these studies were used to calculate a standardised score for change in frailty following either TAVI or SAVR, as part of a pooled random effects meta-analysis, with Hedges' adjusted g value. Result(s): Of 4,093 records screened, nine relevant studies were identified. Among 1,598 TAVI and 200 SAVR patients, no overall changes to frailty were observed, although there was considerable heterogeneity among studies. Improvements to frailty were observed in a sensitivity analysis of lower-risk TAVI cohorts (Society of Thoracic Surgeons predicted risk of mortality [STS-PROM] <=5%). Higher-risk TAVI and SAVR cohorts (STS-PROM >5%) did not show improvements in frailty post-aortic valve intervention. Conclusion(s): Overall, neither TAVI nor SAVR leads to significant changes in frailty measurements, although data are highly heterogeneous. Further research into the possible role of additional frailty interventions, particularly in higher-risk patients with AS undergoing TAVI or SAVR, should be considered. Copyright © 2026 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) <77> Accession Number 2045298475 Title Automated Alerts to Improve Timely Evaluation and Treatment of Valvular Heart Disease. Source Journal of the American College of Cardiology. 87(23) (pp 3335-3346), 2026. Date of Publication: 16 Jun 2026. Author Batchelor W.B.; Lindman B.R.; Coylewright M.; Keller A.; Wehman B.; Chhatriwalla A.; Patel S.M.; Stiver K.; Zahr F.; Sotelo M.; Shin D.; Rogers C.; Hickey G.L.; Williams J.; Fan M.; Vemulapalli S. Institution (Batchelor) Inova Medicine Service Line and Schar Heart and Vascular, Inova Health System, Fairfax, VA, United States (Lindman) Cardiovascular Disease, Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN, United States (Coylewright) Heart and Vascular Center, Essentia Health, Duluth, MN, United States (Keller) Oschner Lafayette General, Lafayette, LA, United States (Wehman) Heart and Vascular Institute, Bon Secours Mercy Health, Richmond, VA, United States (Chhatriwalla) Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO, United States (Patel) Department of Interventional Cardiology, Division of Cardiology, Bon Secours Mercy Health, Lima, OH, United States (Stiver) Department of Cardiology, OhioHealth, Columbus, OH, United States (Zahr) Interventional Cardiology, Oregon Health and Science University, Portland, OR, United States (Sotelo) Data Science, Tempus AI, Inc. Chicago, IL, United States (Shin) Biostats, Tempus AI, Inc, Chicago, IL, United States (Rogers) Cardiovascular, Tempus AI, Inc, Chicago, IL, United States (Hickey, Williams, Fan) Structural Heart and Aortic, Medtronic, Minneapolis, MN, United States (Vemulapalli) Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States Publisher Elsevier Inc. Abstract Background: Severe aortic stenosis (AS) and mitral regurgitation (MR) are frequently undertreated and characterized by persistent sex, racial and ethnic, socioeconomic, and geographic disparities despite effective valve therapies. Whether automated electronic clinician notification (ECN) alerts improve the evaluation and treatment of AS and MR across health systems is unknown. Objective(s): The purpose of this study was to evaluate whether ECN alerts improve guideline-directed evaluation and treatment of significant AS and MR across multiple health systems. Method(s): ALERT is a multisystem, cluster-randomized clinical trial including clinicians ordering echocardiograms across 5 U.S. health systems encompassing 35 hospitals between August 2024 and September 2025. Clinicians were randomized 1:1 to receive an ECN alert identifying significant AS or MR with accompanying care recommendations or to no alert with usual care. The primary endpoint was a hierarchical composite of time to surgical or transcatheter valve intervention, followed by time to multidisciplinary heart team clinic evaluation within 90 days, analyzed using the stratified win-ratio method. Secondary outcomes included individual components of the composite. Result(s): A total of 765 clinicians ordering 2,016 echocardiograms were included. In the win-ratio analysis of the primary endpoint, ECN alert was superior to usual care (win ratio: 1.27; 95% CI: 1.05-1.54; P = 0.007), including higher rates of valve intervention (13.4% vs 9.6%; P = 0.005) and multidisciplinary heart team evaluation (22.7% vs 17.9%; P = 0.005) and shorter times to both endpoint components. Effect sizes were similar in AS (win ratio: 1.29) and MR patients (win ratio: 1.23). No evidence of heterogeneity was noted by valve pathology (P<inf>int</inf> = 0.821) or across prespecified subgroups (age, sex, race, social deprivation index, inpatient vs outpatient setting, provider specialty, and rurality; P<inf>int</inf> > 0.100 for all) and sensitivity analyses yielded consistent results across modified intention-to-treat, intention-to-treat, and per-protocol populations. Conclusion(s): In this multisystem cluster randomized trial, automated ECN alerts improved timely guideline-directed evaluation and valve intervention for clinically significant AS and MR. These findings suggest that electronic health record-integrated clinical decision support may represent a scalable strategy to reduce undertreatment and improve access to specialized valve care. (Addressing Under-treatment and Health Equity in AS and MR Using an Integrated EHR Platform; NCT06099665). Copyright © 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <78> Accession Number 2045868908 Title Surgical left atrial appendage occlusion in valvular heart disease without atrial fibrillation: the OPINION trial. Source European Heart Journal. 47(20) (pp 2440-2448), 2026. Date of Publication: 21 May 2026. Author Yuan X.; Ju F.; Wu H.; Zhao Y.; Liu S.; Wang X.; Zhu J.; Su P.; Xu F.; Feng W.; Yang Y.; Wang Y.; Sun H. Institution (Yuan) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Ju) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Wu) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Zhao) Medical Research and Biometrics Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Wang) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Liu) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Wang) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Zhu) Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, China (Su) Department of Cardiac Surgery, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Road, Chaoyang District, Beijing, China (Xu) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Feng) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Yang) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Wang) Medical Research and Biometrics Centre, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China (Sun) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Centre for Cardiovascular Diseases, No. 167 North Lishi Road, Xicheng District, Beijing, China Publisher Oxford University Press Abstract Background and Aims: While surgical left atrial appendage occlusion (SLAAO) reduces stroke in atrial fibrillation (AF) patients, its efficacy in patients without pre-operative AF but with CHADS-VASc >=2 remains uncertain despite their high post-operative AF risk (15-54%). The aim of this study was to evaluate whether prophylactic SLAAO reduces post-operative thrombo-embolic events in valvular surgery patients. Method(s): The OPINION was a multicentre, open-label, randomized, superiority trial conducted at three cardiac surgery centres in China. Eligible non-AF patients with CHADS-VASc >=2 and an indication for valve repair or replacement due to mitral or aortic valve lesions were randomly assigned (1:1) to undergo SLAAO (intervention arm) or not undergo SLAAO (control arm) during surgery. The primary outcome was a composite of ischaemic stroke, transient ischaemic attack (TIA), or cardiovascular mortality assessed at 1 year. The primary analysis was done in the intention-to-treat population. Result(s): Between April 2021 and June 2024, a total of 2157 patients were enrolled and randomized. After exclusion of 39 patients who withdrew informed consent, 2118 participants were included in the intention-to-treat population (1062 in the SLAAO group and 1056 in the control group). Baseline characteristics were well-balanced between the SLAAO group and control group (mean age 55.5 [11.4] vs 55.6 [11.5] years, P = .65; female 32.9% vs 32.3%, P = .78; CHA<inf>2</inf>DS<inf>2</inf>-VASc score 2.88 [0.98] vs 2.87 [0.96], P = .83; median EuroSCORE II 1.58% [1.42%] vs 1.56% [1.28%], P = .74). The 1-year primary endpoint occurred in 73 (6.9%) patients in the SLAAO group and in 87 (8.2%) patients in the control group (hazard ratio 0.83; 95% confidence interval 0.61-1.14; P = .25). Conclusion(s): For valvular surgery patients with CHADS-VASc scores >=2 but no pre-operative AF, routine prophylactic left atrial appendage closure did not significantly reduce the incidence of the primary composite endpoint (ischaemic stroke, TIA, and cardiovascular mortality) at 1-year follow-up. Trial Registration: ChiCTR.org registry ChiCTR2100042238. Copyright © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <79> Accession Number 2045968017 Title The delirium dichotomy of remimazolam: a differential risk profile for emergence delirium versus postoperative delirium in surgical patients: a systematic review and meta-analysis. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1841225. Date of Publication: 11 May 2026. Author Zhu Z.; Wang S.; Gu X.; Kong J.; Zhang Y.; Yang L.; Ding X.; Yu W. Institution (Zhu, Yang, Ding) Department of Anaesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (Wang, Gu, Yu) Xuzhou Medical University, Jiangsu, Xuzhou, China (Kong, Zhang) Department of Anaesthesiology, Dayao People's Hospital, Yunnan, Chuxiong, China Publisher Frontiers Media SA Abstract Background - The association between remimazolam, a novel ultra-short-acting benzodiazepine, and the risk of postoperative delirium (POD) and emergence delirium (ED) remains controversial, particularly following prolonged infusion. Methods - PUBMED, EMBASE, WEB OF SCIENCE and the Cochrane Library electronic databases were searched up to December 10, 2025. The primary outcome was the incidence of delirium. Secondary outcomes included postoperative nausea and vomiting (PONV), respiratory depression after extubation, extubation time and length of hospital stay. Subgroup and meta-regression analyses were conducted to assess clinical and methodological sources of heterogeneity in intervention effect, including age, type of surgery, assessment methods of delirium, depth of anesthesia monitoring, the use of flumazenil as an antagonist for remimazolam. Results - A total of 30 trials were included, consisting of 25 RCTs, 4 retrospective studies and a prospective cohort study. The incidence of delirium was 11.4% (312/2734) in the remimazolam group and 15.2% (429/2827) in the non-remimazolam group, showing no significant difference (RR=0.81; 95% confidence interval (CI), 0.63-1.05, p=0.11) between groups. Subgroup analysis by anesthesia type, however, revealed a significant effect modification. In patients undergoing general anesthesia, remimazolam was associated with a 23% reduction in the risk of delirium (RR=0.77, 95% CI: 0.60-1.00, p=0.05). When viewed in terms of this dichotomy, no significant difference was observed in 22 studies evaluating the incidence of POD between remimazolam group (13.1%, 295/2260) and non-remimazolam group (16%, 390/2431) (RR=0.93; 95% CI, 0.76-1.15, p=0.52), either in 8 studies on incidence of emergence delirium (RR=0.43; 95% CI, 0.13-1.37, p=0.15). The pooled analysis using a fixed-effect model showed that remimazolam was associated with a statistically significant increase in the risk of PONV compared to non-Remimazolam groups (RR=1.20, 95% CI: 1.02-1.42; p=0.03). Other secondary outcomes, respiratory depression after extubation (RR=0.96; 95% CI, 0.63-1.44, p=0.84), extubation time (MD=-1.30, 95% CI: -3.46-0.85, p=0.24) and length of hospital stay (MD=0.08, 95% CI: -0.28-0.44, p=0.65) showed no significant difference between remimazolam group and non-remimazolam group. Conclusion - In this systematic review and meta-analysis, prolonged continuous intravenous administration of remimazolam throughout the surgical procedure does not increase the risk of delirium compared to other anesthetic regimens. In addition, remimazolam has potential benefits in the pediatric population as it reduces the risk of ED. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420251138775, Identifier: CRD420251138775. Copyright © 2026 Zhu, Wang, Gu, Kong, Zhang, Yang, Ding and Yu. <80> Accession Number 2044528346 Title Effect of Subcutaneous Versus Topical Nitroglycerin on the Radial Artery Dimensions in Pediatric Patients Undergoing Surgery: A Randomized Non-inferiority Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(7) (pp 2053-2060), 2026. Date of Publication: 01 Jul 2026. Author Verma C.; Mahajan V.; Ganesan R.; Biswas I.; Mathew P.J.; Mandal B. Institution (Verma, Mahajan, Ganesan, Biswas, Mathew, Mandal) Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India Publisher W.B. Saunders Abstract Objectives: To compare the changes in radial artery dimensions produced by subcutaneous nitroglycerin (NTG) versus a topical NTG patch in pediatric patients. Design(s): Randomized controlled non-inferiority trial. Setting(s): Pediatric and cardiac operating rooms at a tertiary care hospital. Participant(s): Forty-five children aged 2 to 8 years undergoing surgery requiring radial arterial catheterization for hemodynamic monitoring or blood gas sampling. Intervention(s): Patients were randomized to receive either subcutaneous NTG (5 microg/kg diluted in 0.5 mL of saline solution, administered under ultrasound guidance) or a topical NTG patch (Releasing approximately 200 microg/h) applied over the radial artery 30 minutes before induction. Radial artery dimensions were measured ultrasonographically at baseline and after NTG administration. Measurements and Main Results: The increase in post-intervention vertical diameter in the topical NTG group met the predefined criterion for non-inferiority when compared with the subcutaneous NTG group (non-inferiority margin, -0.3 mm). Compared with subcutaneous NTG, topical NTG produced a significantly greater percentage increase in vertical diameter (0.45% +/- 11.76% v 15.6% +/- 16.18%, p = 0.002), horizontal diameter (3.53% +/- 16.01% v 19.72% +/- 16.42%, p = 0.001), and cross-sectional area (3.6% +/- 18.02% v 38.29% +/- 26.65%, p < 0.001). Subcutaneous NTG resulted in a markedly greater increase in radial artery depth when compared with topical NTG (84.35% +/- 47.09% v -0.37% +/- 15.8%, p < 0.001). The first-attempt cannulation success rate was lower in the subcutaneous NTG group (81.8% v 100%, p = 0.049). No NTG-related adverse events or significant hemodynamic changes were observed in either group. Conclusion(s): Topical NTG was statistically non-inferior to subcutaneous NTG in increasing the radial artery vertical diameter. Although the absolute post-intervention dimensions were similar between groups-likely influenced by the slightly smaller baseline arterial dimensions in the topical NTG group-the topical application produced larger percentage increases from baseline and did not cause the depth increase observed with subcutaneous NTG. Copyright © 2026 Elsevier Inc. <81> Accession Number 2045138279 Title Anticoagulation Monitoring Strategies During Cardiopulmonary Bypass in Patients With Antiphospholipid Syndrome: A Systematic Review. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(7) (pp 2004-2014), 2026. Date of Publication: 01 Jul 2026. Author Yoshida S.; Ishida O.; Tsutsumi K. Institution (Yoshida, Ishida, Tsutsumi) Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan Publisher W.B. Saunders Abstract Objectives: Antiphospholipid syndrome (APS) is an autoimmune prothrombotic disorder that complicates anticoagulation during cardiovascular surgery requiring cardiopulmonary bypass (CPB). This systematic review aimed to characterize the anticoagulation monitoring strategies reported during CPB in patients with APS and to identify recurring limitations and clinical patterns rather than to assess comparative efficacy between management approaches. Design(s): Systematic review of published clinical studies. Setting(s): Hospital-based cardiovascular surgery and perioperative care settings, including single- and multi-institutional reports. Participant(s): Patients with a confirmed diagnosis of APS who underwent cardiac or cardiovascular surgery using CPB with heparin anticoagulation. Intervention(s): Intraoperative anticoagulation strategies during CPB, including activated clotting time (ACT)-based monitoring and adjunctive strategies such as heparin concentration monitoring (Hepcon), anti-factor Xa assays, and viscoelastic testing. Measurements and Main Results: A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020-compliant search of PubMed, Scopus, and the Cochrane Library identified 66 studies, of which 17 met the inclusion criteria. ACT monitoring was reported in 25 patients, Hepcon-guided heparin concentration monitoring in 25, and heparin-ACT titration in 1; most studies used multimodal monitoring approaches. Among 62 patients, 15 perioperative complications were reported, predominantly from a single cohort study that contributed the majority of quantitative outcome data. The aggregated data illustrated the heterogeneous use of monitoring strategies and recurrent concerns regarding the reliability of ACT alone. Conclusion(s): Anticoagulation monitoring during CPB in patients with APS remains heterogeneous and insufficiently standardized. The available evidence does not permit conclusions regarding comparative efficacy among monitoring strategies. Instead, this review highlights recurrent limitations of ACT-based monitoring and the heterogeneous use of adjunctive modalities in reported cases, providing a conceptual framework to inform future prospective investigations. Copyright © 2026 The Author(s) <82> Accession Number 2041375770 Title Transcatheter procedures for tricuspid regurgitation in advanced heart failure: A systematic review. Source Trends in Cardiovascular Medicine. 36(4) (pp 204-215), 2026. Date of Publication: 01 May 2026. Author Kourek C.; Sicouri S.; Magouliotis D.E.; Xanthopoulos A.; Ramlawi B. Institution (Kourek) Department of Cardiology, 417 Army Share Fund Hospital of Athens (NIMTS), Athens, Greece (Sicouri, Magouliotis, Ramlawi) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States (Xanthopoulos) Department of Cardiology, University Hospital of Larissa, Larissa, Greece (Ramlawi) Department of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, United States Publisher Elsevier Inc. Abstract Tricuspid regurgitation (TR) in advanced heart failure (HF) is associated with poor prognosis, functional decline, and increased morbidity. This systematic review synthesizes current evidence of transcatheter device tricuspid transcatheter approaches in advanced HF patients. A comprehensive search of PubMed, Embase, Scopus, CINAHL, and the Cochrane Library identified studies evaluating transcatheter procedures for moderate-to-severe TR in advanced HF, and reporting procedural outcomes, survival, and functional measures. A total of 37 studies encompassing approximately 2,372 patients were included, spanning edge-to-edge repair systems (TriClip, PASCAL), annuloplasty devices (Cardioband, Trialign, TriCinch), transcatheter valve replacement (Evoque, LuX-Valve, NaviGate, Intrepid), heterotopic caval valve implantation (TricValve, Tricento), and leaflet spacers (FORMA). Most patients were in NYHA class III-IV with high surgical risk scores. Across techniques, procedural success rates were high, with consistent reductions in TR severity and improvements in NYHA class, 6-minute walk distance, and quality-of-life scores. Edge-to-edge repair was the most frequently studied, showing favorable safety and symptom improvement. Mortality rates varied, with limited long-term follow-up data. Transcatheter interventions for TR in advanced HF offer promising improvements in symptoms, functional status, and quality of life. Given patient and anatomical heterogeneity, an individualized approach is essential. Copyright © 2025 Elsevier Inc. <83> Accession Number 2039794249 Title Tracheobronchial Replacement: A Systematic Review. Source JAMA Surgery. 160(8) (pp 912-919), 2025. Date of Publication: 13 Aug 2025. Author Martinod E.; Radu D.M.; Onorati I.; Chapalain X.; Santos Portela A.M.; Peretti M.; Freynet O.; Uzunhan Y.; Chouahnia K.; Duchemann B.; Juvin C.; Lebreton G.; Rouard H.; Van Der Meersch G.; Galvaing G.; Chadeyras J.-B.; Tronc F.; Kuczma P.; Tresallet C.; Venissac N.; Beloucif S.; Huet O.; Vicaut E. Institution (Martinod, Radu, Onorati, Santos Portela, Peretti) Chirurgie Thoracique et Vasculaire, Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, Assistance Publique-Hopitaux de Paris (AP-HP), Bobigny, France (Martinod, Radu, Onorati) Hypoxie et Poumon, Faculte de Medecine SMBH, Inserm UMR1272, Universite Sorbonne Paris Nord, Bobigny, France (Martinod, Radu, Onorati) Laboratoire de Recherche Bio-chirurgicale, Fondation Alain Carpentier, Hopital Europeen Georges Pompidou, AP-HP, Universite Paris Cite, Paris, France (Onorati, Rouard) Banque des Tissus, AP-HP, EFS Ile de France, Ivry-sur-Seine, France (Chapalain) Anesthesie-Reanimation, UFR de medecine, Centre Hospitalier Universitaire de Brest, Universite de Bretagne occidentale, Brest, France (Freynet, Uzunhan) Pneumologie, Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France (Chouahnia, Duchemann) Oncologie, Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France (Juvin, Lebreton) Chirurgie Cardiaque, Hopital La Pitie-Salpetriere, AP-HP, Sorbonne Universite, Paris, France (Van Der Meersch) Medecine Intensive Reanimation, Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France (Galvaing, Chadeyras) Service de Chirurgie Thoracique et Endocrinienne, Centre Jean Perrin, Clermont-Ferrand, France (Tronc) Chirurgie Thoracique, Hopitaux Universitaires de Lyon, Lyon, France (Kuczma, Tresallet) Chirurgie Digestive et Endocrinienne, Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France (Venissac) Chirurgie Thoracique, Hopitaux Universitaires de Lille, Lille, France (Beloucif) Anesthesie-Reanimation, Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bobigny, France (Huet) Hopital Avicenne, Hopitaux Universitaires Paris Seine-Saint-Denis, AP-HP, UFR de medecine, Universite de Bretagne occidentale, Brest, Bobigny, France (Vicaut) Unite de Recherche Clinique, Hopitaux Saint Louis-Lariboisiere-Fernand Widal, AP-HP, Universite Paris Cite, Paris, France Publisher American Medical Association Abstract Importance: Tracheobronchial replacement remains a surgical and biological challenge despite several decades of experimental and clinical research. Objective(s): To compile a comprehensive state-of-the-science review examining the current indications, techniques, and outcomes of tracheobronchial replacement in human patients. Evidence Review: A systematic review of the literature was conducted on July 1, 2024, to identify studies examining tracheobronchial replacement. This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines and the PRISMA 2020 statement. We selected the following 3 databases: (1) PubMed via the US National Library of Medicine's PubMed.gov; (2) Embase via Elsevier's Embase.com; and (3) the Cochrane Central Register of Controlled Trials (CENTER) via Wiley's Cochrane Library. An additional search was performed using the following clinical trials registers: the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov, provided by the US National Library of Medicine. Finding(s): The initial search produced 6043 results, with a total of 126 publications included in the final review. Only 1 prospective cohort study and 1 registry, both concerning the use of cryopreserved aortic allografts, were identified. Most publications were case reports and series. From July 1, 2002, to July 1, 2024, a total of 137 cases of tracheobronchial replacement were published. Tracheobronchial replacement was indicated for extensive neoplastic tumors (108 cases [78.8%]) or benign stenoses (29 cases [21.2%]). The most common malignancies were thyroid cancers and adenoid cystic carcinomas. The most frequent resections involved the upper half of the trachea, with reconstructions using muscle flaps, or, most notably, cryopreserved aortic allografts, which have shown promising outcomes and have become the most widely used method since 2022. In the only available registry, the 30-day postoperative mortality and morbidity rates were 2.9% and 22.9%, respectively. Long-term follow-up showed that mortality was related to local recurrences and metastases in patients with cancer. Conclusions and Relevance: This systematic review indicates that extensive malignant lesions are the primary indication for tracheobronchial replacement, with cryopreserved aortic allografts being the only scientifically evaluated surgical technique. Postoperative outcomes were comparable to other major thoracic surgical procedures, while long-term results depended on the underlying disease, especially in cancer cases. Copyright © 2025 American Medical Association. All rights reserved. <84> Accession Number 2045748442 Title Frailty Response in Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Implantation (FRAIL-AS Response Trial): Study Protocol for a Cluster Randomised Controlled Trial. Source Heart Lung and Circulation. 35(6) (pp 787-794), 2026. Date of Publication: 01 Jun 2026. Author Straiton N.; Muller D.W.M.; Macdonald P.; Wilson K.; Arriagada A.; Roy D.; Mills N.; Frost S.A.; McInnes E.; Inglis S.C.; Lauck S.; Herrero M.; Dolja-Gore X.; McCreanor V.; Harrison S.; Holman T.; Ferguson C.; McDonagh J.; Wan C.S.; Dale S.; Fasugba O.; Middleton S. Institution (Straiton, McInnes, Holman, Dale, Fasugba, Middleton) Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, Sydney, NSW, Australia (Straiton, McInnes, Holman, Dale, Fasugba, Middleton) School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia (Straiton, Muller, Macdonald, Roy, Mills, McInnes, Holman, Dale, Middleton) St Vincent's Hospital, Sydney, NSW, Australia (Muller, Macdonald, Arriagada, Roy, Mills) St Vincent's Private Hospital, Sydney, NSW, Australia (Muller, Macdonald, Mills) School of Medicine, University of New South Wales, Sydney, NSW, Australia (Macdonald) Victor Chang Cardiac Research Institute, Sydney, NSW, Australia (Wilson) St Thomas' Hospital London, London, United Kingdom (Roy) University of Notre Dame, Sydney, NSW, Australia (Frost, Ferguson, McDonagh) Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia (Inglis, Herrero) Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia (Lauck) School of Nursing, University of British Columbia, BC, Canada (Herrero) John Hunter Hospital, Newcastle, NSW, Australia (Dolja-Gore, McCreanor) Hunter Medical Research Institute, Newcastle, NSW, Australia (Dolja-Gore, McCreanor) School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia (Harrison) The George Institute for Global Health, Sydney, NSW, Australia (Ferguson, McDonagh) Centre for Chronic and Complex Care Research, Blacktown Hospital, Sydney, NSW, Australia (Wan) School of Translational Medicine, Monash University, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Background & Aim: Aortic stenosis (AS) is a common valvular heart disease in older adults, affecting up to one in eight people over 65 years. Transcatheter aortic valve implantation (TAVI) offers a less invasive alternative surgical aortic valve replacement. However, approximately 30% of TAVI patients are frail, placing them at greater risk of complications and poorer outcomes post procedure. Despite this, evidence-based strategies to manage frailty in TAVI care remain limited. The FRAIL-AS Response Trial aims to implement and evaluate an evidence-based Frailty Response Program to improve care and outcomes for adults with AS and frailty undergoing TAVI. Method(s): We plan a multicentre, cluster-randomised controlled trial with embedded process evaluation being conducted in hospitals and their respective TAVI programs across Australia. Hospitals will be randomised 1:1 to the Frailty Response Program (intervention) or standard care (control). The intervention comprises: (1) a Frailty Response Clinical Protocol focusing on nutritional screening, patient frailty education, General Practitioner (GP) notification of patient's frailty classification, referrals for cardiac rehabilitation and geriatrician review; and (2) an Implementation Strategy informed by the Theoretical Domains Framework, incorporating meetings to determine local barriers and solutions, clinician education, local clinical champions, audit and feedback, action plans and remote facilitation. The primary outcome is the proportion of frail AS patients scheduled for TAVI receiving nutritional screening after frailty identification. Secondary outcomes are patient outcomes (as per the Valve Academic Research Consortium 3 endpoints), processes of care (frailty information provision, GP notifications, referrals for cardiac rehabilitation and geriatrician review) and implementation outcomes (intervention acceptability, feasibility and fidelity). Conclusion(s): The FRAIL-AS Response Trial will determine whether addressing frailty in older adults with AS undergoing TAVI enhances evidence-based care, reduces complications, and improves patient outcomes. If effective, the FRAIL-AS Response Program may provide a scalable, evidence-based model for managing patients with heart valve disease and frailty undergoing transcatheter procedures. Copyright © 2026 The Author(s) <85> Accession Number 609951326 Title A comparative study between propofol and dexmedetomidine as sedative agents during performing transcatheter aortic valve implantation. Source Journal of Clinical Anesthesia. 32 (pp 242-247), 2016. Date of Publication: 01 Aug 2016. Author Khalil M.; Al-Agaty A.; Asaad O.; Mahmoud M.; Omar A.S.; Abdelrazik A.; Mostafa M. Institution (Khalil, Al-Agaty, Asaad) Anesthesia Department, Cairo University, Giza, Egypt (Mahmoud, Abdelrazik) Critical Care Department, Cairo University, Giza, Egypt (Omar) Critical Care Department, Cairo University, Beni-Suef Division, Giza, Egypt (Mostafa) Cardiology Department, Ain-Shams University, Giza, Egypt Publisher Elsevier Inc. Abstract Objective The type of sedative drugs could play a major role in providing hemodynamic stability which is crucial during transcatheter aortic valve implantation (TAVI) procedure. The aim of this study is to compare propofol with dexmedetomidine for conscious sedation during TAVI. Design A prospective randomized pilot study. Patients Fifty patients with a mean age of 74 years, American Society of Anesthesiologists 3-4, complaining from severe aortic stenosis were enrolled in this study to undergo TAVI. Interventions The propofol group (group P; n = 25) received a bolus dose of 0.5 mg/kg propofol followed by a continuous intravenous infusion of propofol at a rate of 30 to 50 mug kg-1 min-1, and the dexmedetomidine group (group D; n = 25) received dexmedetomidine at a loading dose of 1 mug/kg and then a continuous intravenous infusion of dexmedetomidine at a rate of 0.5 mug kg-1 h-1. Measurements Heart rate, mean arterial blood pressure, number of phenylephrine boluses, oxygen saturation, sedation, and satisfaction scores were measured just after the start of infusion of the sedation drugs and at the end of the procedure. Postoperative complications were also recorded. Results There was a statistically significant reduction in the heart rate in group D in comparison to group P where it was 67.28 +/- 6.9 beats/min in the first group in comparison to 78 +/- 6.9 beats/min in the last one (P <.001). The mean arterial blood pressure was statistically significant lower in group D in comparison to group P (58.12 +/- 5.4 mm Hg in group D vs 68.24 +/- 11.4 mm Hg in group P; P <.001). Also, the number of phenylephrine boluses was higher in group D than in group P (36.5 +/- 7.17 in group D vs 20.6 +/- 2.07 in group p; P <.001). No difference between the 2 groups regarding oxygen saturation, sedation, pain, satisfaction scores, and postoperative complications. Conclusion During TAVI, dexmedetomidine may be associated with significant hypotension and bradycardia rather than propofol. Copyright © 2016 Elsevier Inc. All rights reserved. <86> Accession Number 2044526271 Title The Efficacy of Gabapentin in Reducing Perioperative Opioid Requirements in Pediatric Cardiac Surgery: A Randomized, Double-Blinded Controlled Study. Source Journal of Cardiothoracic and Vascular Anesthesia. 40(7) (pp 2061-2068), 2026. Date of Publication: 01 Jul 2026. Author Sayedalahl M.A.; Hassan A.A.; Elmaddawy A.E.A.; Abdelbaser I.; Abdelfattah M.; Badr-Eldin M.N.; Elmorsi Hewidi G.Z.; Gabr M.A.; Elemam E.M.; Eltanany E.; Eissa A.A.; Hassanin Taraby A.I.; Bakrey S.; El Morsy M.M. Institution (Sayedalahl, Elmaddawy, Abdelbaser, Abdelfattah, Badr-Eldin, Elmorsi Hewidi, Elemam, Eltanany, Eissa, Hassanin Taraby, Bakrey) Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt (Hassan) Department of Anesthesiology and Intensive Care, Faculty of Medicine, Port Said University, Port Said, Egypt (Gabr) Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt (El Morsy) Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Damietta University, New Damietta, Egypt Publisher W.B. Saunders Abstract Objectives: To assess the efficacy of gabapentin administration in reducing perioperative opioid consumption among pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Design(s): A prospective, randomized, double-blinded, placebo-controlled trial. Setting(s): University children's hospital. Participant(s): Eighty patients aged 3 to 12 years undergoing elective corrective cardiac surgery. Intervention(s): Participants were randomly allocated to receive either gabapentin (10 mg/kg/d in 3 divided doses) (group G) or placebo (group P), starting preoperatively and continuing for 48 hours postoperatively. Measurements and Main Results: The primary outcome measured was the total rescue fentanyl consumption (in micrograms per kilogram) during the first 48 postoperative hours. Secondary outcomes included intraoperative fentanyl consumption, Modified Objective Pain Score (MOPS), time to extubation, duration of intensive care unit (ICU) stay, and adverse effects. Group G demonstrated a significantly lower requirement for fentanyl (4.04 +/- 1.59 microg/kg) compared with group P (7.01 +/- 1.53 microg/kg, p < 0.001). Gabapentin also resulted in reduced intraoperative opioid use, lower postoperative pain score, shorter time to extubation, and decreased ICU length of stay, without an increase in adverse events. Conclusion(s): Perioperative gabapentin administration effectively reduces opioid requirements, provides effective postoperative analgesia as assessed by the MOPS, and accelerates recovery in pediatric cardiac surgery. Copyright © 2026 Elsevier Inc. <87> Accession Number 2046259648 Title Systematic Review of Coronary Computed Tomography Angiography Guidance for Chronic Total Occlusion Percutaneous Coronary Intervention. Source American Journal of Cardiology. 271 (pp 164-175), 2026. Date of Publication: 15 Jul 2026. Author Kumar S.; Carvalho P.E.P.; Strepkos D.; Alexandrou M.; Opolski M.P.; Azzalini L.; Alaswad K.; Basir M.B.; Jaffer F.; Collet C.; Leipsic J.; Cavalcante J.; Rangan B.V.; Sandoval Y.; Brilakis E.S. Institution (Kumar) Creighton University School of Medicine, Phoenix, AZ, United States (Carvalho, Strepkos, Alexandrou, Cavalcante, Rangan, Sandoval, Brilakis) Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, United States (Opolski) Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland (Azzalini) Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, United States (Alaswad, Basir) Henry Ford Cardiovascular Division, Detroit, MI, United States (Jaffer) Massachusetts General Hospital, Boston, MA, United States (Collet) Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium (Leipsic) Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada Publisher Elsevier Inc. Abstract Coronary computed tomography angiography (CCTA) is emerging as a valuable adjunct for chronic total occlusion (CTO) percutaneous coronary intervention (PCI), particularly for lesions in which angiography incompletely defines procedural anatomy. In this systematic review, the authors evaluated the role of CCTA in CTO diagnosis, lesion characterization, prediction of guidewire crossing and procedural success, and procedural guidance. CCTA provides a detailed assessment of key features that directly influence CTO PCI strategy and outcomes. Randomized and observational data suggest that preprocedural CCTA can improve procedural planning, increase technical success in complex lesions, and support safer and more efficient CTO PCI through fluoroscopic co-registration and other real-time guidance applications. These findings highlight the clinical value of CCTA as a tool that can enhance case selection, optimize crossing strategy, and improve procedural success in contemporary CTO PCI. Copyright © 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <88> Accession Number 2044312711 Title Sex-Specific Growth Rates of Ascending Thoracic Aortic Aneurysms in Non-Syndromic Patients: A Systematic Review. Source Diagnostics. 16(6) (no pagination), 2026. Article Number: 916. Date of Publication: 01 Mar 2026. Author Gylling R.M.J.; Pokka H.M.; Gerke O.; Skovbo J.S.; Lindholt J.S.; Diederichsen A.C.P.; Hansen S.M.; Obel L.M. Institution (Gylling, Pokka, Gerke) Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark (Gerke, Skovbo, Lindholt, Diederichsen) Department of Clinical Research, University of Southern Denmark, Odense, Denmark (Skovbo, Lindholt, Obel) Elite Centre for Individualized Medicine in Arterial Disease, CIMA, Odense University Hospital, Odense, Denmark (Skovbo, Lindholt, Obel) Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark (Diederichsen) Department of Cardiology, Odense University Hospital, Odense, Denmark (Hansen) Research Unit OPEN, University of Southern Denmark, Odense, Denmark (Obel) Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Ascending thoracic aortic aneurysms (aTAAs) pose a high risk of dissection and rupture. Though more prevalent in males, females may experience worse outcomes. Growth rate is considered a part of risk assessment, yet data in non-syndromic females without valve abnormalities remain limited. This study aims to assess whether aTAA growth differs between non-syndromic females and males with normal aortic valve morphology. Method(s): The systematic review followed the PRISMA 2020 guideline. The final search was completed in April 2025, with guidance from a certified librarian. Included studies were RCTs or observational studies of non-syndromic adults with aTAA reporting sex-specific data and included >=10 females. Prior dissection, valve replacement, or surgery were excluded. In addition to the original search, 11 articles were identified as likely to contain sex-specific data, and the corresponding authors were contacted. The protocol is registered in PROSPERO (CRD420251025890). Meta-analysis was not performed due to high heterogeneity and limited study numbers. Result(s): Of 2629 identified studies, 73 studies were screened in full-text, and only three met the inclusion criteria. The most common exclusion reason was lack of appropriately sex-stratified data. Two authors out of the 11 contacted replied with additional datasets, resulting in a total of five studies being included. Of the five included studies, three found faster growth rates in females. Reported growth rates in females varied notably, ranging from -0.7-1.74 mm/year. Conclusion(s): Evidence on sex differences in aTAA growth among non-syndromic patients with normal aortic valves remains inconclusive. Three of the five studies reported faster growth in females. Standardization in future research is needed. Copyright © 2026 by the authors. <89> Accession Number 2046374194 Title Baroreflex Activation Therapy In Heart Failure-the Barostim-Enabled Neurohormonal Intervention for Improving Treatment of Heart Failure (BENEFIT-HF) Trial Rationale and Design. Source Journal of Cardiac Failure. (no pagination), 2026. Date of Publication: 2026. Author Sheikh F.H.; Abraham W.T.; Adamson P.B.; Anker S.D.; Brown S.; Butler J.; Friede T.; Lindenfeld J.; Perez-Izquierdo M.; Sears S.F.; Wilks S.J.; Zannad F.; Zile M.R. Institution (Sheikh) MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, United States (Abraham) Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States (Adamson, Wilks) CVRx, Inc, Minneapolis, MN, United States (Anker) Department of Cardiology (CVK) of German Heart Center Charite, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charite Universitatsmedizin, Berlin, Germany (Brown) Bright Research, Minneapolis, MN, United States (Butler) Baylor Scott and White Research Institute, Dallas, TX, United States (Butler) University of Mississippi, Jackson, MS, United States (Friede) Department of Medical Statistics, University Medical Centre Gottingen, Gottingen, Germany (Lindenfeld) Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States (Perez-Izquierdo) Department of Vascular Surgery, Health First, Melbourne, FL, United States (Sears) East Carolina University, East Carolina Heart Institute, Greenville, NC, United States (Zannad) Universite de Lorraine, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Inserm, Centre d'Investigations Cliniques, Plurithematique 14-33, and Inserm U1116, Nancy, France (Zile) Division of Cardiology, Department of Medicine, Medical University of South Carolina and RHJ Department of Veterans Affairs, Charleston, SC, United States Publisher Elsevier B.V. Abstract Background Baroreflex activation therapy (BAT) using an implanted neurostimulator enhances functional status and quality of life in patients with symptomatic heart failure with reduced ejection fraction (HFrEF). Nonetheless, its influence on mortality, heart failure morbidity, and optimal patient subgroups requires further study. Methods BENEFIT-HF is a prospective, randomized, open-label trial recruiting patients with left ventricular ejection fraction (LVEF) <50% who remain symptomatic despite guideline-directed medical and device therapies. A total of 2500 eligible ambulatory patients with stable heart failure will be randomized 2:1 to BAT implantation (Barostim System, CVRx, Inc, Minneapolis, MN, USA) plus standard care (Treatment Group) or standard care alone (Control Group). The primary efficacy endpoint is a 24-month composite of all-cause mortality, left ventricular assist device implantation or heart transplantation, and recurrent heart failure events. Secondary endpoints encompass changes in health status via the Minnesota Living with Heart Failure Questionnaire, 6-minute hall walk distance, days lost due to death or hospitalization, N-terminal pro-B-type natriuretic peptide levels, and all-cause mortality. Conclusions BENEFIT-HF represents the largest device-based trial evaluating BAT as a neurohormonal modulator in a diverse cohort of patients with HFrEF and heart failure with mildly reduced ejection fraction (HFmrEF), aimed at determining its effects on morbidity, mortality, health status, and functional capacity. Copyright © 2026 The Author(s). <90> Accession Number 2044407654 Title A Primer on Restricted Mean Survival Time in Surgical Research. Source Journal of Surgical Research. 321 (pp 186-194), 2026. Date of Publication: 01 May 2026. Author Jacquemyn X.; Sa M.P.; Sultan I. Institution (Jacquemyn, Sultan) UPMC Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Jacquemyn, Sultan) Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States (Sa) Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, Florida, United States Publisher Academic Press Inc. Abstract Introduction: Time-to-event outcomes, such as postoperative complications, disease recurrence, and mortality, are central to surgical research. Historically, these outcomes have been summarized using hazard ratios from Cox proportional hazards models. However, in many surgical trials, the proportional hazards assumption is often violated, particularly when early postoperative risks differ from long-term outcomes, limiting the interpretability of the hazard ratio. Method(s): We conducted a narrative review to present a conceptual framework for using restricted mean survival time (RMST) as an alternative analytical approach. Result(s): RMST quantifies the average event-free survival over a prespecified, clinically meaningful follow-up period, offering an absolute measure of treatment effect that can be easily understood by clinicians, patients, and policymakers. Unlike hazard ratios, RMST remains valid under nonproportional hazards, accommodates competing risks, and can incorporate covariate adjustment. Drawing on contemporary applications in cardiac surgery, oncology, and other surgical fields, we illustrate how RMST clarifies complex temporal patterns of risk, complements conventional survival metrics, and supports patient-centered decision-making. Conclusion(s): By incorporating RMST into trial design, analysis, and reporting, researchers can enhance the interpretability of findings, facilitate cross-study comparisons, and provide a more transparent assessment of treatment benefits. This conceptual review highlights the practical value of RMST and advocates for its broader adoption to improve the rigor, clarity, and clinical relevance of survival analyses in surgical research. Copyright © 2026 The Author(s) <91> Accession Number 2046371273 Title Murray law-based quantitative flow ratio for functional assessment of coronary lesions: a systematic review and meta-analysis. Source International Journal of Cardiovascular Imaging. (no pagination), 2026. Date of Publication: 2026. Author Skalidis I.; Bennar W.; Garin D.; Pittet T.; Wenaweser P.; Jelisejevas J.; Cioffi G.M.; Meier P.; Simioni L.; Kamdem M.M.; Beretta G.S.; Akodad M.; Hovasse T.; Garot P.; Puricel S.; Togni M.; Cook S. Institution (Skalidis, Bennar, Garin, Pittet, Wenaweser, Jelisejevas, Cioffi, Meier, Simioni, Kamdem, Beretta, Puricel, Togni, Cook) Department of Cardiology, HFR - Fribourg Cantonal Hospital and University, Fribourg, Switzerland (Skalidis) School of Medicine, University of Crete, GreeceGreece (Akodad, Hovasse, Garot) Ramsay Sante, Institut Cardiovasculaire Paris-Sud, Hopital Jacques Cartier, Massy, France Publisher Springer Science and Business Media B.V. Abstract Angiography-derived coronary physiology has emerged as an attractive alternative to pressure-wire-based fractional flow reserve (FFR) for functional lesion assessment. Murray law-based quantitative flow ratio (microQFR) represents a simplified, single-view approach, but its diagnostic performance across diverse clinical settings remains incompletely defined. To evaluate the diagnostic accuracy of microQFR for identifying functionally significant coronary lesions using invasive FFR as the reference standard. We performed a systematic review and diagnostic accuracy meta-analysis in accordance with PRISMA-DTA recommendations. Studies assessing microQFR against invasive FFR (<= 0.80) with extractable lesion-level data were included. Sensitivity and specificity were pooled using a bivariate random-effects model. Secondary analyses explored performance in patients undergoing transcatheter aortic valve implantation (TAVI) and in calcified coronary lesions. Seven studies comprising 1,826 coronary lesions were included. microQFR demonstrated a pooled sensitivity of 0.807 (95% CI 0.690-0.888) and specificity of 0.944 (95% CI 0.893-0.971), with a positive likelihood ratio of 14.41, negative likelihood ratio of 0.20, and diagnostic odds ratio of 70.6. Specificity remained consistently high, whereas sensitivity showed substantial variability. In exploratory subgroup analyses, sensitivity was 0.77 (95% CI 0.64-0.87) in TAVI patients (2 studies; 236 lesions) and 0.72 (95% CI 0.66-0.78) in calcified lesions (2 studies; 691 lesions); these findings are hypothesis-generating only. microQFR demonstrates promising diagnostic accuracy with consistently high specificity. However, its moderate sensitivity, negative likelihood ratio of 0.20, and reduced performance in calcified lesions limit its ability to safely exclude functionally significant disease. Prospective validation is required before microQFR can be recommended as a standalone decision-making tool. Copyright © The Author(s), under exclusive licence to Springer Nature B.V. 2026. <92> Accession Number 651417160 Title Stented vs. stentless in aortic stenosis: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 05 Jun 2026. Author Saeed A.; Gerges K.M.; Saeed O.; Alasnag M.; Whitlock R.; Myers P.O.; Balacumaraswami L.; Alesawy A.F.; Abraheem A.; Elraggal D.; Khalleefah D.R.; Elmesherghi A.F.; Fahaid A.; Aljefairi N.; Elhadi M.; Mamas M. Institution (Saeed, Saeed) Faculty of Medicine, Al-Azhar University, Damietta, Egypt (Gerges) Faculty of Medicine, Sohag University, Egypt (Alasnag) Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia (Whitlock) Population Health Research Institute and McMaster University, Hamilton, ON, Canada (Myers) Hopital de La Tour in Geneva, Zurich University Hospital, Zurich, Switzerland (Balacumaraswami) Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (Alesawy) Clinical microbiology and Immunology Department, Benha university, Egypt (Abraheem) Faculty of Medicine, University of al-azhar, Cairo, Egypt (Elraggal) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Khalleefah) Faculty of Medicine, Sirte University, Sirte, Libyan Arab Jamahiriya (Elmesherghi, Fahaid, Aljefairi, Elhadi) Faculty of Medicine, University of Tripoli, Tripoli, Libyan Arab Jamahiriya (Elhadi) College of Medicine, Korea University, Seongbuk-gu, 145 Anam-ro, Seoul, South Korea (Mamas) Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, United Kingdom Abstract BACKGROUND: Symptomatic aortic stenosis (AS) is often treated surgically with aortic valve replacement using stented or stentless prostheses. While stentless valves offer potential hemodynamic benefits, a robust synthesis of the evidence regarding clinical outcomes is needed. This systematic review and meta-analysis assessed the effectiveness and safety of both valve types. METHOD(S): This study followed the PRISMA guidelines and was prospectively registered in PROSPERO (CRD42025636952). We systematically searched PubMed, Cochrane Library, Scopus, and Web of Science up to December 2024, with a search update in May 2025. We included both randomized and non-randomized studies. The outcomes were early and overall mortality rates, stroke, pacemaker implantation, endocarditis, postoperative atrial fibrillation, total reoperation, severe prosthesis-patient mismatch, hospital stay, cardiopulmonary bypass time, cross-clamp time, and hemodynamic parameters, including postoperative mean aortic valve gradient, left ventricular mass and left ventricular mass index, and left ventricular ejection fraction. A random-effects model with odds ratios (ORs) and mean differences (MDs) was employed. RESULT(S): After screening 1,385 records, 20 studies were included, involving 3,940 participants with AS. Studies were first analyzed by design (randomized and non-randomized), and then pooled. There were no significant differences in all-cause mortality rates either early (OR = 1.04, 95% CI: [0.65 to 1.68], p = 0.861) or overall mortality at 1 year (OR = 0.86, 95% CI: [0.28 to 2.63], p = 0.797) and beyond 1 year (OR = 0.95, 95% CI: [0.62 to 1.46], p = 0.820). Postoperative complications showed comparable results between groups, except for pacemaker implantation, which was significantly increased in stentless valves (OR = 1.82, 95% CI: [1.14 to 2.92], p = 0.013). Hemodynamic outcomes showed no significant differences between groups. CONCLUSION(S): Our study revealed that the rates of early and overall mortality, postoperative complications, and hemodynamic parameters were comparable between stented and stentless valve groups. However, patients receiving stentless valves exhibited a significantly higher incidence of pacemaker implantation. Copyright © 2026. The Author(s). <93> Accession Number 651418034 Title Comparative efficacy and safety of transcatheter edge-to-edge repair versus tricuspid valve replacement versus optimal medical therapy in moderate-to-severe tricuspid regurgitation: a network meta-analysis of randomized controlled trials. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 05 Jun 2026. Author Veettil I.N.K.; Jamandlamudi A.; Khader N.A.; Shehu T.; Lacej D.; Jha S.; Mayowa O.; Zumba J.; Ismailov T.; Almaganbetova Z.; Gabriela B.; Hajjar L.; Safi S.U.; Khawar M. Institution (Veettil) Sree Narayana Institute of Medical Sciences, Ernakulam, India (Jamandlamudi) Guntur Medical College, Guntur, Andhra Pradesh, India (Khader) KMCT Medical College, Calicut, India (Shehu) Endocrinology Department, American Hospital 3, Tirana, Albania (Lacej) Department of Pharmaceutical Sciences, Sapienza University of Rome, Tirana, Albania (Jha) GMERS Medical College, Gandhinagar, India (Mayowa) Obafemi Awolowo University College of Health Sciences, Nigeria (Zumba) Department of Internal Medicine, St. Francis University of Health and Allied Sciences, Ifakara, Tanzania (Ismailov, Almaganbetova) Nazarbayev University School of Medicine, Astana, Kazakhstan (Gabriela) Cardiac Centre, Adam Malik General Hospital, Medan, Indonesia (Hajjar) Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates (Safi) Kabul Medical University, Kabul, Afghanistan (Khawar) King Edward Medical University, Lahore, Pakistan Abstract BACKGROUND: Severe tricuspid regurgitation (TR) is associated with substantial morbidity and increased mortality. Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as less-invasive options for patients remaining symptomatic despite optimal medical therapy (OMT). We conducted a network meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TEER and TTVR versus OMT. METHOD(S): Three RCTs were included after systematic search of PubMed, Embase, and ScienceDirect (inception to December 2025). A frequentist network meta-analysis (random-effects) was performed in R. A Bayesian NMA with vague priors was conducted in parallel to obtain posterior rank probabilities and SUCRA values. Relative effects were translated into absolute risk differences and number-needed-to-treat (NNT) / number-needed-to-harm (NNH) using pooled OMT baseline event rates, with 95% CIs via parametric bootstrap. RESULT(S): The network comprised 1,050 patients (star-shaped, OMT common comparator; no direct TEER-TTVR comparison). Neither TEER (RR 0.99, 95% CI 0.56-1.76) nor TTVR (RR 0.85, 95% CI 0.51-1.41) significantly reduced all-cause mortality. Both interventions improved NYHA class >= 1 class (TEER RR 1.46, 95% CI 1.30-1.64, NNT 8; TTVR RR 3.28, 95% CI 2.41-4.47, NNT 2), KCCQ-OS (TEER MD + 11.00, 95% CI 7.46-14.54; TTVR MD + 17.80, 95% CI 12.78-22.82; both exceeding the 5-point MCID with >= 95% confidence), and 6MWD (TEER MD + 17.53 m; TTVR MD + 30.90 m; neither clearly exceeding the 30-m MCID). Both increased major bleeding (TEER NNH 29; TTVR NNH 21) and new pacemaker implantation (TEER NNH 91; TTVR NNH 10). Bayesian posterior probability that TTVR was best was 100% for NYHA improvement, 99% for KCCQ-OS, and 82% for 6MWD, but only 1% for avoidance of pacemaker implantation. CONCLUSION(S): In patients with symptomatic moderate-to-severe TR, both TEER and TTVR plus OMT provide consistent and clinically meaningful improvements in functional status and quality of life. Longer-term trials with direct head-to-head comparisons are warranted. CLINICAL TRIAL REGISTRATION: Not applicable. This study is a systematic review and meta-analysis of previously published randomized controlled trials. Copyright © 2026. The Author(s). <94> Accession Number 651420575 Title Preoperative IV iron and postoperative blood transfusion reduction in non-anaemic patients undergoing cardiac surgery: a systematic review and meta-analysis of RCTs. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 06 Jun 2026. Author Murad Z.A.; Lahcen A.A.; Alkhawam M.; Elbasosy M.Y.; Abdelhamid M.O.; El Hilali A.; Abdallatif L.A.; Abdelrahman H.; Agnaou Y. Institution (Murad) Faculty of Medicine and Health Sciences, University of Aden, P.O. Box 878, Aden, Yemen (Lahcen) Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Marrakesh, Morocco (Alkhawam) Division of Cardiovascular, University of Alabama at Birmingham, Birmingham, AL, United States (Elbasosy, Abdelhamid) Menoufia University Hospitals, Egypt (El Hilali) Faculty of Medicine and Pharmacy of Agadir, Ibn Zohr University, Agadir, Morocco (Abdallatif) Capital University, Cairo, Egypt (Abdelrahman) Cairo University Hospitals, Cairo, Egypt (Agnaou) Faculte de Sante de Creteil - UPEC (Paris 12) Paris-Est Creteil Val-de-Marne university Paris, Creteil, France Abstract BACKGROUND: Preoperative intravenous iron has become increasingly popular as a strategy to optimize hemoglobin before major surgery. However, its potential benefit in non-anaemic patients undergoing cardiac surgery remains unclear. To address this uncertainty, we conducted a systematic review and meta-analysis to investigate whether preoperative IV iron reduces red blood cell transfusion requirements and improves hematologic and clinical outcomes in adults with normal baseline hemoglobin undergoing cardiac surgery. METHOD(S): We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library until October 2025 for randomized controlled trials. Eligible studies compared preoperative IV iron to a control (placebo, saline, or standard care) in non-anaemic (per WHO definition) adult patients (>= 18 years) undergoing cardiac surgery. The primary outcomes were the incidence of postoperative RBC transfusion and the number of units transfused. Secondary outcomes included postoperative hemoglobin level, Postoperative iron indices, length of ICU stay, length of hospital stay (LOS), overall postoperative infection, All-cause mortality, and adverse events possibly related to IV iron (hypersensitivity, anaphylaxis). We used the Cochrane ROB 2 tool for bias assessment and for evidence certainty. Pooled Risk ratios, odds ratios, mean difference, and standardized mean difference with 95% confidence intervals were calculated using random-effects models, with the fixed-effects model applied when heterogeneity was absent or low (I2 < 10%). RESULT(S): From 529 initial records, 3 RCTs met the inclusion criteria, encompassing 338 patients. The overall risk of bias was low to moderate. Preoperative IV iron significantly reduced the incidence of postoperative RBC transfusion compared to the control group (Risk Ratio [RR] = 0.62; 95% CI 0.43-0.88; p = 0.008; I2 = 0%), representing a 38% relative risk reduction. Furthermore, IV iron significantly decreased the mean number of RBC units transfused (Mean Difference [MD] = - 1.08 units; 95% CI - 1.61 to - 0.54; I2 = 0%). While no significant difference was observed in hemoglobin levels at 48 h or one week postoperatively, the IV iron group showed significantly higher hemoglobin at 4-6 weeks (MD = 0.84 g/dL; 95% CI 0.41-1.26; p = 0.0001). IV iron also significantly increased postoperative serum ferritin and transferrin saturation. There were no statistically significant differences in overall postoperative infection rates (RR = 1.16; 95% CI 0.64-2.08) or all-cause mortality (Risk Difference = - 0.00; 95% CI - 0.03 to 0.03). The GRADE certainty of evidence for the primary outcome was moderate. CONCLUSION(S): In non-anaemic adult patients undergoing cardiac surgery, preoperative IV iron administration significantly reduces the incidence of postoperative RBC transfusion and the total volume of blood transfused. This intervention also improves hemoglobin levels during the 4-6 week recovery period without an increased risk of infection or mortality. The moderate-certainty evidence suggests this is a beneficial strategy, though further adequately powered RCTs are warranted to strengthen these findings. PROSPERO REGISTRY REFERENCE: CRD420251161421. Copyright © 2026. The Author(s). <95> Accession Number 2037880166 Title Surgical Repair of Post-Infarction Ventricular Septal Rupture with or without Concomitant Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Outcomes and Prognostic Implications. Source Cor et Vasa. 67(6) (pp 677-685), 2025. Date of Publication: 2025. Author Irawan E.; Sembiring Y.E. Institution (Irawan, Sembiring) Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Airlangga University, Surabaya, Indonesia (Irawan, Sembiring) Department of Thoracic, Cardiac and Vascular Surgery, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia Publisher Czech Society of Cardiology Z.S Abstract Introduction: Post-myocardial infarction ventricular septal rupture (VSR) is a rare but fatal complication that requires urgent surgical repair. The benefit of adding concomitant coronary artery bypass grafting (CABG) remains controversial. While CABG may protect viable myocardium in patients with coronary artery disease, it also increases operative complexity and ischemic time. This review evaluates the prognostic impact of concomitant CABG during VSR repair. Method(s): A systematic literature search was conducted in PubMed, ScienceDirect, BMC, and Springer data-bases according to PRISMA guidelines. Studies reporting surgical VSR repair with and without CABG were included. The primary endpoint was survival, analysed through meta-analysis, and prognostic variables were also reviewed. Result(s): Twelve retrospective studies involving 2,050 patients were identified, including 857 who underwent concomitant CABG and 1,193 who had isolated VSR repair. Baseline demographics were broadly comparable, although CABG patients more frequently presented with multivessel disease. Patch closure was the predominant repair technique. CABG was associated with longer cross-clamp times but not with higher perioperative complications. Survival events occurred in 547/857 (63.8%) of CABG patients versus 780/1,193 (65.4%) without CABG. The pooled odds ratio for survival was 1.02 (95% CI, 0.84-1.24; p = 0.83), with negligible heterogeneity (I2 = 0%). These findings suggest concomitant CABG can be performed safely, with potential value in patients with complex coronary disease, although increased operative time may pose risk in elderly or unstable individuals. Conclusion(s): Concomitant CABG during VSR repair does not provide a universal survival advantage but remains a safe option, particularly for patients with multivessel disease. Surgical decisions should be individualized, and further prospective studies are needed to refine treatment strategies. Copyright © 2025, Czech Society of Cardiology Z.S. All rights reserved. <96> Accession Number 2046485866 Title Utility of genetic testing in heart transplant recipients: a systematic review and meta-analysis. Source Transplantation Reviews. 40(4) (no pagination), 2026. Article Number: 101030. Date of Publication: 01 Dec 2026. Author Shokravi A.; Bertelli M.; Mahon N.; Archer L.; Dauter A.; Ballantyne B.; Fine N.; Howlett J.; Lyons K.; Sharma N.; Marcadier J.; McBride K.L.; Harper L.; Kiamanesh O.; Miller R.J.H. Institution (Shokravi) Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (Bertelli, Ballantyne, Fine, Howlett, Lyons, Sharma, Kiamanesh, Miller) Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada (Mahon, Archer, Dauter, Kiamanesh) Broderick Cardiomyopathy Program, University of Calgary, Calgary, AB, Canada (Marcadier, McBride) Department of Medical Genetics, University of Calgary, Calgary, AB, Canada (Harper) Department of Respirology, University of Calgary, Calgary, AB, Canada Publisher Elsevier Inc. Abstract Genetic cardiomyopathies commonly cause end-stage heart failure, yet genetic testing is inconsistently applied in heart transplant recipients. Identifying pathogenic/likely pathogenic (P/LP) variants clarifies etiology and informs familial risk, but data on diagnostic yield are limited. We performed a meta-analysis to quantify genetic testing yield in heart transplant recipients and implications for cascade testing. MEDLINE and Embase were searched for studies examining cardiomyopathy-focused genetic testing in heart transplant recipients. Pooled P/LP cardiomyopathy variant yields were estimated using random-effects models, stratified by cardiomyopathy phenotype. Cascade testing outcomes were summarized. Eleven studies met inclusion criteria. Overall, 32% (95% CI: 21-46%) of heart transplant recipients carried a P/LP variant. Yield was highest in non-ischemic cardiomyopathy (34%, 95% CI: 24-47%) and non-ischemic dilated cardiomyopathy cohorts (29%, 95% CI: 12-54%), and lowest in ischemic cardiomyopathy cohorts (8%, 95% CI: 4-18%). Heterogeneity ranged from I2 35% to 92%. Among studies reporting cascade testing outcomes, 52-92% of families underwent testing; 30-40% of relatives had P/LP variants, 15-69% of which demonstrated a phenotypic CM. While exact estimates should be interpreted cautiously given heterogeneity across cohorts, the consistency of findings suggests meaningful clinical relevance. Cardiomyopathy-focused genetic testing identifies P/LP variants in many heart transplant recipients, with important implications for cascade testing, supporting integration of cardiomyopathy-related genetic evaluation into heart transplant programs. Copyright © 2024 <97> Accession Number 651415988 Title Aortocoronary vs Composite Grafting Strategies in Coronary Artery Bypass Surgery - A Network Meta-Analysis. Source The Canadian journal of cardiology. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Gupta A.K.; Zaka A.; Tyagi D.; Chang S.; Burton E.; Munir L.; Mutahar D.; Ren J.; Stretton B.; Kovoor J.G.; Bacchi S.; Edwards S.; Kovoor P.; Maddern G.J.; Bennetts J.S.; Vallely M.P. Institution (Gupta) University of Adelaide, Adelaide, Australia; Gold Coast University Hospital, Southport, Australia (Zaka, Mutahar) Gold Coast University Hospital, Southport, Australia (Tyagi) University of Newcastle, Newcastle, Australia (Chang, Munir) Griffith University, Southport, Australia (Burton) Royal Adelaide Hospital, Adelaide, Australia (Ren) University of Melbourne, Melbourne, Australia (Stretton, Edwards) University of Adelaide, Adelaide, Australia (Kovoor, Bacchi) University of Adelaide, Adelaide, Australia; Royal Adelaide Hospital, Adelaide, Australia (Kovoor) Westmead Hospital, Australia (Maddern) University of Adelaide, Adelaide, Australia; Royal Australasian College of Surgeons, Adelaide, South Australia, Australia (Bennetts) Flinders Medical Centre, Adelaide, Australia; Flinders University, Adelaide, Australia (Vallely) St George Hospital, Sydney, Australia Abstract Coronary artery bypass graft surgery (CABG) has traditionally utilised an in-situ left internal mammary artery (LIMA) graft to the left anterior descending artery, in addition to aortocoronary anastomoses to graft non-LAD target vessels. Composite grafting provides an opportunity to avoid aortic anastomoses by utilizing non-aortic anastomoses to provide greater efficiency in the use of conduits for improved all-cause mortality and reduced aortic manipulation to lower the incidence of postoperative stroke. We performed a network meta-analysis (NMA) to compare aortocoronary and various composite grafting strategies for CABG. A systematic search of six electronic databases identified all publications reporting outcomes of CABG with aortocoronary or composite grafting strategies. The primary outcome was in-hospital or 30-day all-cause mortality, and studies which reported this were included in a NMA. Our study protocol was registered with PROSPERO (CRD42023402665) and conformed with PRISMA 2020 and MOOSE guidelines. A systematic search of six electronic databases identified all publications reporting outcomes of the included operations. A total of 6656 articles were screened, of which 24 studies (8 RCTs and 16 observational studies) were included with a total of 9692 patients. There was no difference in conventional aortocoronary anastomosis and composite grafting for the outcome of in-hospital or 30-day all-cause mortality (p=0.387). There was also no difference in rates of stroke (p=0.277), myocardial infarction (p=0.09), reoperation for bleeding (p=0.500), postoperative atrial fibrillation (p=0.219) and deep sternal wound infection (p=0.549). This Bayesian NMA of 9692 patients demonstrated that composite grafting CABG can be performed as safely as conventional aortocoronary CABG. Copyright © 2026. Published by Elsevier Inc. <98> Accession Number 2046526007 Title Intercostal Nerve Cryoablation Therapy in Thoracic and Cardiac Surgery for Postoperative Pain Management: A Systematic Review and Meta-Analysis. Source Interdisciplinary Cardiovascular and Thoracic Surgery. 41(6) (no pagination), 2026. Article Number: ivag143. Date of Publication: 01 Jun 2026. Author Towe C.W.; Bauman Z.M.; O'Connor L.A.; Quinn C.C.; Pelletier M.P.; Hahn A.K.; Ndikintum N.; Dua M.M.; Cantu E. Institution (Towe) Department of Surgery, Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States (Bauman) Department of Surgery, Division of Acute Care Surgery, University of Nebraska Medical Center, Omaha, NE, United States (O'Connor, Quinn) Division of Thoracic Surgery, Elliot Health System, Manchester, MA, United States (Pelletier) Division of Cardiac Surgery, Yale New Haven Hospital, New Haven, CT, United States (Hahn, Ndikintum, Dua) AtriCure, Inc, Mason, OH, United States (Cantu) Department of Surgery, Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States Publisher Oxford University Press Abstract Objectives: Thoracic and cardiac surgical procedures are associated with significant postoperative pain. Intercostal nerve cryoablation (INC) is a non-opioid adjunctive pain management strategy. The objective of this study was to comprehensively review published outcomes of INC during non-pectus repair thoracic and cardiac surgeries to inform clinical practice and guideline development. Method(s): A literature search was conducted in PubMed, Embase, Google Scholar, and using manual approaches to identify comparative studies of patients undergoing non-pectus repair thoracic or cardiac procedures with INC versus standard of care (SOC) without INC. Meta-analyses were performed to quantitively evaluate opioid consumption and hospital length of stay (LOS). Secondary outcomes were summarized qualitatively. Result(s): Twenty-four studies were included encompassing 18465 patients, of whom 10.6% (n = 1954) received INC. INC was applied during surgical stabilization of rib fractures, thoracotomy, pulmonary resections, lung transplants, aortic aneurysm repair, and cardiac procedures. Meta-analyses of adult studies demonstrated a significant reduction in inpatient opioid consumption by 102 morphine milligram equivalents (MME) (95% CI: -180.00, -23.87) and a non-significant reduction in opioid consumption after discharge by 89 MME (95% CI: -182.00, 4.56) with INC. Sub-group analysis demonstrated the largest effect size in inpatient opioid reduction for bilateral thoracotomy or thoracosternotomy for lung transplants. Meta-analysis demonstrated no significant difference in hospital stay for adult patients treated with INC. Conclusion(s): The results of this systematic review and meta-analysis provide evidence to support the association between INC and reduced inpatient opioid consumption in non-pectus repair thoracic and cardiac procedures. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <99> Accession Number 2046530817 Title Rectus sheath catheters versus thoracic epidural analgesia for pain management after open surgery: systematic review and meta-analysis. Source British Journal of Surgery. 113(6) (no pagination), 2026. Article Number: znag058. Date of Publication: 01 Jun 2026. Author Fankhauser C.D.; Breitenstein S.; Gelpke H.; Madjdpour C.; Meili G.; Sultan-Beyer L.; Wyss T.R.; Kaufmann E. Institution (Fankhauser) Division of Urology, Department of Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland (Fankhauser, Kaufmann) Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland (Fankhauser, Kaufmann) Clinic for Urology, University Teaching and Research Hospital of the University of Lucerne, Lucerne, Switzerland (Fankhauser, Breitenstein, Madjdpour) Faculty of Medicine, University of Zurich, Zurich, Switzerland (Breitenstein, Gelpke) Department of Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland (Madjdpour) Department of Anaesthesiology, Cantonal Hospital of Winterthur, Winterthur, Switzerland (Meili, Sultan-Beyer) Department of Gynaecology and Obstetrics, Cantonal Hospital of Winterthur, Winterthur, Switzerland (Wyss) Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (Wyss) Department of Interventional Radiology and Vascular Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland Publisher Oxford University Press Abstract Background: Thoracic epidural analgesia (TEA) remains the 'gold standard' for postoperative pain management after major open surgery, but is potentially associated with hypotension, urinary retention, and delayed recovery. Rectus sheath catheters (RSCs) offer a simple regional alternative that avoids sympathetic blockade while maintaining somatic analgesia. The aim of this review was to compare analgesic efficacy, complications, recovery, patient satisfaction, and costs between RSCs and TEA in open surgical procedures. Method(s): This systematic review was registered with PROSPERO, the international prospective register of systematic reviews (registration number: CRD420251234467). A systematic PubMed search was conducted to identify studies comparing continuous wound infusion via RSCs with TEA in adult patients undergoing open abdominal, pelvic, thoracic, or vascular surgery. RCTs, as well as prospective and retrospective comparative studies, were included. A meta-analysis was performed for randomized trials. Result(s): In total, 31 studies (21 prospective and 10 retrospective) involving 2162 patients were included. RSCs and TEA did not differ significantly with respect to postoperative pain (standardized mean difference -0.35 (95% c.i. -2.01 to 1.32)) or opioid consumption (standardized mean difference -0.32 (95% c.i. -1.71 to 1.07)). No differences were observed in recovery of bowel function, urinary retention, time to mobilization, or length of hospital stay. RSCs significantly reduced the risk of hypotension compared with TEA (risk ratio 0.40 (95% c.i. 0.26 to 0.60)) and were associated with lower costs with savings ranging from $500 to $6632 per case. Subgroup analyses suggested less urinary retention and earlier mobilization with RSCs in non-visceral surgery and non-laparotomy incisions. Conclusion(s): RSCs provide analgesia comparable to TEA with fewer complications, facilitating earlier recovery and potential cost savings. Considering the growing shift toward fast-track surgery, RSCs represent a pragmatic and resource-efficient alternative for postoperative pain management in open surgical procedures. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <100> Accession Number 651419569 Title Prevalence and prognostic role of untreated moderate-to-severe tricuspid regurgitation: a systematic review and meta-analysis. Source European journal of heart failure. (no pagination), 2026. Date of Publication: 06 Jun 2026. Author Tomasoni D.; Oriecuia C.; Adamo M.; Ravasio F.; Nava G.; Costa P.; Pagnesi M.; Lombardi C.M.; Specchia C.; Metra M.; Savarese G. Institution (Tomasoni, Adamo, Nava, Costa, Pagnesi, Lombardi) Cardiology. ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy (Tomasoni, Savarese) Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden (Oriecuia, Specchia) Department of Molecular and Translational Medicine, Universita degli Studi di Brescia, Brescia, Italy (Ravasio) Division of Cardiac Surgery, ASST Spedali Civili Di Brescia, University of Brescia, Italy (Metra) Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy Abstract AIM: We aimed to assess the prognostic role of untreated moderate-to-severe tricuspid regurgitation (TR) by a systematic review and meta-analysis. METHOD(S): We searched Pubmed from database inception to 14 August 2025. Studies reporting data on clinical outcomes associated with different TR grades not receiving treatment were considered eligible. The primary endpoint was all-cause mortality; secondary endpoints included cardiovascular (CV) mortality and heart failure (HF) hospitalization. Pooled estimates were calculated using random-effects models. RESULT(S): Our literature search yielded 2,727 articles, of which 225 were assessed for full-text eligibility. A total of 106 studies (107 comparisons) comprising 961,136 patients, were included in the quantitative synthesis. The overall prevalence of untreated moderate-to-severe TR was 13.5%, but varied widely across population subgroups. Moderate-to-severe TR was associated with a significantly higher all-cause mortality compared with none-to-mild TR (unadjusted HR 2.07; 95% CI 1.89-2.26; p < 0.001). The association was confirmed in adjusted models and among different subgroups (i.e., patients performing a general echocardiographic irrespective of indication, patients with left-side valvular heart disease [LSVHD], HF without LSVHD, patients undergoing cardiac implantable electronic device implantation, left ventricular assist device recipients and in patients with pulmonary artery hypertension), but not after heart transplantation. A stepwise increase in mortality was observed with increasing TR severity. Moderate-to-severe TR was also associated with higher risk of CV mortality and HF hospitalization (HR 1.92 [1.64-2.26] and HR 1.63[1.44-1.84], respectively). CONCLUSION(S): Untreated moderate-to-severe TR is associated with higher risk of all-cause mortality, CV mortality and HF hospitalization, underlying the role of timely diagnosis and appropriate management. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. <101> Accession Number 651416429 Title Management of anticoagulation in patients with heparin-induced thrombocytopenia requiring cardiac surgery with cardiopulmonary bypass: Guidance from the ISTH SSC on Perioperative and Critical Care Haemostasis and Thrombosis. Source Journal of thrombosis and haemostasis : JTH. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Pishko A.M.; Frere C.; Maier C.L.; Levy J.H.; Connors J.M. Institution (Pishko) Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Frere) Department of Hematology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris; Sorbonne Universite, INSERM UMR_S 1166, Paris, France (Maier) Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States (Levy) Department of Anesthesiology, Critical Care and Surgery, Duke University School of Medicine, Durham, NC, United States (Connors) Hematology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States Abstract Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction characterized by thrombocytopenia and a high risk of thrombosis. Patients with HIT and a need for cardiac surgery with cardiopulmonary bypass (CPB) represent a challenging group, as anticoagulation with unfractionated heparin (UFH) is the primary treatment choice. We conducted a systematic review evaluating intraoperative anticoagulation strategies for patients with a history of HIT who required cardiac surgery with CPB. Guidance statements were generated through consensus of the writing group. Of 1732 screened articles, 30 studies were included. Strategies evaluated were (1) direct thrombin inhibitors; (2) UFH after preoperative or intraoperative therapeutic plasma exchange (TPE); (3) UFH in combination with a potent antiplatelet agent; and (4) Heparin re-exposure in patients with negative functional assays. Of these, bivalirudin has the strongest supporting data and appears effective; still, its association with increased bleeding and practical limitations, including a lack of a reversal agent, limit its use. TPE with or without IVIG reduces anti-PF4/heparin antibody titers and allows for intraoperative UFH use, although protocols are heterogeneous. Use of potent antiplatelet agents with UFH re-exposure show promise but carry risks of bleeding and hypotension. Thus, alternative strategies of using UFH in combination with TPE or potent antiplatelet agents may be considered on a case-by-case basis. For patients with negative functional assays, evidence suggests that limited intraoperative UFH re-exposure carries a low risk of HIT recurrence, provided postoperative monitoring is performed. These guidance statements provide a framework for multidisciplinary decision-making in a complex clinical scenario. Copyright © 2026. Published by Elsevier Inc. <102> Accession Number 2037892660 Title Iatrogenic Left Main Coronary Artery Stenosis Following Interventional and Surgical Procedures: A Literature Review. Source Kosuyolu Heart Journal. 29(1) (pp 76-80), 2026. Date of Publication: 01 Mar 2026. Author Bozkurt B.; Yavuz S.; Kus M.K.; Memetoglu M.E. Institution (Bozkurt) Department of Cardiovascular Surgery, Kastamonu Training and Research Hospital, Kastamonu, Turkey (Yavuz) Department of Cardiology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey (Kus, Memetoglu) Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Publisher Kare Publishing Abstract Iatrogenic left main coronary artery (LMCA) stenosis is a rare but life-threatening complication that may occur after percutaneous coronary intervention (PCI) or cardiac valve surgery. While initially uninvolved, the LMCA can develop significant stenosis months after manipulation of other coronary vessels, raising diagnostic and therapeutic challenges. This review aims to synthesize existing case reports and clinical experiences regarding the development of iatrogenic LMCA stenosis in patients with no prior LMCA lesions, focusing on procedural causes and subsequent treatment strategies. A comprehensive review of the literature identified and analyzed a total of 14 publications comprising 8 multi-patient case series, 4 single case reports, and 1 retrospective cohort were identified, who developed iatrogenic LMCA stenosis following PCI or aortic valve surgery. Mechanisms, clinical presentations, diagnostic approaches, and outcomes of various treatment modalities were analyzed. The most common mechanisms included catheter-induced trauma, balloon overdistension, and ostial cannulation during valve surgery. Clinical presentation ranged from recurrent angina to cardiogenic shock. Treatment strategies included coronary artery bypass grafting, percutaneous coronary angioplasty with stenting, and in select hemodynamically stable patients, conservative medical therapy. PCI was often reserved for high-risk surgical patients or when rapid revascularization was essential. Iatrogenic LMCA stenosis should be considered in patients presenting with angina after coronary or valvular interventions, especially in the absence of prior LMCA disease. Early recognition through angiography and appropriate selection of revascularization strategy, surgical or percutaneous, is critical for optimizing outcomes. Copyright © 2026 by Kosuyolu Heart. <103> Accession Number 2044266658 Title Radiofrequency Needle and Conventional Mechanical Needle for Transseptal Access: A Systematic Review and Meta-Analysis. Source PACE - Pacing and Clinical Electrophysiology. 49(6) (pp 742-752), 2026. Date of Publication: 01 Jun 2026. Author de Amorim S.O.; Ferreira M.D.S.; Soares C.; Bastos V.C.L.; Aires M.F.M.; Pereira F.H.L.; da Silva N.F.C.; Neto J.A.; Honorato M.M. Institution (de Amorim, Ferreira, Pereira, da Silva, Neto, Honorato) Faculty of Medicine, University of the State of Para (UEPA), Para, Santarem, Brazil (Soares) Faculty of Medicine, UniAtenas, Minas Gerais, Passos, Brazil (Bastos, Aires, Honorato) Faculty of Medicine, Amazon University Center (UNAMA), Para, Santarem, Brazil Publisher John Wiley and Sons Inc Abstract Background: Transseptal puncture (TSP) is essential for various structural and electrophysiological cardiac procedures. However, the conventional mechanical needle can be challenging in complex anatomies. Radiofrequency (RF)-assisted puncture systems offer an alternative to facilitate septal crossing and potentially reduce complications. This study aimed to evaluate the efficacy and safety of RF needle TSP compared with the conventional mechanical approach. Material(s) and Method(s): A systematic review and meta-analysis was conducted following PRISMA guidelines (PROSPERO: CRD420251272470). Primary efficacy outcomes included unassisted success, crossover, and TSP and fluoroscopy time, failure to obtain left atrial access, while safety outcomes included pericardial effusion or cardiac tamponade. Statistical analyses were conducted in R software (version 4.5.1) risk ratios (RR) and differences (MD), and heterogeneity was assessed by I2 statistics. Result(s): This review included nine studies, amongst them randomized and nonrandomized. The RF needle demonstrated statistically significant superiority in several efficacy outcomes: increased unassisted success (RR: 1.05; 95% CI: 1.01-1.10), marked reduction risk in crossover rate (RR: 0.11; 95% CI: 0.03-0.38), and failure to obtain transseptal access (RR: 0.11; 95% CI: 0.04-0.33). Furthermore, the RF technique significantly reduced TSP time (MD: -154.7 s) and fluoroscopy time (MD: -84.5 s). Successful TSP rates (RR: 1.03; 95% CI: 0.99-1.06) and pericardial effusion or cardiac tamponade (RR: 0.55; 95% CI: 0.12-2.57) were comparable between groups. Conclusion(s): RF-assisted TSP demonstrated superior performance compared with the conventional mechanical technique, offering higher unassisted primary efficacy, reducing access failures, and improving procedural efficiency. Although major complication rates are similar, RF may be considered a preferred strategy, especially in complex anatomies, due to its predictability and potential benefit in neurological safety. Copyright © 2026 Wiley Periodicals LLC. <104> Accession Number 651399570 Title Interventions to reduce the impact of post-tuberculosis lung disease: a scoping review of the literature. Source BMC pulmonary medicine. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Byrne A.L.; Gunther G.; Tadyanemhandu C.; de Almeida C.P.B.; Dewi I.M.; Mitnick C.D.; Koenig S.P.; Romanowski K.; Wallis R.S. Institution (Byrne) Department of Thoracic Medicine, St Vincent's Hospital, Sydney, Australia (Byrne) Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia (Gunther) Department of Pulmonology, Allergology and Clinical Immunology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (Gunther) Department of Clinical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia (Tadyanemhandu) Department of Physiotherapy, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates (de Almeida) Faculty of Public Health, Federal University of Sul e Sudeste do Para, Maraba, Brazil (Dewi) Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia (Dewi) Research Center for Care and Control of Infectious Diseases (RC3ID), Universitas Padjadjaran, Bandung, Indonesia (Mitnick) Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States (Koenig) Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States (Romanowski) Department of Global and Public Health, McGill University, Montreal, Canada (Wallis) Aurum Institute, Johannesburg, South Africa Abstract BACKGROUND: Post tuberculosis lung disease (PTLD) is an increasingly recognized contributor of long-term morbidity among the estimated 155 million survivors of Mycobacterium tuberculosis disease. While a range of interventions may influence PTLD risk, the full spectrum has not been systematically reviewed. METHOD(S): We conducted a scoping review following Joanna Briggs Institute methodology to identify interventions delivered during or after TB treatment with potential to affect PTLD outcomes. Embase was searched from inception to March 31, 2025, for seven intervention categories: host-directed therapy (HDT), therapeutic drug monitoring (TDM), inhaled pharmacotherapy, antimicrobials beyond TB treatment, treatment shortening, thoracic surgery, and microbiome-altering interventions. Outcomes were grouped into disability, lung function, radiology, biomarkers, and histopathology, and categorized as showing improvement, worsening, or no effect on PTLD. RESULT(S): Of 7,965 records screened, 87 studies were included. Most were small, uncontrolled, and designed to assess microbiological cure rather than post-TB sequelae. Radiology and unstructured symptom reports were the most common outcomes, while validated disability tools and advanced lung function measures were rarely used. Corticosteroids and several HDTs showed signals of radiological or spirometric benefit, but the findings were inconsistent. Doxycycline and metformin improved cavity resolution in small trials. Inhaled bronchodilators demonstrated short-term spirometric gains in two studies and a survival benefit in one retrospective cohort. Antifungals for chronic pulmonary aspergillosis improved symptoms, radiology, and inflammatory biomarkers, whereas evidence for antibacterial or NTM-directed therapy was lacking. TDM was associated with faster culture conversion in some studies but was not linked to PTLD-specific outcomes. Microbiome studies consistently reported reduced diversity and altered composition during TB treatment, but no direct associations with PTLD. CONCLUSION(S): Evidence for interventions to prevent or mitigate PTLD remains sparse, heterogeneous, and largely incidental. High-quality studies using standardized, person-centered outcomes are urgently needed to guide care for TB survivors worldwide. Copyright © 2026. The Author(s). <105> Accession Number 2044213022 Title Efficacy of oral sucrose for preterm infants undergoing point-of-care lung ultrasound: a randomized assessor-blinded controlled trial. Source European Journal of Pediatrics. 185(4) (no pagination), 2026. Article Number: 212. Date of Publication: 01 Apr 2026. Author Elkhouli M.; Mohsen N.; Elhanafy T.; Ibrahim J.; Lee S.; Cheng C.; Taddio A.; Shah V.; Mohamed A. Institution (Elkhouli) Scarborough Health Network, Toronto, ON, Canada (Elkhouli, Shah, Mohamed) Department of Paediatrics, University of Toronto, Toronto, ON, Canada (Mohsen) Department of Pediatrics, Mansoura University, Mansoura, Egypt (Elhanafy, Ibrahim, Lee, Cheng, Shah, Mohamed) Department of Paediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada (Taddio) Lesile Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada (Cheng) Department of Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom Publisher Springer Science and Business Media Deutschland GmbH Abstract Although lung ultrasound (LUS) is considered non-invasive in nature, handling and probe pressure may provoke pain and transient physiological changes in preterm infants. The aim of this study was to determine whether oral sucrose combined with a pacifier reduces procedural pain and stress in preterm infants undergoing bedside LUS. A two-arm randomized controlled trial was conducted between November 2020 and January 2023. Preterm infants undergoing LUS were randomized to receive either oral sucrose-plus-pacifier or pacifier-alone, administered 2 min before the scan. Pain was evaluated using the premature infant pain profile (PIPP) at four time points: baseline (30 s before intervention), 30 s into scanning, midpoint of the scan, and 30 s post-procedure. Physiological parameters (heart rate, oxygen saturation, and apneic episodes) and duration of the procedure were recorded. Group differences in PIPP scores were analyzed using repeated-measures ANOVA. Out of 60 infants enrolled, 30 infants were randomized in each group with data available on 29 infants in the sucrose-plus-pacifier group and 27 in the pacifier-alone group. Baseline demographics and clinical characteristics were comparable between groups. No statistically significant differences were observed in PIPP scores and physiological parameters at any time point between groups. Repeated-measures ANOVA showed a significant change in PIPP scores across procedural phases (p < 0.0001), with no differences between groups (p = 0.16) or group-by-phase interaction, indicating similar PIPP score trajectories in both groups (p = 0.21). Conclusion(s): Among preterm infants, sucrose did not add benefit to pacifier-alone for reducing procedural pain and stress during lung ultrasound. Trial registration: NCT05717088. (Table presented.) Copyright © Crown 2026. <106> Accession Number 2044281715 Title Estimated End-Tidal Sevoflurane Concentration to Maintain Optimal Anesthetic Depth During Cardiopulmonary Bypass: A Meta-Analysis. Source Biomedicines. 14(3) (no pagination), 2026. Article Number: 535. Date of Publication: 01 Mar 2026. Author Lee S.-H.; Kang T.H.; Yoo S.; Kim K. Institution (Lee, Kang) Department of Anesthesiology and Pain Medicine, Kyungpook National Medical Center, Kyungpook National University School of Medicine, Daegu, South Korea (Yoo, Kim) Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, South Korea Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Volatile anesthetic dosing during cardiopulmonary bypass (CPB) is poorly standardized. We estimated the end-tidal sevoflurane (ETsevo) concentration required to maintain adequate anesthesia during CPB and investigated the effects of age and body temperature. Method(s): This study is a PRISMA-compliant, PROSPERO-registered meta-analysis. PubMed, Embase, and the Cochrane Library were searched. Prospective studies of adults who underwent cardiac surgery with CPB and receiving sevoflurane were included. Primary outcome was mean ETsevo concentration when bispectral index (BIS) was 40-60. Three-level random-effects meta-analytic models with robust variance estimation were used to pool repeated measurements within studies. Age and body temperature were then examined as study-level moderators. Risk of bias was determined using ROBINS-I. Result(s): Five studies (n = 129) fulfilled the criteria. Pooled ETsevo during CPB was 0.88 vol% (95% confidence interval [CI] 0.29 to 1.46; p = 0.02) with substantial heterogeneity (I2 = 87.6%). Body temperature was not a significant moderator (difference 0.26 vol%; 95% CI -1.12 to 1.64; p = 0.27). Higher mean age was associated with lower ETsevo, evidenced by the finding that patients with a mean age of >62.0 years required 0.45 vol% less ETsevo (95% CI -0.78 to -0.13; p = 0.01), and sensitivity analysis revealed a 0.05 vol% decrease per additional year. Conclusion(s): To maintain BIS at 40-60 during CPB, the estimated ETsevo requirement is 0.88 vol% (minimum alveolar concentration 0.53-0.58 in patients in their 60s). Requirements decreased with age, and body temperature exerted no detectable effect. Copyright © 2026 by the authors. <107> Accession Number 2044431896 Title The Effect of Text Messaging on the Postoperative Pain Experience in Pediatric Patients Undergoing Thoracic Surgery: Randomized Controlled Trial. Source Journal of Medical Internet Research. 28 (no pagination), 2026. Article Number: e81806. Date of Publication: 2026. Author Shi Y.; Wang Q.; Liu A.; Jiang L. Institution (Shi, Wang, Liu, Jiang) Department of Anesthesiology, Children's Hospital of Fudan University, Shanghai, China Publisher JMIR Publications Inc. Abstract Background: Inadequately controlled postoperative pain continues to pose a significant clinical challenge in pediatric patients undergoing thoracic surgery. Objective(s): This randomized controlled study aimed to investigate the effectiveness of SMS-based educational support for postoperative pain management on patients' pain experience. Method(s): A total of 100 pediatric patients undergoing thoracic surgery were enrolled between December 2, 2023, and January 28, 2025. Patients in the intervention group (group 1) received structured postoperative pain management education via SMS text messages, whereas those in the control group (group 2) received standard oral education. Pain intensity and pain-related interference were assessed using the Brief Pain Inventory, and self-efficacy was measured using the Pain Self-Efficacy Scale. Result(s): The number of patients with moderate-to-severe average pain was significantly lower in group 1 than in group 2 (n=19, 18% vs n=19, 38%; P=.04), and group 1 had significantly higher patient self-efficacy scores (mean 29.3, SD 7.5 vs mean 25.2, SD 8.7; P=.01). Least pain scores were lower in group 1 compared with group 2 across all 3 consecutive postoperative days (PODs): POD1 (mean 2.8, SD 0.8 vs mean 3.3, SD 0.7; P<.001), POD2 (mean 2.2, SD 0.8 vs mean 2.7, SD 0.5; P<.001), and POD3 (mean 1.7, SD 0.7 vs mean2.2, SD 0.4; P<.001). Similarly, average pain intensity was lower in group 1 compared with group 2 across all 3 consecutive PODs: POD1 (mean 3.7, SD 0.9 vs mean 4.7, SD 0.6; P<.001); POD2 (mean 3.3, SD 0.8 vs mean 3.6, SD 0.5; P=.01); and POD3 (mean 2.5, SD 0.8 vs mean 3.1, SD 0.5; P<.001). General activity was significantly less affected in group 1 on POD 1 (mean 4.3, SD 1.0 vs mean 5.0, SD 1.5; P=.004) and POD 2 (mean 3.1, SD 0.7 vs mean 3.7, SD 1.3; P=.009). Conclusion(s): The use of an SMS-based educational intervention significantly improved the postoperative pain experience of pediatric patients undergoing thoracic surgery. Further research is needed to clarify its impact on clinical outcomes and to better understand the mechanisms underlying improved pain management. Copyright © Yun Shi, Qianqiu Wang, Aihua Liu, Li Jiang. <108> Accession Number 2046251528 Title Risk prediction models for postoperative delirium in adult patients undergoing cardiac surgery: a systematic review and meta-analysis. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 489. Date of Publication: 01 Dec 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, Jiangsu, Nanjing, China (Wang, Wang) Nursing Department, Zhongda Hospital, School of Medicine, Southeast University, Jiangsu, Nanjing, China (Du, Shen, Sun) Anesthesiology, Surgery and Pain Management Department, Zhongda Hospital, School of Medicine, Southeast University, Jiangsu, Nanjing, China (Cao) Cardiovascular Surgery Department, Zhongda Hospital, School of Medicine, Southeast University, Jiangsu, Nanjing, China Publisher BioMed Central Ltd Abstract Background: Postoperative delirium (POD), a frequent complication following cardiac surgery, is associated with adverse clinical outcomes. Despite the development of numerous prediction models for estimating the risk of POD, the overall performance and methodological quality of these models are not well understood. Objective(s): To systematically review and meta-analyze the performance of prediction models for postoperative delirium in adult patients undergoing cardiac surgery, with a particular emphasis on model discrimination and the identification of key predictors. Method(s): This study included studies that developed or validated multivariable prediction models for POD in adults undergoing cardiac surgery. Ten databases were searched from inception to July 10, 2025. Data extraction followed a standardized form based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) checklist. Risk of bias and applicability were assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed using R software. Result(s): A total of 22 studies comprising 27 prediction models were included. All studies were rated as having a high risk of bias. The pooled area under the curve for modeling cohorts was 0.821 (95% CI: 0.778-0.858; 95%PI: 0.562-0.943), indicating a robust discrimination despite substantial heterogeneity (I2=96.7%, tau2 = 0.3692). Seven significant predictors were identified, including age, history of cerebrovascular disease, cardiopulmonary bypass time, mechanical ventilation time, American Society of Anesthesiologists classification, operative time, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Conclusion(s): Although, existing prediction models for POD in patients undergoing cardiac surgery demonstrate promising performance, the evidence is limited by high risk of bias and heterogeneity across studies. There remains a need to improve methodological rigor, such as multicenter prospective studies and external validation. Relevance to clinical practice: This systematically review provides a reference for the development and validation of subsequent models for adults undergoing cardiac surgery. Although with modest discrimination, future models should focus on the construction of the preoperative models, which provide more opportunities for early prevention. Clinical trial number: PROSPERO: CRD420251081560. Copyright © The Author(s) 2026. <109> Accession Number 2046508544 Title Early Enteral Levothyroxine as Rescue Therapy in Cardiac Surgery Patients With Delayed Neurologic Recovery: A Randomized Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Elghareeb S.; Saleh M.; Abd Al Jawad M.; Monier A. Institution (Elghareeb, Saleh, Monier) Department of Anesthesiology, ICU and Pain Management, Ain Shams University, Cairo, Egypt (Abd Al Jawad) Department of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt Publisher W.B. Saunders Abstract Objectives: To evaluate the efficacy and safety of early enteral levothyroxine as rescue therapy for delayed neurologic and respiratory recovery in adults following on-pump cardiac surgery. Design and Setting: A single-center, randomized, double-blind, placebo-controlled trial conducted at Ain Shams University Hospitals (Cairo, Egypt). Participant(s): Seventy adult patients undergoing cardiac surgery with cardiopulmonary bypass who exhibited delayed recovery, defined as requiring mechanical ventilation for >48 hours or having a Glasgow Coma Scale (GCS) score <15 at 48 hours postoperatively. Intervention(s): Participants were randomized to receive either enteral levothyroxine (25-50 microg/d, titrated by body mass index) or an identical placebo from postoperative day 2 until intensive care unit (ICU) discharge. Measurements and Main Results: The primary outcome was the change in GCS score from intervention initiation (48 hours postoperatively) to ICU discharge. Secondary outcomes included cardiac function (ejection fraction), catecholamine requirements, 30-day mortality, hospital length of stay, and thyroid hormone levels. The levothyroxine group (n = 35) showed significantly greater neurologic recovery (adjusted mean difference [aMD] in GCS score, +7.81; 95% confidence interval [CI], 5.24-10.38; p < 0.001) with a 128% faster recovery rate (p < 0.001). Cardiac function improved (attenuated ejection fraction decline; aMD, +12.99%; p < 0.001) with 41% to 63% lower catecholamine needs (p <= 0.01). Treatment with levothyroxine was associated with a significantly lower 30-day mortality rate (14.3% v 45.7%; adjusted hazard ratio, 0.24 [95% CI, 0.09-0.65]; p = 0.005). Given the small number of events (n = 21), this finding should be considered exploratory. Hospital stay was longer in the levothyroxine group (13.1 days v 10.3 days, p = 0.005), attributed to survivorship bias. Levothyroxine normalized thyroid hormone levels, and each 1-pg/mL increase in free triiodothyronine correlated with a 2.1-point gain in GCS score (p < 0.001). Conclusion(s): Early enteral levothyroxine administration in cardiac surgery patients with delayed postoperative recovery was associated with significantly accelerated neurologic recovery and improved cardiac function. The observed reduction in 30-day mortality is hypothesis generating and requires confirmation in a larger, multicenter trial. These findings support further investigation into the integration of thyroid hormone replacement into perioperative care for this high-risk subgroup. Copyright © 2026 Elsevier Inc. <110> Accession Number 2046523241 Title ROLE OF ARTIFICIAL INTELLIGENCE IN MODERN SURGERY: APPLICATIONS AND LIMITATIONS. Source International Journal of Drug Delivery Technology. 16(56 Supplement) (pp 338-347), 2026. Date of Publication: 2026. Author Kour A.; Ahluwalia A.S.; Chawla S. Institution (Kour) Department of Surgery, MMIMSR, Mullana, Haryana, Ambala, India (Ahluwalia) Department of Minimal Access and Bariatric Surgery, MMIMSR, Mullana, Haryana, Ambala, India (Chawla) Department of General Surgery, MMIMSR, Mullana, Haryana, Ambala, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract In the healthcare industry, especially in surgery, Artificial Intelligence (AI) has become one of the most revolutionary technological advances. AI has taken numerous steps to enhance the precision of diagnosis, surgical planning, surgical guidance, robotic assistance, postoperative monitoring, and predictive analytics in surgical practice. These technologies, such as machine learning algorithms, deep learning systems, natural language processing and computer vision, have helped healthcare professionals analyse vast clinical data and make surgical decisions based on evidence, while improving efficiency and accuracy. AI-powered robotic surgical systems have optimized minimally invasive surgeries, decreased surgical complications, increased precision and shortened recovery times. While these progressions have been promising, there are significant challenges ahead with the implementation of AI in surgical practice, including ethical issues, data privacy concerns, algorithmic bias, legal liability, technical constraints, and costs. This is a review paper in which the role of AI in modern surgery has been critically examined with a particular focus on its applications in AI-assisted diagnosis and surgical planning, robotic assistance in surgical procedures and ethical concerns related to the use of AI in healthcare systems. Studying methodology is adopted in a narrative review based on current literature, published clinical evidence and technological evaluation based on peer-reviewed research articles that are identified by the international scientific databases. The clinical impact and significance of AI-based surgical systems have been reviewed and assessed through the systematic analysis of numerical data on surgical outcomes, diagnostic accuracy, surgical efficiency, and minimizing the risk of complications. The results show that AI-assisted surgery has significantly improved diagnostic sensitivity, decreased surgical mistakes, increased precision, and optimized patient outcomes in various surgical specialties such as neurosurgery, cardiovascular surgery, orthopedic surgery, gastrointestinal surgery, and oncological surgery. But issues of ethics surrounding patient confidentiality, transparency, informed consent, and reliance on algorithmic systems are substantial hurdles to universal adoption. AI has significant promise to transform the nature of surgery in the future through its ability to enable precision medicine, predictive analytics, and autonomous assistance, but the full integration will require thorough regulatory frameworks, interdisciplinary collaboration and ethical governance to ensure sustainability. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <111> Accession Number 2046502373 Title Anticholinergic Burden as a Modifiable Risk Factor in Cardiac Surgery: A Randomized Controlled Study. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Cobas M.; Demir Z.A.; Aykut A.; Ozsan N.; Yigit C.A.; Kurtbeyoglu S.; Katipoglu B.; Akca O. Institution (Cobas, Demir, Aykut, Ozsan, Yigit, Kurtbeyoglu) Department of Anesthesiology and Reanimation, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey (Katipoglu) Department of Geriatrics, University of Health Sciences, Balikesir Ataturk City Hospital, Balikesir, Turkey (Akca) Department of Anesthesiology & Critical Care Medicine, School of Medicine, Johns Hopkins University, Johns Hopkins Hospital, Baltimore, MD, United States Publisher W.B. Saunders Abstract Objectives: This study assessed whether reducing immediate perioperative anticholinergic burden improves functional recovery in older patients undergoing coronary artery bypass grafting (CABG). Design(s): Prospective randomized controlled study. Setting(s): Single-institution tertiary care hospital. Participant(s): One hundred twenty-two patients aged >=60 years with preoperative Anticholinergic Cognitive Burden scores >=3. Intervention(s): Patients were assigned to either standard anesthetic and/or analgesic care including anticholinergic drugs (standard group) or a deprescribing strategy avoiding perioperative anticholinergic anesthetic and analgesic drugs (deprescribing group). Measurements and Main Results: Primary outcomes were functional recovery on postoperative day 90 assessed using the Katz Index and the Clinical Frailty Scale. On postoperative day 90, full independence (Katz Index score of 6) was significantly more frequent in the deprescribing group than in the standard group (75.0% v 41.1%, p < 0.001). Frailty scores were significantly lower in the deprescribing group at 90 days (median, 3 [interquartile range (IQR), 3-3] v 4 [IQR, 3-4]; p < 0.001). Multivariate logistic regression identified perioperative use of anticholinergic anesthetic and analgesic drugs as an independent predictor of 90-day total complications (odds ratio, 2.430; 95% confidence interval, 1.031-5.726; p = 0.042). Within-group analyses showed decreased frailty scores and increased Katz Index scores from baseline to day 90 in the deprescribing group (p < 0.001 for both), whereas the standard group showed increased frailty (p < 0.001) with no significant change in Katz Index scores (p = 0.317). Conclusion(s): In older CABG patients, immediate perioperative deprescribing of anticholinergic medications improved 90-day functional recovery trajectories and was associated with fewer cardiac and pulmonary complications. Anticholinergic burden may represent a modifiable perioperative risk factor that should be routinely addressed in surgical care pathways to optimize outcomes in older adults. Copyright © 2026 Elsevier Inc. <112> Accession Number 2046509657 Title Objective Evaluation of Three-Dimensional Models for Training Congenital Cardiac Surgeons: A Systematic Review. Source World Journal for Pediatric and Congenital Heart Surgery. (no pagination), 2026. Date of Publication: 2026. Author Francis J.; Brophy S.; George A.; Hussein N. Institution (Francis) Department of Cardiac Surgery, St Thomas' Hospital, London, United Kingdom (Francis) Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom (Brophy) Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom (George) Department of Anaesthesiology, University of Arkansas for Medical Sciences, Little Rock, United States (Hussein) Department of Paediatric Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom Publisher SAGE Publications Inc. Abstract Objectives: This systematic review aimed to evaluate the types, validity, and outcomes of objective assessment tools used to measure surgeon performance during congenital cardiac surgical training using three-dimensional (3D) models. Method(s): A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted from inception to December 2025 in accordance with PRISMA guidelines. Original studies reporting objective educational, technical, or performance-based assessments of surgeons undergoing surgical training using 3D congenital heart models were included. Result(s): Of 1359 records identified, 9 studies met the inclusion criteria. Objective assessments included procedure-specific checklists, global rating scales, time-based measures, and correlated clinical outcomes. Objective assessments consistently demonstrated improvements in technical performance and procedural accuracy, and reductions in task completion time, following simulation-based training. Evidence of skill retention was reported in a subset of studies employing repeated objective testing. Objective assessment of nonoperative technical skills and transferability to the operating room was reported infrequently and remained methodologically limited. Conclusion(s): Objective assessment using 3D heart models provides a measurable and reproducible means of developing technical skills and anatomical understanding in congenital and pediatric cardiac surgery. While simulation cannot fully replicate the complexity of the operative experience, these models may support early procedural planning, build strategies for anatomical exposure, and structured skills acquisition in a training environment increasingly limited by case complexity and operative opportunities. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). <113> [Use Link to view the full text] Accession Number 2046235989 Title Comparison of the effect of intravenous acetaminophen and oral acetaminophen in the prevention of delirium in the elderly after heart surgery: a randomized controlled trial. Source International Journal of Surgery Open. 64(3) (pp 158-164), 2026. Date of Publication: 01 Jun 2026. Author Nikzad-Jamnani A.; Taziki J.; Sabaghi M.; Boskabadi S.J.; Kargar-Soleimanabad S.; Khazaee M. Institution (Nikzad-Jamnani) Department of Anesthesiology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Iran, Islamic Republic of (Taziki) Department of Anesthesiology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Sabaghi, Kargar-Soleimanabad, Khazaee) Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Boskabadi) Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of Publisher Lippincott Williams and Wilkins Abstract Background: - Pain is one of the important causes of delirium. Recent studies have reported some evidence of the appropriate effect of acetaminophen in delirium. Therefore, this study aimed to determine the effect of intravenous (IV) acetaminophen with oral acetaminophen on the incidence of delirium after cardiac surgery. Method(s): - This study was a double-blind randomized clinical trial. Patients with available inclusion criteria were randomly allocated into either the oral or IV acetaminophen groups. In the IV group, 1 gram of acetaminophen was administered every 8 hours after the cardiac surgery, and continued until the first 48 hours. In the oral group, 500 mg of acetaminophen was administered every 6 hours for 48 hours. In addition, both groups received morphine (PRN) for pain, and the dosage and repetition were recorded. The primary outcome was the incidence of delirium based on the Richmond Agitation Sedation Scale scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Result(s): - There was no significant difference in pain level between the two groups (P > 0.05). The mean dose of morphine was higher in the oral acetaminophen group, but no significant difference was observed between the two groups (P > 0.05). There was no significant difference between the two groups in terms of delirium incidence and ICU length of stay (P > 0.05). Conclusion(s): - According to the results of the present study, it seems that the administration of IV and oral acetaminophen does not statistically significant effect in terms of pain intensity, surgical complications, and delirium. Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc. <114> Accession Number 651403420 Title eNutriCardio improves diet quality in NHS cardiac rehabilitation patients: a randomised controlled study. Source Proceedings of the Nutrition Society. Conference: Nutrition Society Winter Conference 2026. London United Kingdom. 85(OCE1) (pp E52), 2026. Date of Publication: 01 May 2026. Author Kelly E.; Weech M.; Fallaize R.; Brunton M.; Dymott L.; Mark S.; Weller J.; Hollywood A.; Gray C.; Dunmore K.; Lovegrove J.; McKenna C.; Hwang F. Institution (Kelly, Weech, Hollywood, Lovegrove, Hwang) University of Reading, United Kingdom (Fallaize) University of Hertfordshire, United Kingdom (Brunton, Dymott, Mark, Weller, Gray, Dunmore, McKenna) Royal Berkshire Hospital, United Kingdom Publisher Cambridge University Press Abstract Cardiovascular disease (CVD) is a leading cause of death in the UK, and cardiac rehabilitation (CR) is recommended post-myocardial infarction to improve outcomes. However, uptake remains low due to referral barriers, logistical challenges, and limited resources. Poor diet is a modifiable risk factor for CVD, yet access to tailored nutrition support within CR is limited. NICE guidance recommends personalised dietary advice as part of C(1), and remote delivery of personalised nutrition may offer a scalable solution to improve diet quality and support equitable CR access. eNutriCardio is a novel web-based personalised nutrition advice (PNA) tool adapted from the validated eNutri web-app(2), originally developed for the general population(3). This study investigated the effectiveness of eNutriCardio in improving diet quality in UK NHS patients offered CR. Patients eligible for CR completed a validated food frequency questionnaire (FFQ) via eNutriCardio shortly after their cardiac event or procedure. Participants were randomised to receive either usual care (including CR programme) (control) or usual care plus eNutriCardio PNA (intervention). The PNA was tailored to individual FFQ responses and an 11-component diet quality score (DQS), providing food-based recommendations to improve their three lowest scoring DQS components, where a higher score reflects greater adherence to UK dietary guidance. Intervention participants received coaching emails at weeks 2, 4 and 8, prompting participants to set and reflect on healthy eating intentions. After 12 weeks, both groups repeated the FFQ and provided feedback. An independent samples t-test compared change in overall DQS between groups (primary outcome). Targeted analysis (paired samples t-tests) explored whether change in DQS differed between PNA components that intervention participants intended to change versus components they either did not intend to change nor received advice about. The study was registered with ClinicalTrials.gov (ID: NCT05449769) and conducted according to the principles outlined in the Declaration of Helsinki. Twenty-seven participants were included in the present analysis (intervention: n=13; control: n=14). Baseline characteristics were not significantly different between groups: mean age 61 years (SD 8), 82% male, and mean BMI 27.9 kg/m2 (SD 5.4). Intervention participants showed a 54% greater increase in total DQS (+21.2 points, out of 100) compared with control participants (+9.8 points) after 12 weeks (p=0.036). Within the intervention group, changes in DQS component scores were 80% higher for components participants intended to change versus those without intentions or advice (p<=0.001). No significant difference in BMI change was observed. All intervention participants agreed that eNutriCardio PNA helped them eat healthier and should be offered to all CR-eligible patients. Adding eNutriCardio PNA to usual care improved diet quality significantly more than usual care alone in NHS patients offered CR. This digital tool may enhance CR by offering a remote, personalised nutrition solution for patients unable to attend in-person programmes. <115> Accession Number 2044456198 Title Year in Review 2025: Noteworthy Literature in Cardiac Anesthesiology. Source Seminars in Cardiothoracic and Vascular Anesthesia. 30(2) (pp 103-114), 2026. Date of Publication: 01 Jun 2026. Author Yao A.; Asseff D.; Badakhsh O.; Jamal A.; Li D.; Liu H.; Peterfreund G.; Weitzel N. Institution (Yao, Asseff, Badakhsh, Jamal, Li, Liu, Peterfreund, Weitzel) Department of Anesthesiology and Pain Medicine, University of California, Davis Health, Sacramento, CA, United States Publisher SAGE Publications Inc. Abstract Cardiac anesthesiology continues to evolve as new evidence reshapes practice across multiple domains of patient care. The pace and volume of publication make it increasingly difficult for clinicians to identify studies that are most likely to change day-to-day practice. We performed a structured search of major bibliographic databases and targeted high-impact journals to identify significant cardiac anesthesia research published in 2025. Of 639 records identified, 24 publications were selected by three reviewers based on methodological rigor, clinical relevance, and anticipated impact on perioperative management. The included literature clustered into six themes: prevention of acute kidney injury, blood conservation and coagulation management, multimodal analgesia and opioid-sparing strategies, Enhanced Recovery After Surgery (ERAS) protocols with emphasis on ventilation strategies and delirium prevention, point-of-care ultrasound applications, and workforce sustainability. Together, these studies highlight a continued shift from reactive rescue to proactive optimization-before, during, and after cardiac surgery. This review summarizes the most practice-informing cardiac anesthesiology publications from 2025 to support evidence-based decision-making at the bedside. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). <116> Accession Number 651399546 Title Multimodal opioid-free anesthesia containing esketamine versus opioid-based anesthesia: a systematic review and meta-analysis. Source BMC anesthesiology. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Fang Y.; Gao M.; Wang X.; Zheng B.; He M.; Zeng X.; Shi Y.; Li L.; Zhang B.; Xu Y.; Gong X. Institution (Fang, Zheng, He, Zeng, Shi, Li, Zhang, Xu) Department of Pain, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei Province, China (Gao) Department of Anesthesiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China (Wang, Gong) Department of Anesthesiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei Province, China Abstract INTRODUCTION: The paradigm shift toward opioid-free anesthesia (OFA) is gaining traction, yet evidence regarding specific viable alternatives remains fragmented. This meta-analysis comprehensively evaluates the efficacy and safety of multimodal OFA regimens containing esketamine compared to traditional opioid-based anesthesia (OBA). METHOD(S): This study conducted a systematic review and meta-analysis by searching the electronic databases PubMed, The Cochrane Library, Web of Science, and Embase, including randomized controlled trials published from inception to September 20, 2024. The included studies had to feature at least one OFA group (defined as a multimodal regimen containing esketamine), where opioids were not used during the preoperative phase, anesthetic induction, intraoperative maintenance, or before anesthesia recovery. RESULT(S): A total of 14 RCTs (1,703 patients) were analyzed. Regarding the primary outcomes, postoperative pain scores at 24 h (MD = -0.07; 95% CI: -0.27, 0.13; moderate certainty) and 48 h (MD = 0.00; 95% CI: -0.29, 0.30; moderate certainty) showed no statistically significant differences between the groups. However, multimodal OFA regimens containing esketamine demonstrated a reduced risk of chronic postoperative pain based exclusively on data from only two thoracic surgery trials (RR = 0.64; 95% CI: 0.44, 0.92; low certainty). Regarding secondary outcomes, the OFA group showed a significantly lower incidence of intraoperative hypotension (RR = 0.29; 95% CI: 0.17, 0.49; high certainty) and postoperative nausea and vomiting (PONV) (RR = 0.47; 95% CI: 0.27, 0.79; high certainty). No statistically significant differences were detected in extubation time, PACU length of stay, rescue analgesia requirements, or the incidence of nightmares or hallucinations. Notably, substantial statistical heterogeneity was observed across several outcomes, including pain scores, PONV, extubation time, and PACU length of stay. CONCLUSION(S): Multimodal OFA regimens containing esketamine provide comparable postoperative analgesia to opioid-based anesthesia while reducing PONV and intraoperative hypotension. However, these findings represent combined multimodal effects across heterogeneous settings, and potential benefits for chronic pain prevention should be viewed strictly as hypothesis-generating. TRIAL REGISTRATION: PROSPERO ID: CRD42024588900. Copyright © 2026. The Author(s). <117> Accession Number 651399775 Title Perineural dexamethasone as an adjuvant to erector spinae plane block for acute and chronic pain after cardiac surgery. Source Scientific reports. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Linares L.A.R.; Martinez R.C.R.; Carvalho V.H.; Navarro E Lima L.H.; Zeferino S.P.; Carneiro J.O.; Galas F.R.B.G. Institution (Linares) University of Sao Paulo School of Medicine, Sao Paulo, Brazil (Linares) InCor, Sao Paulo, Brazil (Martinez) Hospital Sirio-Libanes, Sao Paulo, Brazil (Martinez) IPq-FMUSP, Sao Paulo, Brazil (Carvalho) UNICAMP, Campinas, Brazil (Navarro E Lima) University of Manitoba, Winnipeg, MB, Canada (Zeferino, Carneiro, Galas) University of Sao Paulo School of Medicine, Sao Paulo, Brazil (Zeferino, Galas) InCor, Sao Paulo, Brazil Abstract Pain control after cardiac surgery remains suboptimal. The erector spinae plane (ESP) block offers a safer regional alternative to neuraxial techniques, but its duration is limited. We tested whether perineural dexamethasone added to bilateral ESP blocks reduces acute postoperative pain intensity and attenuates chronic post surgical pain (CPSP) after coronary artery bypass grafting (CABG). In this randomized, double-blind trial (NCT04313959), 43 patients undergoing elective CABG received bilateral ESP blocks with 0.2% ropivacaine alone (control, n = 21) or ropivacaine plus 8 mg perineural dexamethasone (dexamethasone, n = 22). Primary Outcome: pain intensity at rest on postoperative day 1, measured using the numerical rating scale (NRS). Pre-specified secondary outcomes were mechanical ventilation duration, 48-hour opioid consumption, and pain interference at 30, 60, and 90 days measured using the Brief Pain Inventory (BPI). The primary outcome was not significantly different between groups: NRS pain at rest on day 1 was 1.35 +/- 1.95 (control) vs. 1.57 +/- 2.27 (dexamethasone), p = 0.781 (Fig. 1). Acute pain scores and 48-hour opioid consumption were comparable (Fig. 3). Mechanical ventilation was shorter in the dexamethasone group (median 11.6 vs. 14.7 h; p = 0.041; Table 2). At 30 days, no significant between-group differences were found in any BPI domain (all p > 0.05; Table 3). At 60 days, pain intensity scores were lower in the dexamethasone group (composite score 0.47 +/- 0.88 vs. 1.21 +/- 1.28; p = 0.019; Table 3; Fig. 2). By 90 days, all outcomes were comparable (all p > 0.05). One procedure-related adverse event occurred (pneumothorax, control group). Addition of dexamethasone to ropivacaine did not add to the reduction of acute pain. The secondary exploratory findings of shorter mechanical ventilation time and lower pain intensity at 60 days are hypothesis-generating and should be evaluated using larger, adequately powered multicenter trials with intraoperative blinding and a systemic comparator arm.Trial registry: NCT04313959. Copyright © 2026. The Author(s). <118> Accession Number 2038239235 Title Donning gloves before patient contact, with or without prior hand hygiene. Source Journal of Infection in Developing Countries. 20(5) (pp 750-754), 2026. Date of Publication: 01 May 2026. Author Bayhan G.I.; Altuntas C.A.; Cevahir N. Institution (Bayhan) Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey (Altuntas) Ankara City Hospital, Department of General Pediatrics, Ankara, Turkey (Cevahir) Ankara Yildirim Beyazit University, Faculty of Medicine, Department of Microbiology, Ankara, Turkey Publisher Journal of Infection in Developing Countries Abstract Objective: Hand hygiene (HH) is a fundamental infection prevention measure in healthcare settings, playing a crucial role in reducing healthcare-associated infections (HAIs). Despite its importance, HH compliance remains suboptimal worldwide. A common error is omitting HH before donning gloves, specifically during WHO Moment 1 ("Before touching a patient"). This study investigates bacterial contamination associated with direct gloving and its potential implications for infection control. Method(s): A randomized controlled trial included nurses and doctors preparing to touch patients in the pediatric cardiovascular surgery intensive care unit. Participants were divided into two groups: (1) "HH prior to gloving" (HH performed before donning gloves) and (2) "direct gloving" (no HH before gloves). For each group, 129 samples were collected. Bacterial counts on gloved hands were compared between groups and against bare hands. Result(s): The total bacterial colony counts on gloved hands were similar between the HH prior to gloving group and the direct gloving group (p = 0.559). However, bacterial colony counts on gloved hands in both groups were significantly lower compared to bare hands (p = 0.0001, p = 0.0001). Conclusion(s): Direct gloving did not increase bacterial contamination on gloves relative to HH before gloving. However, given the established benefits of HH in broader infection control practices, further research is needed to assess the impact of both or separate HH and gloving techniques across different clinical settings. Copyright © 2026 Bayhan et al. <119> Accession Number 651399368 Title A rare case of relapsed primary pulmonary synovial sarcoma (PPSS) following surgery with multidisciplinary team management: case report and systematic review of literature. Source Journal of cardiothoracic surgery. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Haj Khalaf M.A.; Higaze M.; Kikoyan H.; Hartmann A.; Agaimy A.; Stohr R.; Rieker R.; Sirbu H. Institution (Haj Khalaf) Department of Thoracic Surgery, Erlangen University Hospital, Krankenhausstr. 12, Erlangen, Germany (Haj Khalaf) Erlangen University Hospital, Faculty of Medicine, Friedrich-Alexander University Erlangen-Nurnberg (FAU), Erlangen, Germany (Higaze, Kikoyan, Sirbu) Department of Thoracic Surgery, Erlangen University Hospital, Krankenhausstr. 12, Erlangen, Germany (Higaze, Kikoyan, Hartmann, Agaimy, Stohr, Rieker, Sirbu) Erlangen University Hospital, Faculty of Medicine, Friedrich-Alexander University Erlangen-Nurnberg (FAU), Erlangen, Germany (Hartmann, Agaimy, Stohr, Rieker) Pathology Institute, Erlangen University Hospital, Erlangen, Germany Abstract BACKGROUND: Primary pulmonary synovial sarcoma (PPSS) is a rare and invasive subtype of soft tissue sarcoma that originates in the lung. Because of its rare incidence, nonspecific presentation, and radiographic overlap with other thoracic malignancies, diagnosis is often delayed. This systematic review aims to synthesize evidence to improve clinical management of such case presentations. METHOD(S): This systematic review was conducted and reported in accordance with the PRISMA statement, which guided the literature search strategy, data extraction, and data management. To ensure structured and consistent data collection, the PICO framework was applied to define the population, intervention, comparison, and relevant outcomes for each individual reported case of primary pulmonary synovial sarcoma (PPSS). Methodological quality of the included reports was assessed using the Murad tool for case reports and case series. The search targeted single-case reports and case series published through April 2025. In addition, we report a 58-year-old male patient with a confirmed primary pulmonary synovial sarcoma (PPSS). Treatment was provided by a multidisciplinary team (MDT) at the Department of Thoracic Surgery, University Hospital Erlangen. RESULT(S): The result of our systematic review revealed a total of 146 PPSS cases. Geographical distribution: Asia (56.6%, 82 cases), the Americas (21.4%, 31), Europe (20%, 29), and Africa (2%, 4). The majority of reported patients were male (61.6%, 90), and (29.5%, 43) reported smoking. The surgical resection was performed in (91.1%, 133), chemotherapy in (51.4%, 75), and radiotherapy in (24.0%, 35). Most patients underwent open surgical resection (72.6%), predominantly lobectomy (65.1%), reflecting advanced tumor size at diagnosis, with 80.1% of tumors measuring >= 3 cm. The monophasic subtype was the most common (62.3%, 91), followed by the biphasic subtype (22.0%, 32) and the poorly differentiated subtype (15.8%, 23). At the time of publication, the reported patient shows no evidence of disease (NED). CONCLUSION(S): PPSS requires early diagnosis and multidisciplinary management. Surgical resection is still the most important measure, supplemented by chemotherapy and/or radiotherapy. However, recurrence remains a major challenge. Further research is needed to standardize treatment and improve outcomes. Copyright © 2026. The Author(s). <120> Accession Number 2046250095 Title Perioperative pulmonary infection prevention and management in adult patients after coronary artery bypass grafting: a summary of best evidence. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 488. Date of Publication: 01 Dec 2026. Author Peng Y.; Chen Y.; Hu Q.; Guo B.; Chen N.; Xu D.; Gao C.; Hu F. Institution (Peng, Chen, Hu, Guo, Gao) Department of Cardiovascular Surgery, Zhongnan Hospital of Wuhan University, #169 East Lake Road, Wuchang Distr, Hubei, Wuhan, China (Peng) Hubei Provincial Engineering Research Center of Minimally Invasive Cardiovascular Surgery, Hubei, Wuhan, China (Chen) Wuhan Clinical Research Center for Minimally Invasive Treatment of Structural Heart Disease, Hubei, Wuhan, China (Gao) State Key Laboratory of Metabolism and Regulation in Complex Organisms, Hubei, Wuhan, China (Chen, Xu) Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Hubei, Wuhan, China (Hu) Department of Nursing, Zhongnan Hospital of Wuhan University, #169 East Lake Road, Wuchang Distr, Hubei, Wuhan, China (Hu) Center for Critical Care and Anesthesia Nursing Research, Wuhan University, Hubei, Wuhan, China Publisher BioMed Central Ltd Abstract Background: Coronary artery bypass grafting is an important surgical treatment for coronary heart disease. As an open thoracic procedure, pulmonary infection is a common and potentially serious complication of coronary artery bypass grafting. Its occurrence may prolong mechanical ventilation, increase hospital length of stay, and raise mortality risk. This study therefore aims to evaluate and summarise the evidence for the prevention and management of perioperative pulmonary infection in patients undergoing coronary artery bypass grafting to inform clinical practice. Method(s): This evidence summary adheres to the standardised reporting framework of the Fudan University Centre for Evidence-Based Nursing (Registration No: ES20246831). The process encompassed clinical question identification, evidence retrieval, literature screening, methodological quality assessment, and evidence synthesis and grading. A systematic search was conducted from January 1, 2015, to December 31, 2025, across the following databases: UpToDate; BMJ Best Practice; the UK National Institute for Health and Care Excellence; the Registered Nurses' Association of Ontario; the National Guideline Clearinghouse; the Scottish Intercollegiate Guidelines Network; the Guidelines International Network; the Cochrane Library; the JBI Evidence Synthesis Database; PubMed; Web of Science; the China National Knowledge Infrastructure; Wanfang Data; and the Medlive Guidelines Network. Literature types included clinical decisions, guidelines, expert consensuses, systematic reviews, and evidence summaries. Result(s): This study included 19 publications comprising 2 clinical decisions, 2 guidelines, 2 expert consensuses, 6 systematic reviews, and 7 evidence summaries. It synthesised 4 themes and 23 best practice recommendations covering four critical phases: risk assessment and optimisation; preoperative early exercise and prehabilitation; intraoperative safety strategies and anaesthetic management; and postoperative respiratory exercise and rehabilitation. Conclusion(s): This study systematically synthesised 23 evidence-based measures for preventing and managing pulmonary infection in coronary artery bypass grafting patients. Collectively, these measures form a systematic approach to pulmonary infection prevention and management. Implementation of these recommendations may enable healthcare providers globally to enhance the quality and standardization of perioperative coronary artery bypass grafting care, while reducing the incidence of perioperative pulmonary infections and associated prognostic burden. Copyright © The Author(s) 2026. <121> Accession Number 2046352237 Title Quantifying Radiation Exposure Across Cardiac Catheterization Procedures. Source Diagnostics. 16(11) (no pagination), 2026. Article Number: 1636. Date of Publication: 01 Jun 2026. Author Khaled M.F.I.; Rahman M.W.; Mahabub S.M.E.E.; Ahmed S.; Munna M.M.H.; Islam M.M.; Kamal M.H.M.; Zaman S.M.M.; Banerjee S.K.; Mandal M.R.M. Institution (Khaled, Rahman, Mahabub, Munna, Zaman, Banerjee, Mandal) Department of Cardiology, Bangladesh Medical University, Dhaka, Bangladesh (Ahmed) Department of Cardiology, Bangladesh Specialized Hospital, Dhaka, Bangladesh (Islam) Department of Animal Resources, Ministry of Municipality, Doha, Qatar (Kamal) Department of Radiology and Imaging, Bangladesh Medical University, Dhaka, Bangladesh Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Coronary angiography and percutaneous coronary intervention are essential procedures for managing coronary artery disease but expose patients and healthcare personnel to ionizing radiation. Radiation exposure varies with procedural complexity and vascular access route, and repeated occupational exposure in catheterization laboratories (cath-labs) has been linked to serious health hazards among operators. Objective(s): Given the high procedural volume and limited routine monitoring at Bangladesh Medical University (BMU), Bangladesh, this study aimed to quantify operator radiation exposure and identify factors influencing radiation dose. Method(s): This analytical cross-sectional study was conducted from November 2023 to April 2024 in two cardiac cath-labs at BMU using two Siemens Axiom Artis angiography systems. Patient, operator, and procedural data, including demographics, operator experience, procedure type, vascular access route, fluoroscopic view, procedure duration, and radiation exposure, were collected from randomly selected routine procedures. Operator radiation exposure was measured at four working positions using a dosimeter, and cumulative annual exposure was estimated based on procedural workload. Descriptive, univariable, and multivariable analyses were performed to identify factors associated with radiation exposure. Result(s): The study analyzed 776 procedures, in which most patients were aged 46-65 years and male. The majority of procedures were coronary angiography performed via the femoral route. On average, each procedure required 14.28 fluoroscopic views and lasted 8.16 min, with a mean radiation exposure of 1034.5 mGy. Procedural complexity, radial access, and stent use were associated with higher fluoroscopic views, longer procedure time, and increased radiation exposure. Multivariable analysis showed that procedure type and stent number are primarily determinants for the number of fluoroscopic views, while procedure time was mainly driven by imaging demand and vascular access route. Radiation exposure was strongly associated with both procedure time and the number of views, and was higher among male and older patients but slightly lower with femoral access and among older operators. Direct measurements showed higher radiation levels near the operator's X-ray beam, while estimated annual operator exposure remained low inside the lead apron (0.03-0.05 mSv) compared with outside the lead apron (0.6-1.1 mSv), which is within the limit of internationally accepted cumulative absorbed radiation. Conclusion(s): This study provides the first comprehensive evaluation of operator radiation exposure in a cardiac cath-lab in the country and the wider region. Procedural characteristics, particularly fluoroscopy use and procedural complexity, were the primary determinants of radiation exposure, while effective shielding and increased distance substantially reduced operator dose. These findings highlight the importance of imaging optimization and consistent implementation of the ALARA principle through structured radiation safety training and careful procedural planning to further minimize occupational exposure. Copyright © 2026 by the authors. <122> Accession Number 2046061579 Title Catheter-Based Foetal Cardiac Interventions: Literature Review. Source Fetal Diagnosis and Therapy. (pp 1-20), 2026. Date of Publication: 23 Mar 2026. Author Chow P.-c. Institution (Chow) Cardiology Centre, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong, China Publisher S. Karger AG Abstract Abstract - Background: Foetal cardiac interventions (FCIs) represent a groundbreaking advancement in maternal-foetal medicine, offering therapeutic strategies to address congenital heart defects (CHDs) in utero. Summary: The indications, techniques, complications, and outcomes of the three most reported FCIs, namely, foetal aortic valvuloplasty, foetal pulmonary valvuloplasty, and foetal atrial septal intervention, were systematically reviewed based on the published literature. The challenges and future directions of this field were also highlighted. Key Messages: FCIs open the therapeutic opportunity of several severe CHDs. However, the selection of cases for best outcome is yet to be refined due to lack of randomized controlled trial. Copyright © 2026 S. Karger AG, Basel <123> Accession Number 2046061430 Title Efficacy and Safety of No-Touch versus Conventional Saphenous Vein Harvesting in Coronary Artery Bypass Grafting: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Cardiology (Switzerland). (pp 1-15), 2026. Date of Publication: 27 Feb 2026. Author Chen X.; Zhang X.; Xiang X.; Fang X.; Wei F.; Liu Y.; Feng S. Institution (Chen, Fang, Wei, Feng) Department of Cardiology, Dazhou Second People's Hospital, Dazhou, China (Zhang) Department of Otorhinolaryngology Head and Neck Surgery, Dazhou Second People's Hospital, Dazhou, China (Xiang) Department of Critical Care Medicine, Chengdu Fifth People's Hospital, Chengdu, China (Liu) Department of Thoracic, Cardiovascular and Breast Surgery, Dazhou Second People's Hospital, Dazhou, China Publisher S. Karger AG Abstract Abstract - Introduction: Saphenous vein graft (SVG) failure is a key determinant of long-term outcomes after coronary artery bypass grafting (CABG), particularly in individuals with multivessel disease or diabetes. This meta-analysis aimed to evaluate whether the no-touch SVG harvesting technique reduces graft occlusion and improves cardiovascular outcomes compared with the conventional approach. Method(s): A comprehensive literature search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted up to May 2025 to identify randomized controlled trials (RCTs) comparing the no-touch and conventional saphenous vein harvesting techniques in CABG. A random-effects model was used for meta-analysis, and the certainty of evidence was evaluated using the GRADE framework. Result(s): Eight RCTs involving 4, 258 CABG patients (no-touch: 2, 144; conventional: 2, 114) were included. The no-touch technique significantly reduced the risk of vein graft occlusion (risk ratio, 0.59; 95% CI: 0.47-0.73; p < 0.00001; I2 = 31%). Subgroup analyses confirmed the consistency of this effect across regions and follow-up durations. Although differences in secondary outcomes - including all-cause and cardiovascular mortality, myocardial infarction, stroke, and repeat revascularization - were not statistically significant, most effect estimates favored the no-touch approach. The certainty of evidence was rated as moderate for the primary and several secondary outcomes according to the GRADE assessment. Conclusion(s): This meta-analysis shows that no-touch saphenous vein harvesting is associated with a lower risk of graft occlusion compared with conventional harvesting in CABG. However, current randomized evidence does not demonstrate a definitive improvement in major cardiovascular outcomes. These findings highlight the need to balance angiographic benefits against potential trade-offs and underscore the need for large-scale, event-driven randomized trials to clarify the net clinical benefit of this technique. Copyright © 2026 S. Karger AG, Basel <124> Accession Number 2046324225 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. 26(1) (no pagination), 2026. Article Number: 499. Date of Publication: 01 Dec 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, The First Hospital of Hebei Medical University, 89 Donggang Road, Hebei Province, Shijiazhuang, China (Wang) Department of Cardiac Function and Rehabilitation, The First Hospital of Hebei Medical University, Shijiazhuang, China (Zhang) Department of Otolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital, Shijiazhuang, China Publisher BioMed Central Ltd Abstract Background: Anxiety, depression, and reduced quality of life are common after coronary artery bypass grafting (CABG), yet participation in traditional center-based cardiac rehabilitation (CBCR) is limited by access barriers. This study aims to compare the effectiveness of a home-based telerehabilitation (HBTCR) program with CBCR in improving psychological and quality-of-life outcomes for post-CABG patients. Method(s): In this prospective randomized controlled trial, 110 clinically stable patients 4-8 weeks post-CABG were allocated to a 12-week HBTCR program (wearable monitoring, mobile app, weekly nurse support), CBCR (supervised center sessions), or usual care. Primary outcomes were changes in Hamilton Anxiety (HAMA) and Depression (HAMD-17) scores. The secondary outcome was change in health-related quality of life (SF-36). Result(s): Both HBTCR and CBCR groups demonstrated significant and comparable improvements compared to usual care (mean HAMA change: -8.3 vs. -7.9 vs. -1.1, P < 0.001; HAMD-17: -9.5 vs. -9.1 vs. -1.5, P < 0.001). No significant difference was found between HBTCR and CBCR. Quality of life improved significantly across all SF-36 domains in both intervention groups versus control (P < 0.01). Conclusion(s): A structured home-based telerehabilitation program is as effective as traditional center-based rehabilitation in alleviating psychological distress and enhancing quality of life after CABG. HBTCR represents a vital, accessible alternative to deliver comprehensive cardiac rehabilitation and overcome participation barriers. Trial registration: This trial was retrospectively registered at ClinicalTrials.gov (identifier: NCT07232693, Registration date: 2025-11-14). Copyright © The Author(s) 2026. <125> Accession Number 2046510039 Title Perioperative Normoxia Versus Hyperoxia in Cyanotic Congenital Heart Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source World Journal for Pediatric and Congenital Heart Surgery. (no pagination), 2026. Date of Publication: 2026. Author Goncalves L.B.; Delgado L.M.; Oliveira R.E.N.D.N.; Carvalho E.D.A.; Loftin M.; Tenorio D.F. Institution (Goncalves) Universidade Federal de Uberlandia, Minas Gerais, Uberlandia, Brazil (Delgado, Carvalho) Universidade Federal de Minas Gerais, Minas Gerais, Belo Horizonte, Brazil (Oliveira) Department of Thoracic Surgery, Barretos Cancer Center, Sao Paulo, Barretos, Brazil (Loftin, Tenorio) Department of Cardiothoracic and Vascular Surgery, University of Texas at Austin, Austin, TX, United States Publisher SAGE Publications Inc. Abstract Background: Optimal oxygenation strategies during cardiopulmonary bypass (CPB) in children with cyanotic congenital heart disease remain controversial. Although hyperoxia has traditionally been used to compensate for chronic hypoxemia, concerns exist regarding reoxygenation injury and oxidative stress. This systematic review and meta-analysis aimed to compare perioperative normoxic versus hyperoxic strategies during CPB in this population. Method(s): We performed a literature search in MEDLINE, Embase, and the Cochrane Library from inception to November 2025. Random-effects models were used to pool risk ratios (RRs) for binary outcomes and mean differences for continuous outcomes. Heterogeneity was assessed using the I2 statistic, and risk of bias was evaluated using the RoB 2 tool. Result(s): Five randomized controlled trials comprising 241 children were included, with 121 patients allocated to normoxia and 120 to hyperoxia. There were no statistically significant differences between groups in all-cause mortality (RR 1.31; 95% confidence interval [CI] 0.37-4.67; P = .67; I2 = 0%). Postoperative recovery outcomes, including intensive care unit (ICU) stay, ventilation time, length of hospital stay, and duration of inotropic support, were also comparable. Operative parameters (CPB time and aortic cross-clamp time) and safety outcomes, such as neurological complications, arrhythmias, and cardiac arrest, did not differ significantly between strategies. Conclusion(s): In children with cyanotic congenital heart disease undergoing surgery with CPB, normoxic, and hyperoxic oxygenation strategies were associated with statistically similar mortality, recovery, operative, and safety outcomes. These findings suggest that carefully monitored normoxic strategies may represent a safe and physiologically sound alternative to routine hyperoxia during CPB. Copyright © The Author(s) 2026 <126> Accession Number 2046501984 Title Perioperative Management: HeartMate 3 Left Ventricular Assist Devices in Non-Cardiac Surgery. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author O'Callaghan L.; Walsh D.; Mulligan D.; Merdad M.; Luk A.; Billia F.; Rao V.; Wasowicz M.; Griffin M.; Efrimescu C. Institution (O'Callaghan, Walsh, Mulligan, Griffin, Efrimescu) Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland (Merdad, Luk, Billia, Rao, Wasowicz) Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada (Luk, Billia, Rao, Wasowicz) University of Toronto, Toronto, Canada (Griffin) School of Medicine, University College Dublin, Dublin, Ireland Publisher W.B. Saunders Abstract The HeartMate 3 (HM3) left ventricular assist device is currently the most widely used left ventricular assist device worldwide. Advances in technology have enabled its use both as a bridge to transplant and as destination therapy. The HM3's fully magnetically levitated rotor, wider blood flow pathways, and artificial pulse technology have significantly improved hemocompatibility and reduced the incidence of pump thrombosis, stroke, and gastrointestinal bleeding. As a result, the HM3 offers greater durability and fewer complications than its predecessors. With the growing disparity between organ availability and transplant demand, anesthesiologists are increasingly likely to encounter patients supported by HM3 devices in both cardiac and non-cardiac surgical settings. A thorough understanding of the HM3's function, physiological implications, and potential perioperative complications is essential for safe anesthetic management. This narrative review explores the underlying physical principles of the HM3, key technical parameters necessary for monitoring device function, and perioperative management strategies. Topics include multidisciplinary team coordination, anesthetic approach and monitoring, relevant cardiac physiology, and the management of common emergencies. Although cardiac anesthesiologists are ideally suited to manage these complex cases, this may not always be possible. Therefore, it is imperative that all anesthesiologists, particularly those practicing in mechanical circulatory support centers-develop a comprehensive understanding of the HM3 system. Copyright © 2026 <127> Accession Number 2046300609 Title Clinical Utility and Limitations of Traditional Risk Scores (EuroSCORE, EuroSCORE II, and STS-PROM) in Patients Undergoing TAVI: A Narrative Review. Source Journal of Clinical Medicine. 15(11) (no pagination), 2026. Article Number: 4113. Date of Publication: 01 Jun 2026. Author Klausa F.; Swiatoniowska-Lonc N.; Skotny A.; Mak M.A.; Wysokinska-Kordybach A.; Skiba J.; Sciborski K.; Banasiak W.; Doroszko A. Institution (Klausa, Mak, Skiba) Department of Cardiac Surgery, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland (Swiatoniowska-Lonc, Wysokinska-Kordybach, Sciborski, Banasiak, Doroszko) Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, Wroclaw, Poland (Skotny) Clinical Research Support Center, 4th Military Hospital, Wroclaw, Poland (Skotny) Harvard T.H. Chan School of Public Health-Executive and Continuing Education, Harvard University, Boston, MA, United States (Sciborski, Banasiak, Doroszko) Clinical Department of Cardiology, Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract The rapid evolution of structural heart interventions, particularly transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge repair (TEER), and hybrid procedures, has significantly expanded treatment options for elderly, frail, and multimorbid patients previously considered high risk or inoperable. However, perioperative risk stratification in this population remains challenging. Traditional risk scores such as EuroSCORE, EuroSCORE II, STS-PROM, CHA<inf>2</inf>DS<inf>2</inf>-VASc, and HAS-BLED were developed and validated primarily in cohorts undergoing conventional open-heart surgery (CABG and surgical valve replacement) more than 15-25 years ago. This narrative review critically evaluates the performance and limitations of these classical models in contemporary populations undergoing modern structural cardiac interventions. Evidence from registries and meta-analyses indicates only moderate discriminatory ability and systematic calibration errors. EuroSCORE II and STS-PROM frequently overestimate risk in low- and intermediate-risk patients while underestimating it in high-risk and frail individuals, particularly regarding neurological, renal complications, and prolonged hospitalization. Similar limitations apply to CHA<inf>2</inf>DS<inf>2</inf>-VASc and HAS-BLED when used beyond their original scope in the peri-procedural setting of TAVI/TEER. The review highlights the growing role of frailty assessment, procedure-specific variables, and machine learning algorithms, which demonstrate superior predictive performance compared to conventional scores. Until dedicated, regularly updated risk models based on large TAVI/TEER registries become available, traditional scores should be used only as supportive tools within multidisciplinary Heart Team discussions that incorporate individual frailty, quality of life, and patient preferences. Copyright © 2026 by the authors. <128> Accession Number 2046474123 Title Left Atrial Appendage Closure versus Oral Anticoagulants in Patients with Atrial Fibrillation: Systematic Review. Source Clinical and Applied Thrombosis/Hemostasis. (no pagination), 2026. Date of Publication: 2026. Author Liu H.; Li Z.; Chen X.; Zhou J. Institution (Liu, Li) Department of Cardiology, Heyuan People's Hospital, Heyuan, China (Chen) Department of Cardiology, Heyuan People's Hospital, The First Clinical College of Guangdong Medical University, Heyuan, China (Zhou) Department of Critical Care Medicine, Heyuan People's Hospital, Heyuan, China Publisher SAGE Publications Inc. Abstract Background: Oral anticoagulants (OACs) remain the standard strategy for stroke prevention in atrial fibrillation (AF) but are limited by bleeding risk, intolerance, and long-term adherence challenges. Left atrial appendage closure (LAAC) has emerged as a catheter-based alternative for thromboembolic prevention in non-valvular AF. This systematic review evaluated the comparative efficacy and safety of LAAC versus OAC therapy in patients with AF. Method(s): PubMed and Embase were systematically searched for randomized controlled trials (RCTs) comparing percutaneous LAAC with OACs, including direct oral anticoagulants (DOACs) and warfarin, in patients with AF. Result(s): Four pivotal randomized trials (PROTECT AF, PREVAIL, PRAGUE-17, and OPTION) were included. Compared with DOAC therapy, LAAC demonstrated non-inferiority for the composite endpoint of all-cause death, stroke, or systemic embolism in OPTION and for the primary composite outcome in PRAGUE-17. LAAC was associated with significantly lower non-procedural bleeding compared with DOACs in OPTION and PRAGUE-17. Compared with warfarin, LAAC achieved non-inferiority for ischemic stroke or systemic embolism beyond 7 days after randomization in PREVAIL and reduced long-term cardiovascular mortality in PROTECT AF. Procedure-related complications declined with increasing operator experience. Conclusion(s): LAAC provides non-inferior thromboembolic protection compared with OAC therapy while reducing long-term bleeding events in selected patients with AF. LAAC represents an important alternative for patients at elevated bleeding risk or with contraindications to long-term anticoagulation. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). <129> Accession Number 2038235515 Title ASSESSMENT OF CARDIOVASCULAR PHYSIOLOGICAL CHANGES IN PATIENTS UNDERGOING OPEN VERSUS LAPAROSCOPIC ABDOMINAL SURGERY A COMPARATIVE STUDY. Source International Journal of Medicine and Public Health. 16(2) (pp 2823-2829), 2026. Date of Publication: 01 Apr 2026. Author Hoda H.; Hoda Z. Institution (Hoda) Department of Physiology, Mansarovar Medical College and MGU Hospital, Village Gadia Bilkisganj Sehore M.P, Sehore, India (Hoda) Jharkhand National Hospital, Purulia Road Kantatoli Jharkhand, Ranchi, India Publisher Pink Petals Publications Pvt Ltd Abstract Background: Abdominal surgeries, both open and laparoscopic, are associated with significant physiological alterations, particularly affecting the cardiovascular system. Laparoscopic surgery, though minimally invasive, involves pneumoperitoneum which may induce distinct hemodynamic changes compared to open surgery. Aim(s): To assess and compare cardiovascular physiological changes in patients undergoing open versus laparoscopic abdominal surgery. Objective(s): To evaluate intraoperative cardiovascular parameters in patients undergoing open abdominal surgery. To assess cardiovascular physiological changes in patients undergoing laparoscopic abdominal surgery. To compare cardiovascular responses between the two surgical techniques. Material(s) and Method(s): This prospective comparative observational study was conducted on 120 patients undergoing elective abdominal surgeries at a tertiary care hospital. Patients were divided into two groups: open surgery (n = 60) and laparoscopic surgery (n = 60). Baseline demographic and clinical parameters were recorded. Intraoperative cardiovascular parameters including heart rate, systolic and diastolic blood pressure, mean arterial pressure, and oxygen saturation were monitored at predefined intervals. Data were analyzed using SPSS software. Independent and paired t-tests and Chi-square tests were applied, with p < 0.05 considered statistically significant. Result(s): Both groups showed significant intraoperative increases in heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure (p < 0.001). However, the magnitude of increase was significantly higher in the laparoscopic group compared to the open surgery group (p < 0.05). A higher proportion of patients in the laparoscopic group experienced heart rate rise >20 beats/min and intraoperative hypertension requiring intervention. Oxygen saturation showed a slight decline in both groups, which was not clinically significant. Conclusion(s): Laparoscopic abdominal surgery is associated with more pronounced cardiovascular physiological changes compared to open surgery, primarily due to pneumoperitoneum and increased intra-abdominal pressure. Adequate intraoperative monitoring and careful anesthetic management are essential to minimize potential cardiovascular complications. Copyright © 2026, Pink Petals Publications Pvt Ltd. All rights reserved. <130> Accession Number 2046248137 Title Evaluation of a multi-component intervention aimed at reducing time to treatment in transcatheter aortic valve implantation: Protocol for a cluster randomized controlled trial. Source Archives of Cardiovascular Diseases. (no pagination), 2026. Date of Publication: 2026. Author Chevreul K.; Michel M.; Hariz A.J.; Beziau-Gasnier D.; Iung B.; Durand E.; Didier R.; Gilard M.; Eltchaninoff H. Institution (Chevreul, Michel, Hariz) ECEVE, UMR 1123, Inserm, Universite Paris Cite, Paris, France (Chevreul, Michel, Hariz) Assistance Publique-Hopitaux de Paris, Hopital Robert-Debre, Service de sante publique, equipe REPERES, 75019, Paris, France (Beziau-Gasnier, Durand, Eltchaninoff) INSERM U1096, Universite de Rouen Normandie, Rouen, France (Beziau-Gasnier, Durand, Eltchaninoff) CHU Rouen, Department of Cardiology, Rouen, France (Beziau-Gasnier, Durand, Eltchaninoff) Institut Alain Cribier, Rouen, France (Iung) INSERM LVTS 1148, Universite Paris-Cite 75018, Paris, France (Iung) Cardiology Department, Bichat Hospital, AP-HP, 75018, Paris, France (Didier, Gilard) INSERM UMR1304-GETBO, University of Brest, Brest, France (Didier, Gilard) Cardiology Department, CHU Brest, Brest, France Publisher Elsevier Masson s.r.l. Abstract Background Transcatheter aortic valve implantation (TAVI) has become widely used to treat symptomatic patients with aortic stenosis (AS), but increasing demand has led to treatment delays, which are associated with increased morbi-mortality. Aims To reduce time to treatment in patients awaiting a TAVI, we constructed a multi-component intervention which includes (1) a paper- and internet-based component aimed at improving AS and TAVI knowledge and (2) an organizational component aimed at TAVI centres to improve scheduling of examinations and procedures. Their effectiveness, cost-effectiveness and implementation were evaluated in a cluster randomized controlled trial (cRCT). Methods The cRCT (NCT_05237804) used a factorial design to evaluate the two components of the intervention, alone and together. The cluster was the TAVI centre. As patients may be referred to TAVI centres by regional hospitals, participating regional hospitals were included in the cluster of their referral TAVI centre. Clusters were allocated to one of four treatment groups after stratification on annual number of TAVI procedures, presence of a coordinating nurse and participation of a regional hospital. Patients aged >= 18 years with symptomatic AS and a TAVI indication were included in the study. The expected sample size was 798 patients. The primary outcome is the percentage of patients treated within 2 months of the TAVI indication. Secondary outcomes are time to treatment, mortality, quality of life, knowledge regarding TAVI and AS, medication compliance and incremental cost-effectiveness ratios. Implementation measures include dose, fidelity, adaptations, reached population, satisfaction and acceptability. Trial status Overall, 828 patients have been enrolled. Data had not been analysed at the time the protocol was submitted. Copyright © 2026 The Authors. <131> Accession Number 2046395954 Title Effects of digoxin in modern heart failure treatment: Rationale and design of the DIG-Mod HF trial. Source Revista Portuguesa de Cardiologia. (no pagination), 2026. Date of Publication: 2026. Author Valentim Goncalves A.; Cardim N.; Fiarresga A.; Pereira-da-Silva T.; Ilhao-Moreira R.; Galrinho A.; Rio P.; Carvalheiro R.; Ferreira F.; Lopes J.; Marques Antunes M.; Selas M.; Viana B.; Domingues L.; Cruz Ferreira R. Institution (Valentim Goncalves, Fiarresga, Pereira-da-Silva, Ilhao-Moreira, Galrinho, Rio, Carvalheiro, Ferreira, Lopes, Marques Antunes, Selas, Viana, Cruz Ferreira) Departamento de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Universitario de Lisboa Central. Centro Clinico Academico de Lisboa, Lisboa, Portugal (Valentim Goncalves, Cardim, Fiarresga, Pereira-da-Silva) NOVA Medical School, Centro Clinico Academico de Lisboa, Lisboa, Portugal (Valentim Goncalves, Cardim, Rio) Hospital CUF Descobertas, Lisboa, Portugal (Domingues) NOVA Clinical Research Unit - NOVA CRU, NOVA Medical School, Lisboa, Portugal Publisher Sociedade Portuguesa de Cardiologia Abstract Aims: Even though it is the oldest heart failure (HF) medication still in use, digoxin has not been evaluated alongside the updated algorithm for treating HF with reduced ejection fraction patients. This could help explain the low use of digoxin in recent HF studies. The main objective is to assess the effectiveness of digoxin in functional capacity and cardiac function when combined with modern HF therapy. Method(s): An interventional, open-label, randomised, crossover trial among adults with chronic Heart Failure and reduced ejection fraction (<=45%) was designed to allocate 50 patients for 24 weeks in each arm (48 weeks of study). The arms are daily intake of digoxin 0.125 mg plus standard of care versus standard of care alone. Both patients with sinus rhythm and atrial fibrillation were enrolled. At the end of each 24-week arm, patients will undergo the co-primary outcome measurement of the peak oxygen consumption, evaluated through cardiopulmonary exercise test, and the global work index, measured by transthoracic echocardiography. Key secondary outcome includes a safety composite of death, need for urgent heart transplantation or mechanical assist device, total hospitalizations and sustained ventricular arrhythmias. The study completed recruitment in April 2025 and will complete follow up in March 2026. Conclusion(s): The use of digoxin could be significantly affected by evidence that it still has a considerable effect on functional capacity and cardiac function in HF patients. EU CT Number: 2024-513448-26-00. Copyright © 2026 Sociedade Portuguesa de Cardiologia <132> Accession Number 2046228246 Title Randomized Clinical Trial Comparing Effects of Pulsatile vs Nonpulsatile Cardiopulmonary Bypass on Neurologic Outcomes. Source Annals of Thoracic Surgery. (no pagination), 2026. Date of Publication: 2026. Author Rajesh S.; Dayi K.; Lussier M.J.; McKeone D.J.; Halstead E.S.; Kunselman A.R.; Myers J.L.; Undar A. Institution (Rajesh, Dayi, Lussier, McKeone, Halstead, Kunselman, Myers, Undar) Penn State Hershey Pediatric Cardiovascular Research Center, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, PA, United States (McKeone) Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States (Halstead) Division of Pediatric Hematology/Oncology, Division of Pediatric Critical Care Medicine, Penn State College of Medicine, Hershey, PA, United States (Halstead) Department of Molecular and Precision Medicine, Penn State College of Medicine, Hershey, PA, United States (Kunselman) Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States (Myers, Undar) Division of Pediatric Cardiology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States (Myers, Undar) Department of Surgery, Penn State College of Medicine, Hershey, PA, United States (Undar) Department of Biomedical Engineering, College of Engineering, The Pennsylvania State University, University Park, PA, United States Publisher Elsevier Inc. Abstract Background The objective of this secondary analysis was to examine the impact of 2 perfusion modalities on S100 calcium-binding protein B (S100B) levels and neural injury outcomes in patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB). Methods Pediatric patients (aged <18 years) were randomly assigned to nonpulsatile or pulsatile perfusion. S100B levels were measured in patients at 5 time points (baseline before incision, 3 to 5 minutes on pump, right before weaning from CPB, 1 hour after CPB, and 24 hours after CPB). All patients were assessed for short-term clinical outcomes and with chart review for postsurgical neural injury: stroke, seizure, white matter injury, developmental delays, behavioral issues, memory loss, unexplained loss of consciousness, hearing impairment, and attention-deficit/hyperactivity disorder. Results A total of 144 consecutive patients were enrolled (70 nonpulsatile, 74 pulsatile). Pulsatile perfusion produced CPB characteristics similar to those of nonpulsatile perfusion and created a greater pulsatility index in the middle cerebral artery and arterial line. S100B levels at all measured time points were similar between both perfusion modalities. A total of 36 patients had neural injuries (15 nonpulsatile, 21 pulsatile). Additionally, S100B levels at all measured time points were similar in patients with and without neural injury. In all groups, S100B levels rose during CPB and were greatest before weaning from CPB and 1 hour after CPB. The 24-hour S100B levels had a weak association with clinical outcomes (0.25 < r <inf> S </inf> <0.5). Conclusions The choice of perfusion modality did not appear to affect S100B levels. Additionally, the measurements of S100B may not be sufficiently sensitive to predict neural injury reliably in patients with congenital heart defects who are undergoing CPB. Copyright © 2026 The Society of Thoracic Surgeons. <133> Accession Number 2046492130 Title Balancing the evidence with the SPAQI recommendations: from perioperative discontinuation towards continuation of SGLT2 inhibitors. Source British Journal of Anaesthesia. (no pagination), 2026. Date of Publication: 2026. Author Garcia B.; Dixit A.A.; Legrand M. Institution (Garcia) Department of Intensive Care, Saint-Pierre University Hospital, Universite libre de Bruxelles (ULB), Brussels, Belgium (Garcia, Legrand) French Clinical Research Infrastructure Network-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France (Dixit) Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States (Legrand) Department of Anesthesia & Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States Publisher Elsevier Ltd Abstract The Society for Perioperative Assessment and Quality Improvement consensus recommends a perioperative management strategy for sodium-glucose cotransporter 2 inhibitors based on surgical type, metabolic context, and underlying indication. This risk-stratified approach balances the low but real risk of euglycaemic ketoacidosis against established cardio-renal benefits. Current evidence is limited and suggests that euglycaemic ketoacidosis is driven more by metabolic context, particularly diabetes mellitus and fasting, than by drug continuation alone. Importantly, discontinuation could lead to a loss of cardiovascular benefit, whereas emerging data suggest potential perioperative benefits, although evidence remains limited. Overall, these recommendations shift toward a strategy based on euglycaemic ketoacidosis risk factors and careful metabolic monitoring rather than systematic discontinuation pending large randomised controlled trials. Copyright © 2026 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <134> Accession Number 2046453758 Title 3D Printing for Mitral Valve Disease: A Systematic Review. Source Interdisciplinary Cardiovascular and Thoracic Surgery. 41(6) (no pagination), 2026. Article Number: ivag155. Date of Publication: 01 Jun 2026. Author Pavlykova-Chertovska A.; Cheheili Sobbi S.; Lazoryshynets V.; Sardari Nia P. Institution (Pavlykova-Chertovska, Cheheili Sobbi, Sardari Nia) Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands (Lazoryshynets) Amosov National Institute of Cardiovascular Surgery, National Academy of Medical Science of Ukraine, Kyiv, Ukraine Publisher Oxford University Press Abstract Objectives: Mitral valve disease remains one of the most prevalent and complex cardiac conditions, with treatment strategies varying based on anatomical and pathological factors. The heterogeneity in mitral valve morphology complicates standardized treatment, highlighting the importance of procedural planning and surgical training. This systematic review evaluates current techniques, materials, and clinical applications of 3D printing in mitral valve disease, with a focus on procedural planning and simulation. Method(s): A comprehensive literature search of PubMed and MEDLINE databases was conducted to identify studies published from 1996 to August 2025. A total of 63 studies were included, all involving 3D printing technologies related to mitral valve disease. Extracted data covered imaging modalities, software tools, printing techniques, materials used, total time required for model creation, and clinical applications. Result(s): CT, 3D transoesophageal echocardiography, and MRI were the main imaging modalities, with CT being the most common. Data segmentation and model generation were performed using software such as Mimics, 3D Slicer, and Philips QLAB. The primary 3D printing techniques were stereolithography, fused deposition modelling, and PolyJet, using photopolymer resins and thermoplastics. Total processing time-from image acquisition to model completion-ranged from 45 min to 72 h, depending on complexity. Applications included procedural planning, surgical training, and the development of medical and simulation-based educational devices. Conclusion(s): 3D printing enhances mitral valve surgery by enabling precise planning and training. Although challenges like standardization and accessibility persist, advances in imaging, software, and materials are expected to expand its clinical impact. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. <135> Accession Number 2046393607 Title The 2026 American Association for Thoracic Surgery Expert Consensus Document: Evaluation and management of N2+ non-small cell lung cancer. Source Journal of Thoracic and Cardiovascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Linden P.A.; Martin L.W.; Stiles B.; Opitz I.; Chen H.; Spicer J.; Lanuti M.; Tong B.C.; Liberman M.; Bestvina C.M.; Sands J.; Huang J.; Price M.; Samson P.; Boutros C.S.; Rabinovich E.P.; Park B.; D'Amico T.A. Institution (Linden, Boutros) Division of Thoracic and Esophageal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States (Martin) Division of Thoracic Surgery, University of Virginia Health System, Charlottesville, VA, United States (Stiles) Division of Thoracic Surgery, Montefiore Einstein Medical Center, New York, NY, United States (Opitz) Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland (Chen) Division of Thoracic Surgery, Department of Surgery, Fudan University Shanghai Medical Center, Shanghai, China (Spicer) Department of Surgery, McGill University Health Center, McGill University, Montreal, QC, Canada (Lanuti) Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass, United States (Tong, D'Amico) Division of Thoracic Surgery, Department of Surgery, Duke University, Durham, NC, United States (Liberman) Department of Surgery, Centre Hospitalier de L'Universite de Montreal, University of Montreal, Montreal, QC, Canada (Bestvina) Department of Medicine, University of Chicago Medicine, Chicago, Ill, United States (Sands) Department of Medicine, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Mass, United States (Huang, Park) Department of Surgery, Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States (Price) Department of Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex, United States (Samson) Department of Radiation Oncology, Washington University, St Louis, Mo, United States (Rabinovich) Department of Surgery, University of Virginia Health System, Charlottesville, VA, United States Publisher Elsevier Inc. Abstract Objective: Multimodal therapy is recommended for the optimal treatment of N2 positive non-small cell lung cancer (NSCLC). Recent advancements in the use of immune checkpoint inhibitors and targeted therapy have dramatically changed the landscape of treatment. We reviewed recent trials and literature to develop consensus statements concerning the evaluation and treatment of potentially resectable NSCLC with N2 involvement. Method(s): The American Association for Thoracic Surgery Clinical Practice Standards Committee assembled an international panel of medical oncologists, radiation oncologists, radiologists, and thoracic surgeons. A focused literature review was performed with the assistance of a medical librarian. The panel used a modified Delphi method to develop expert consensus statements with class of recommendation and level of evidence on issues related to the treatment of potentially resectable N2 positive NSCLC. Result(s): Consensus was reached on 13 statements on topics related to staging, determinants of unresectable disease, use of chemoimmunotherapy or targeted therapies, proper use of neoadjuvant and/or adjuvant therapy, restaging, and the safety of resection after chemoimmunotherapy. Conclusion(s): NSCLC with N2 disease remains a challenging, heterogeneous disease. These expert consensus recommendations are meant to provide guidance to identify appropriate surgical patients and to formulate the best multimodality treatment of patients with N2-positive NSCLC. Copyright © 2026 The American Association for Thoracic Surgery <136> Accession Number 2046209326 Title Effects of deep parasternal intercostal plane block on opioid consumption and pain after cardiac surgery: a meta-analysis of randomized controlled trials with meta-regression and trial sequential analysis. Source Journal of Clinical Anesthesia. 113 (no pagination), 2026. Article Number: 112259. Date of Publication: 01 Jul 2026. Author Dost B.; Karapinar Y.E.; Turunc E.; Turan E.I.; Beldagli M.; 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 (Turan) Department of Anesthesiology and Reanimation, Health Science University, Istanbul Kanuni Sultan Suleyman Education and Training Hospital, Istanbul, Turkey (Beldagli) Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun, 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 Elsevier Inc. Abstract Objective The deep parasternal intercostal plane (D-PIP) block has been used to relieve pain after cardiac surgery. However, the analgesic efficacy of the D-PIP block in adults undergoing cardiac surgery remains unclear. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing analgesic efficacy of the D-PIP block. PubMed, Embase, CENTRAL, Web of Science, Scopus, ClinicalTrials.gov , and gray literature were searched until February 2026. Trials comparing the D-PIP block with standard or placebo analgesia were pooled using a random-effects model. The primary outcome was 24-h opioid use, expressed as morphine milligram equivalents (MME). Risk of bias was assessed using RoB 2 and certainty using GRADE. Prespecified subgroup analyses, sensitivity analysis, meta-regression for the primary outcome, and trial sequential analysis were performed. Results Seventeen RCTs (n = 1165) were included. The D-PIP block was associated with a reduction in 24-h opioid consumption versus controls (MD -9.38 mg MME; 95% CI -14.72 to -4.03). Substantial heterogeneity was observed across studies (I2 = 98%). Pain scores at rest and movement were lower at all time points with substantial heterogeneity. Postoperative nausea and vomiting (PONV) incidence was significantly reduced in the D-PIP block group (OR 0.30; 95% CI 0.18-0.52), with no observed between-study heterogeneity (I2 = 0%). Extubation time and intensive care unit (ICU) length of stay (LOS) were shorter, while hospital LOS was unchanged. Comparator type explained most heterogeneity. Evidence certainty was low-very low overall and high for PONV. Conclusions There is very low-certainty evidence supporting a modest reduction in 24-h opioid consumption and early postoperative pain with D-PIP block. In contrast, high-certainty evidence supports a significant reduction in the incidence of PONV. Trial registration International Prospective Register of Systematic Reviews (PROSPERO: CRD420261298563) on February 1, 2026. Copyright © 2026 Elsevier Inc. <137> Accession Number 2046441475 Title Comparison of short-term outcome between awake (epidural) and general endotracheal anesthesia in patients undergoing off-pump coronary artery bypass grafting. Source International Journal of Drug Delivery Technology. 16(57 Supplement) (pp 662-669), 2026. Date of Publication: 2026. Author Sazzed-Al-Hossain M.; Rahman K.M.A.; Barua S.; Mahbub K. Institution (Sazzed-Al-Hossain) Department of Cardiac Surgery, National Institute of Cardiovascular Disease and Hospital, Dhaka, Bangladesh (Rahman) Department of Cardiac Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh (Barua) Department of Cardiac Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh (Mahbub) Department of Cardiac Surgery, Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Off-pump coronary artery bypass grafting (OPCABG) helps cut down on complications related to cardiopulmonary bypass. The type of anesthesia used can also play a role in how patients do after surgery. Some suggest that awake OPCABG with thoracic epidural anesthesia could be a better option than the usual general endotracheal anesthesia, possibly leading to better breathing and quicker recovery. Objective(s): To compare short- term outcomes between awake (epidural) anesthesia and general endotracheal anesthesia in patients undergoing OPCABG. Method(s): This prospective observational study was conducted at BSMMU, Dhaka, from March 2017 to February 2019. We enrolled 30 patients, scheduled for elective OPCABG, and split them into two groups. Group A had their surgery with awake thoracic epidural anesthesia, while Group B was given general endotracheal anesthesia. Data were analyzed by SPSS version 23.0. Result(s): After looking into the postoperative lung function measured by FEV1 and PEFR at 24, 48, and 72 hours, we found that the awake epidural group performed significantly better (p<0.05). Patients in this group also had shorter stays in the ICU (p=0.004) and in the hospital (p=0.003). As for hemodynamic stability and complication rates, they were similar across both groups, which suggests that awake anesthesia is both safe and effective. Conclusion(s): Awake thoracic epidural anesthesia in OPCABG was associated with improved postoperative pulmonary function and reduced ICU and hospital stay compared with general endotracheal anesthesia, without increasing perioperative complications. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <138> Accession Number 651386714 Title Does Anatomy Dictate Outcome?: Self-Expanding vs Balloon-Expandable Transcatheter Aortic Valve Replacement in Small and Extra-Small Annuli. Source Cardiology in review. (no pagination), 2026. Date of Publication: 04 Jun 2026. Author Abdelrahman A.K.; Elkholy M.; Arce J.E.; Al-Muhaisen R.; Ahmed K.; Omara G.; Altujjar M.; Leon M.B.; Beohar N. Institution (Abdelrahman, Arce, Al-Muhaisen, Altujjar, Beohar) From the Department of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, Puerto Rico (Elkholy) Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, United States (Ahmed, Omara) Department of Internal Medicine, Faculty of Medicine, Menoufia University, Egypt (Leon) Department of Cardiology, Columbia University Irving Medical Center, New York, NY Abstract The optimal transcatheter aortic valve replacement strategy in patients with a small aortic annulus (SAA) remains unclear. We performed a systematic review and meta-analysis comparing self-expanding valves (SEVs) to balloon-expandable valves (BEVs) in SAA patients. We searched PubMed, Embase, Web of Science, and Scopus for studies comparing SEVs and BEVs in patients with SAA defined by computed tomography. A random-effects model using the Der Simonian and Laird estimator was used to pool odds ratios (ORs) and mean differences (MDs). We identified 25 studies encompassing 13,846 patients (5633 BEV; 8213 SEV). SEVs demonstrated superior hemodynamics, including a larger indexed effective orifice area (MD: 0.20 cm2/m2; P < 0.00001), a lower mean transvalvular gradient (MD: -4.11 mm Hg; P < 0.00001), and a lower risk of severe patient-prosthesis mismatch (OR: 0.37; P < 0.00001). However, SEVs were associated with a higher risk of permanent pacemaker implantation (PPI) (OR: 1.63; P = 0.0008) and moderate or severe paravalvular leak (PVL) (OR: 2.26; P < 0.00001). There was no significant difference in all-cause mortality at 1 year (OR: 0.96; P = 0.55) or stroke at 30 days (OR: 1.34; P = 0.18). Notably, in a subgroup analysis restricted to patients with extra-small annuli (area <400 mm2 or diameter <23 mm), the hemodynamic advantages of SEVs persisted while the elevated risks of PPI and PVL were no longer statistically significant. In patients with SAA, SEVs provide better hemodynamics but carry safety concerns including higher risks of PVL and PPI in the overall population. These risks were not observed in the extra-small annulus subgroup. Valve selection should be individualized based on patient anatomy and procedural risk profile. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <139> Accession Number 2046476428 Title Prophylactic closed-incision negative pressure wound therapy after median sternotomy: a scoping review of surgical site infection prevention bundle reporting and implication for interpretation. Source Journal of Hospital Infection. 173 (pp 230-239), 2026. Date of Publication: 01 Jul 2026. Author Yoshida S.; Ishida O.; Tsutsumi K. Institution (Yoshida, Ishida, Tsutsumi) Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan Publisher W.B. Saunders Ltd Abstract Background: Closed-incision negative pressure wound therapy (ciNPT) is increasingly used to reduce surgical site infection (SSI) after median sternotomy, yet its true preventive effect remains uncertain. Published studies rarely specify which infection prevention measures were used alongside the therapy, making interpretation difficult. Aim(s): In this scoping review, we examined the completeness of reporting of infection prevention practices in studies evaluating ciNPT after cardiac surgery. Method(s): A systematic search of PubMed, Scopus, and the Cochrane Library identified studies of adult cardiac surgery in which negative pressure therapy was applied prophylactically to the closed sternal incision. Information on study design, patient characteristics, therapy protocols, clinical outcomes, and reporting of infection prevention elements was extracted. Reporting was classified as complete, partial, or absent according to 13 components derived from major clinical guidelines. Finding(s): Twenty-five studies met the inclusion criteria. Most studies reported fewer SSIs in patients receiving negative pressure therapy, but none described a complete set of infection prevention measures. Eighty-seven percent of recommended elements were not reported, and selective use of the therapy introduced additional bias. Conclusion(s): The substantial absence of infection prevention reporting limits the interpretability and reproducibility of current evidence. Standardized and transparent documentation is required to better define the preventive value of ciNPT. Copyright © 2026 The Author(s) <140> Accession Number 2046455211 Title Scar-specific outcomes following minimally invasive versus conventional median sternotomy in cardiac surgery: A systematic review and meta-analysis. Source Perfusion (United Kingdom). (no pagination), 2026. Date of Publication: 2026. Author Chhatwal K.; On Chun Siu A.; Arab S.; Salih A.; Shah A.; Arjomandi Rad A.; Chong G.L.W.; Showkat M.; Punjabi S.; Punjabi P. Institution (Chhatwal, Arab, Salih, Showkat) Imperial College School of Medicine, Imperial College London, London, United Kingdom (Chhatwal) National Heart and Lung Institute, Imperial College London, London, United Kingdom (On Chun Siu) Department of Cardiology, Royal Berkshire Hospital Foundation Trust, NHS England, London, United Kingdom (Arab) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Shah) Division of Medicine, University College London Medical School, England, London, United Kingdom (Arjomandi Rad) Department of Cardiothoracic Surgery, Oxford University Foundation Trust, NHS England, England, Oxford, United Kingdom (Chong) School of Medical Sciences, University of Birmingham, England, Birmingham, United Kingdom (Punjabi) Department of Dermatology, London North West Hospitals NHS Trust, London, United Kingdom (Punjabi) Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom Publisher SAGE Publications Ltd Abstract Background: With improved cardiac surgical outcomes, attention has shifted to patient-centred outcomes, including cosmetic appearances of surgical scars. Minimally invasive cardiac surgery (MICS) is often promoted for its cosmetic benefits, yet empirical evidence remains limited. This study aimed to systematically evaluate scar-specific outcomes comparing MICS to conventional full median sternotomy (FMS) in adult cardiac surgery. Method(s): A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, Embase, Central, and Scopus were searched from inception to August 2025. Studies comparing MICS to FMS, reporting scar-related patient-reported outcomes, wound complications, or cosmetic satisfaction, were included. The primary outcome was scar assessment using validated instruments. Random-effects models calculated standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals. Result(s): Twenty-two studies comprising 3131 patients (1459 MICS, 1672 FMS) met inclusion criteria. MICS demonstrated significantly better scar assessment scores (SMD -0.74, 95% CI -1.27 to -0.22; p < 0.01; I2 = 88%, six studies), higher patient satisfaction rates (RR 1.42, 95% CI 1.21-1.66; p < 0.001; I2 = 84%, 12 studies), and reduced wound complications (RR 0.31, 95% CI 0.20-0.47; p < 0.001; I2 = 0%, nine studies). Only six studies reported validated scar assessment scores, highlighting limited integration of these measures. Substantial heterogeneity was observed due to diverse assessment tools and surgical techniques. Conclusion(s): MICS can offer significant advantages in scar-specific outcomes compared to FMS in carefully selected patient populations. Cosmetic outcomes should be interpreted within the context of overall effectiveness and may support shared decision making only when clinical outcomes between surgical approaches are comparable. The lack of standardised scar assessment protocols and limited reporting of cosmetic outcomes represent critical gaps. Future research should prioritise standardised scar evaluation tools and expand cosmetic outcome reporting across all cardiac surgical procedures. Copyright © The Author(s) 2026 <141> Accession Number 651376472 Title Totally Endoscopic Approach for Aortic Valve Replacement: A Single-Arm Meta-Analysis. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Anghel F.; Blindaru A.D.C.; Danet A.; Bistriceanu M.I.A.; Ursu C.G.; Parsan V.I.; Paun M.A.; Badiu C.C. Institution (Anghel, Blindaru, Danet, Badiu) Emergency University Hospital Bucharest, Bucharest, Romania (Bistriceanu, Ursu, Parsan, Paun) "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Publisher Georg Thieme Verlag Abstract Background: Totally endoscopic aortic valve replacement (TE-AVR) is a minimally invasive technique offering potential benefits of reduced surgical trauma and faster recovery compared with median sternotomy or other minimally invasive access. While isolated aortic valve replacement is well established through conventional and minimally invasive access, large-scale evidence for the totally endoscopic approach remains limited. This meta-analysis aimed to systematically assess the safety and feasibility of TE-AVR by aggregating perioperative outcomes, including mortality, stroke, conversion, bleeding, paravalvular leak (PVL), and atrial fibrillation (AF). Method(s): A systematic search of PubMed, Embase, and the Cochrane Library was performed from December 1, 2024, to March 15, 2025, following PRISMA 2020 guidelines. Observational studies and randomized controlled trials reporting outcomes of totally endoscopic or thoracoscopic AVR were eligible. After independent screening and selection, data were analyzed using a single-arm proportion model, with proportions stabilized through the Freeman-Tukey or arcsine transformation. Pooled estimates were calculated using a DerSimonian-Laird random-effects model, with heterogeneity assessed by Cochran's Q and the I2 statistic. Leave-one-out sensitivity analyses were performed to evaluate the influence of individual studies. The protocol was registered in PROSPERO (CRD42024610128). Result(s): A total of 11 studies comprising 1,383 patients were included. The pooled perioperative mortality was 0.5% (95% CI: 0.1-0.8; I2 = 0%), indicating highly consistent results across cohorts. The stroke incidence was 1.1% (95% CI: 0.6-1.7; I2 = 0%), confirming the low cerebrovascular risk of this approach. Conversion to sternotomy occurred in 2.5% of cases (95% CI: 1.1-3.9; I2 = 51%), with heterogeneity not attributable to a single study, suggesting variability in surgical expertise. Reintervention for bleeding occurred in 0.4% (95% CI: 0.0-0.7; I2 = 20%), while PVL was reported in 0.7% (95% CI: 0.2-1.2; I2 = 21.9%). AF incidence showed high heterogeneity, with subgroup analysis revealing clustering around 5% and 25%, likely due to differences in reporting methodology. Conclusion(s): TE-AVR is a safe and feasible technique associated with very low perioperative mortality, bleeding, and stroke rates, as well as low PVL incidence. Variability in AF reporting underscores the need for future randomized studies with harmonized definitions. Overall, TE-AVR offers a promising minimally invasive alternative for aortic valve replacement, with potential advantages in recovery, hospital stay, and aesthetic outcomes. <142> Accession Number 651376387 Title Mitral Valve Re-Repair After Failed Primary Repair: An Individual Patient Data Meta Analysis. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Al-Tawil M.; Kolat P.; Kovalova J.; Kolashov A.; Donovan T.J.; Diab A.H.; Haneya A. Institution (Al-Tawil, Kolat, Kovalova, Kolashov, Donovan, Diab, Haneya) Department of Cardiac and Thoracic Surgery, Heart Center Trier, Trier, Germany Publisher Georg Thieme Verlag Abstract Background: Failed primary mitral valve repair (MVr) is increasingly observed as the number of procedures rises. Growing experience and emerging evidence suggest that, when technically feasible, re-repair should be actively considered. To better understand its outcomes, we performed an up-to-date meta-analysis of the available evidence. Method(s): A comprehensive literature search was conducted to identify studies reporting outcomes of reoperation after failed primary MVr, published up to July 2025. An individual patient data meta-analysis was performed by extracting and digitizing relevant data from the included studies. The primary outcome was overall survival compared with valve replacement. Secondary outcomes included freedom from a third reoperation and freedom from moderate or greater mitral regurgitation. Result(s): A total of nine studies from eight centers were included in the analysis, comprising 341 patients who underwent re-repair and 799 patients who underwent valve replacement. Ten-year survival was significantly higher in the re-repair group compared with the replacement group (78.3% vs. 58.3%; HR: 2.44, 95% CI: [1.79-3.33], p < 0.001). Regarding freedom from reoperation, patients who underwent re-repair had lower freedom from a third mitral reoperation compared with those who received valve replacement (84.7% vs. 96.5%, p = 0.003). At 8 years of follow-up, freedom from moderate or greater mitral regurgitation in the re-repair group was 64.9 +/- 7%. Conclusion(s): Mitral valve re-repair after failed primary MVr is safe and durable when technically feasible, offering favorable survival and preservation of native valve function. The mode and timing of repair failure largely guide the decision-making process. <143> Accession Number 651376449 Title Comparing Sutures vs. Staples for Leg Wound Closure after Coronary Artery Bypass Grafting: A Randomized Controlled Trial. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Grossmann C.; Schumacher N.; Krasivskyi I.; Djordjevic I.; Gerfer S.; Kuhn E.; Rosenberg K.; Conradi L.; Wahlers T.; Eghbalzadeh K. Institution (Grosmann) Department of Cardiology, University Hospital Cologne, Deutschland, Cologne, Germany (Schumacher, Krasivskyi, Djordjevic, Gerfer, Kuhn, Conradi, Wahlers, Eghbalzadeh) Universitatsklinik Koln, Koln, Germany (Rosenberg) Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany Publisher Georg Thieme Verlag Abstract Background: Postoperative wound complications following saphenous vein harvesting delay recovery after coronary artery bypass grafting (CABG), increase morbidity, and prolong hospitalization. To date, no clear recommendations exist regarding the optimal surgical wound closure technique in this context. Two methods-conventional intracutaneous suture technique and staple closure-are commonly employed, with the choice primarily depending on the surgeon's preference. Method(s): In this prospective, randomized, single-center study, a total of 301 patients were included in the study. Of these, 151 patients were randomized for leg wound closure with intracutaneous sutures, while 150 were selected to have their leg wound closed with staples. The modified intention to treat population due to intraoperative changes, protocol deviations (cross-over), and exclusions included 122 patients in the staples group and 130 patients in the suture group. The primary endpoint was a composite of surgical site complications and infections within 6 months after the procedure. Result(s): A surgical site complication within 6 months after the operation, defined as the development of a surgical site infection or disturbance of wound healing, occurred in 31 out of 122 (25.4%) patients in the staples group and in 40 out of 130 patients (30.7%) in the suture group, with no statistically significant difference (p = 0.728). A surgical site infection was found in 3.3% of patients in the stapler group and 8.5% of patients in the suture group (p = 0.082). Female gender (p = 0.357), age (p = 0.732), and diabetes (p = 0.266) were not significant risk factors for wound complications. However, an elevated BMI (>25 kg/m2) was significantly associated with an increased incidence of wound complications (p = 0.004). Among the exogenous risk factors, elevated blood glucose levels 6 hours postoperatively (p = 0.007) and 12 hours postoperatively (p = 0.002) were identified as significant risk factors. Additionally, a prolonged ICU stay was associated with the occurrence of surgical site complications (p = 0.024). Conclusion(s): The incidence of surgical site complications following conventional saphenous vein harvesting in CABG remains high. While the use of staplers showed a slight advantage in terms of surgical site infections, this effect was not statistically significant for the primary endpoint at follow-up. We were able to show a significant association between elevated blood glucose levels and wound complications, highlighting the importance of postoperative glycaemic control. Therefore, postoperative management may be more important than the choice of the surgical technique. <144> Accession Number 651376351 Title Percutaneous Coronary Intervention vs. Coronary Artery Bypass Grafting in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Contemporary Evidence. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Kirov H.; Caldonazo T.; Hieber C.I.; Runkel A.; Dadashzadeh A.; Mukharyamov M.; Fischer J.K.; Doenst T. Institution (Kirov, Caldonazo, Hieber, Runkel, Dadashzadeh, Mukharyamov, Fischer, Doenst) Klinik fur Herz- und Thoraxchirurgie am Universitatsklinikum Jena, Jena, Germany Publisher Georg Thieme Verlag Abstract Background: In the setting of acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) is the predominant invasive strategy when urgent restoration of coronary perfusion is required. Coronary artery bypass grafting (CABG) is undertaken in only a minority of patients, typically in the presence of complex coronary anatomy, left main disease, or failed PCI. Current European and American guidelines recommend PCI as the primary approach in ACS, reserving CABG for selected high-risk patients or specific subgroups. However, these recommendations are largely based on expert consensus, extrapolation from stable coronary artery disease trials, or observational studies, as no randomized controlled trials (RCTs) directly comparing CABG and PCI in the context of ACS exist. This lack of high-level evidence creates uncertainty regarding the optimal treatment strategy in this high-risk population. We therefore performed a meta-analysis of the available contemporary evidence. Method(s): We systematically searched three databases, selecting studies published in the last 10 years comparing PCI and CABG in ACS. The primary outcome was long-term mortality. Secondary outcomes were short-term mortality, myocardial infarction (MI), major adverse cardiac events (MACE), and stroke. For long-term outcomes, pooled Kaplan-Meier survival curves after reconstruction of individual patient data were generated. Result(s): A total of 15 studies totaling 179,158 patients were included. In the pooled Kaplan-Meier analysis, CABG showed significantly better long-term survival (HR: 0.746, 95% CI, 0.73-0.76, p < 0.001). During the observation period, CABG was also associated with lower rates of MACE (HR: 0.733, 95% CI, 0.68-0.79, p < 0.001) and MI (HR: 0.671, 95% CI, 0.64-0.70, p < 0.001). All other outcomes did not differ significantly.(Table Presented) Conclusion(s): CABG is associated with superior long-term survival compared to PCI in patients with ACS. This survival advantage is associated with fewer MACE and MI. <145> Accession Number 651376452 Title Fresh Frozen Plasma Compared to Crystalloid as Priming Solution for Cardiopulmonary Bypass in Left Ventricular Assist Device Implantation. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Bonni S.; Zayat R.; Sales M.C.; Ramnath N.W.M.; Tewarie L.; Moza A. Institution (Bonni, Zayat, Sales, Ramnath, Tewarie, Moza) RWTH Aachen University Hospital, Aachen, Germany Publisher Georg Thieme Verlag Abstract Background: Fresh frozen plasma (FFP) is frequently used in pediatric cardiac surgery as a priming solution for cardiopulmonary bypass (CPB) to mitigate bleeding and reduce perioperative complications; however, robust evidence to support this practice is limited, and data in adult cardiac surgery are even scarcer. The aim of this study was to evaluate the effect of CPB priming with FFP on perioperative outcomes, particularly postoperative bleeding, transfusion requirements, hemodynamic stability, and mortality in patients undergoing left ventricular assist device (LVAD) implantation. Method(s): We conducted a retrospective analysis of 80 patients who underwent LVAD implantation at our institution between January 2021 and April 2025. Patients were stratified according to the CPB priming strategy, comparing plasma-based (n = 35) with crystalloid-based (n = 45) priming solutions. Co-primary outcomes were chest tube drainage volume as a measure of postoperative bleeding, requirement for blood product transfusions, requirement for vasoactive and inotropic medications, quantified by the Maximum Vasoactive-Inotropic Score (VISmax) and Cumulative Vasoactive-Inotropic Score (VIS-index). Secondary outcomes included postoperative hepatic and renal function, inflammatory response, and mortality. Result(s): Patients with plasma-based priming compared to crystalloid-based priming had a lower incidence of postoperative dialysis (7 (20%) vs. 20 (44.4%), p = 0.035), a lower incidence of right heart failure (3 (8.6%) vs. 14 (31.1%), p = 0.030), higher postoperative hemoglobin values (10.3 +/- 1.2 vs. 9.4 +/- 1.4 g/dL, p = 0.008), and higher postoperative plasma-protein values (5.2 +/- 0.4 g/dL vs. 4.8 +/- 0.4 g/dL, p = 0.013). The overall survival did not differ between the two groups (log-rank, p = 0.140). No difference in postoperative bleeding incidence or VIS-index was noted. Conclusion(s): In this single-center retrospective cohort, FFP-based CPB priming was associated with less severe postoperative organ dysfunction-namely, lower dialysis use and RHF-without reductions in bleeding, transfusion needs, vasoactive support, or mortality. These hypothesis-generating findings suggest potential hemodynamic/oncotic benefits of FFP priming but do not support its routine use for bleeding prophylaxis. Larger prospective studies, ideally randomized, are needed to confirm efficacy, define patient selection, and weigh benefits against added transfusion exposure and cost. <146> Accession Number 651376342 Title Hans Georg Borst Preis: Multi-Vessel Minimally Invasive vs. Sternotomy CABG: A Meta-Analysis of Early and Mid-Term Outcomes of Propensity-Matched Studies. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Al-Tawil M.; Diab A.H.; Imperatore G.; Sino S.; Frey K.; Kolat P.; Haneya A. Institution (Al-Tawil, Diab, Sino, Frey, Kolat, Haneya) Department of Cardiac and Thoracic Surgery, Heart Center Trier, Trier, Germany (Imperatore) University of Pisa, Pisa, Italy Publisher Georg Thieme Verlag Abstract Background: Multi-vessel Minimally Invasive CABG (MICS) is gaining increasing popularity. This is the first meta-analysis of matched studies to report on early and mid-term outcomes of MICS vs. Sternotomy CABG (ST-CABG). Method(s): We searched the literature up to July 2025 to identify studies comparing MICS-CABG to ST-CABG. Only propensity-score matched studies in which all patients received at least two distal anastomoses were included. We performed both pairwise and reconstructed time-to-event meta-analyses to evaluate early and mid-term outcomes. Result(s): We included six matched studies published between 2022 and 2025, comprising a total of 1,866 patients (933 MICS vs. 933 ST-CABG). The majority of patients were males, with similar frequencies in both groups (81%). The mean number of anastomoses was significantly lower in the MICS group (MD: -0.44 [-0.57; -0.32], p < 0.001). There was a trend toward shorter hospital stay (MD: -0.64 days [-1.50, 0.21], p = 0.14) and lower transfusion rates (20.6% vs. 27.6%, p = 0.08) in the MICS group. No significant differences were observed in in-hospital mortality (0.8% vs. 1.4%, p = 0.20), re-thoracotomy (3.9% vs. 2.6%, p = 0.14), or complete anatomical revascularization (94.6% vs. 96.6%, p = 0.23). Mid-term outcomes from pooled analyses of three studies showed no differences in 5-year survival (HR = 1.09 [95% CI: 0.70-1.69], p = 0.70) or MACCE incidence (HR = 1.17 [95% CI: 0.83-1.66], p = 0.37). Conclusion(s): Overall, MICS-CABG appears as safe as ST-CABG, with potential advantages of earlier recovery and lower transfusions, while mid-term outcomes remain comparable. Nonetheless, caution regarding incomplete revascularization is warranted, and further validation and careful patient selection are essential. <147> Accession Number 651381167 Title Association of pectoral nerve (PECS) and Serratus Anterior Plane (SAP) blocks with intraoperative left internal mammary artery free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting: a randomized controlled trial. Source BMC anesthesiology. (no pagination), 2026. Date of Publication: 02 Jun 2026. Author Tekeli A.E.; Eker E.; Sahinalp S.; Yuzkat N.; Caliskan R.; Catulay D.; Uzlas M.; Elkassabany N. Institution (Tekeli, Yuzkat, Catulay, Uzlas) Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine, Van, Turkey (Eker) Department of Anesthesiology and Reanimation, Memorial Bodrum Hospital, Mugla, Turkey (Sahinalp) Department of Cardiovascular Surgery, Van Yuzuncu Yil University School of Medicine, Van, Turkey (Caliskan) Department of Cardiovascular Surgery, Health Sciences University Dr. Siyami Ersek Chest, Heart, Vascular Surgery Training and Research Hospital, Istanbul, Turkey (Elkassabany) Department of Anesthesiology and Perioperative Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States Abstract BACKGROUND: Ultrasound-guided pectoral nerve (PECS) and serratus anterior plane (SAP) blocks are increasingly used for perioperative analgesia in cardiac surgery. However, their effect on intraoperative physiological parameters, such as left internal mammary artery (LIMA) blood flow, remains unclear. This study aimed to evaluate the association of PECS and SAP blocks with intraoperative LIMA free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting (CABG). METHOD(S): In this prospective, randomized controlled trial, 150 adult patients undergoing elective, isolated, on-pump CABG were allocated to three groups: control (no block), PECS block, or SAP block (n = 50 per group). Blocks were performed preoperatively under ultrasound guidance. LIMA free blood flow was measured intraoperatively after harvesting under standardized hemodynamic conditions and expressed as mL/min. Hemodynamic responses to surgical incision, intraoperative opioid requirements, and vasoactive drug use were also recorded. RESULT(S): Baseline characteristics were comparable among groups. LIMA free blood flow was higher in the PECS and SAP groups compared with the control group (mean +/- SD: 83.1 +/- 23.8 and 92.5 +/- 21.0 vs. 60.6 +/- 20.0 mL/min, respectively; p < 0.001), with higher values observed in the SAP group compared with the PECS group (p < 0.01). Both block groups demonstrated significantly attenuated increases in mean arterial pressure and heart rate in response to surgical incision (p < 0.001 for all comparisons) and reduced rescue opioid requirements. Vasoactive drug use prior to LIMA flow measurement was comparable among groups. CONCLUSION(S): PECS and SAP blocks were associated with attenuated hemodynamic responses to surgical incision and higher measured LIMA free blood flow under standardized conditions in patients undergoing CABG. These findings suggest that chest wall regional anesthesia techniques may influence intraoperative physiological parameters beyond their established analgesic effects. However, this study does not demonstrate improved graft patency, myocardial perfusion, or clinical outcomes. Further studies are warranted to determine whether these intraoperative differences translate into clinically meaningful benefits. TRIAL REGISTRATION: ClinicalTrials.gov NCT05907798. Registered on 23 May 2023, before the initiation of patient recruitment at our institution. Copyright © 2026. The Author(s). <148> Accession Number 651376421 Title Unchanged Coagulation Activation Despite Intraoperative Cytokine Removal in Cardiac Surgery. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Taghiyev Z.T.; Useini D.; Senker A.; Kern L.C.; Karabacak E.C.; Chapugi B.; Sachs U.; Muller J.; Boning A. Institution (Taghiyev, Senker, Kern, Karabacak, Chapugi, Boning) Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany (Useini) Klinik fur Herz-, Thorax- und Gefaschirurgie, Universitatsmedizin Gottingen, Gottingen, Germany (Sachs) Institute for Clinical Immunology and Transfusion Medicine, Giessen, Germany (Muller) Institute for Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany Publisher Georg Thieme Verlag Abstract Background: Postoperative hypercoagulability is a well-established phenomenon following cardiac surgery, driven by surgical trauma, systemic inflammation, and cardiopulmonary bypass (CPB). Adsorptive therapies such as hemoadsorption have been supposed to attenuate these responses, but their effects on plasmatic coagulation activation and thrombin generation remain unclear. Method(s): In this prospective, randomized controlled trial, 50 adult patients undergoing elective cardiac surgery with CPB were randomized to intraoperative hemoadsorption treatment (n = 25) or standard of care (n = 25). Blood samples were collected at baseline (T0), after CPB (T3), 8 hours after CPB (T5), and 24 hours after CPB (T6). Coagulation markers (prothrombin fragments F1.2, thrombin-antithrombin [TAT] complexes, antithrombin III, fibrinogen, D-dimer) and thrombin generation parameters (lag time, time to peak, peak height, velocity index, endogenous thrombin potential) were analyzed. Result(s): Baseline characteristics and conventional coagulation tests were comparable between groups. Across both groups, thrombin generation parameters showed significant temporal changes: AUC, Peak, and Velocity Index decreased from T0 to T6, while lag time and time to peak were prolonged (all p < 0.05). F1.2 and TAT increased significantly from T0 to T3 and remained elevated at T5. Slope analyses confirmed consistent within-group trends. Between-group comparisons revealed only isolated differences, such as a transient difference in lag time at T3 (p = 0.041), without consistent divergence between hemoadsorption and Control patients. Conclusion(s): Cardiac surgery with CPB induces marked and parallel changes in thrombin generation and clot dynamics, irrespective of hemoadsorption treatment. Adsorptive therapy did not modify the trajectory of plasmatic coagulation activation. <149> Accession Number 2046176828 Title A Bayesian re-analysis of hypothermic oxygenated perfusion versus static cold storage in the NIHP2019 heart transplantation trial. Source Journal of Heart and Lung Transplantation. (no pagination), 2026. Date of Publication: 2026. Author Heuts S.; Lebreton G.; Dellgren G.; Wallinder A.; Rega F.; Para M.; Michel S.; Schramm R.; Begot E.; Vandendriessche K.; Kamla C.; Gerosa G.; Berman M.; Boeken U.; Clark S.; Ranasinghe A.; Ius F.; Forteza A.; Pivodic A.; Hennig F.; Guenther S.; Kaul P.; Goerler A.; Aliabadi-Zuckermann A.; Gummert J.F.; Van Cleemput J.; Zuckermann A.; Knosalla C. Institution (Para) Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Universite Paris Cite, Paris, France (Michel, Kamla) Clinic of Cardiac Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany (Michel, Kamla) Munich Heart Alliance, German Center for Cardiovascular, Research, Munich, Germany (Schramm, Guenther, Gummert) Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine Westfalia, Ruhr-University Bochum, Bad Oeynhausen, Germany (Begot) Cardiac Surgery Department, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France (Vandendriessche) Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium (Gerosa) Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy (Berman, Kaul) Cardiothoracic Surgery Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom (Boeken) Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany (Clark) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom (Ranasinghe) Cardiac Surgery, Queen Elizabeth Hospital, University Hospitals, Birmingham NHS Trust, Birmingham, United Kingdom (Ius, Goerler) Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany (Forteza) Department of Cardiac Surgery, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain (Pivodic) APNC Sweden, Molndal, Sweden (Hennig, Knosalla) Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Berlin, Germany (Hennig, Knosalla) Charite-Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Germany (Aliabadi-Zuckermann, Zuckermann) Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria (Van Cleemput) Department of Cardiology, University Hospitals Leuven, Leuven, Belgium (Heuts, Rega) Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium (Heuts) Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands (Lebreton) Cardiac Surgery Department, Pitie-Salpetriere Hospital, APHP, Sorbonne University, Paris, France (Dellgren) Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Dellgren, Wallinder) Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden Publisher Elsevier Inc. Abstract The NIHP2019-trial compared hypothermic oxygenated perfusion (HOPE) with static cold storage (SCS) during heart transplantation and investigated clinical outcomes. This post hoc Bayesian re-analysis estimated the probability of clinically meaningful overall treatment effects. In total, 204 patients were analyzed at 12 months (HOPE n = 101, SCS n = 103). Bayesian models with minimally informative priors were used to derive relative risks (RR), absolute risk differences (ARD), and posterior probabilities. In these Bayesian models, HOPE was associated with lower rates of the primary composite endpoint (RR 0.71, 95%CrI 0.49-0.99; ARD -13.8%, 95%CrI -26.8; -0.4%). The probability of any benefit was 97.8%, and the probability of a clinically relevant effect exceeded 90%. For all-cause mortality, the probability of benefit was 90.5%, with a >85% probability of a clinically relevant effect. The results were robust across sensitivity analyses. These findings demonstrate clinically meaningful benefits with HOPE and provide a complementary interpretation of the NIHP2019-trial's results. Copyright © 2026 The Authors. <150> Accession Number 651376340 Title Comparison of Uncoated vs. Transiently Coated Central Venous Catheters for the Prevention of Biofilm Formation in Cardiac Surgery Patients. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Varghese S.; Niklas C.; Margraf S.; Meyer E.; Pfensig C.; Heiden C.; Wacker M.; Sauer M.; Wippermann J.; Awad G. Institution (Varghese, Meyer, Wacker, Wippermann, Awad) Department of Cardiothoracic Surgery, University Hospital Magdeburg, Magdeburg, Germany (Niklas) Department of Anesthesia and Intensive Care Medicine, University Hospital Magdeburg, Magdeburg, Germany (Margraf, Pfensig, Heiden) Biomedizinisches Forschungszentrum, Rostock, Germany (Sauer) Hospital Magdeburg, Center of Anaesthesia, Intensive Care Medicine, Magdeburg, Germany Publisher Georg Thieme Verlag Abstract Background: Central venous catheters (CVCs) are essential in cardiac surgery but can become contaminated by bacteria from the patient's skin, sometimes causing bloodstream infections and sepsis. Standard disinfectants may not reach bacteria in deeper skin layers. Biofilms develop on about 10% of catheters, even from a single bacterium, and can release large bacterial colonies into the bloodstream, leading to catheter-related bloodstream infections (CRBSI). Coating catheters with antibacterial gel may help reduce this risk and provide extra protection. Method(s): As part of a multicenter, prospective, randomized study (CutSep, Solvamed), 195 patients undergoing cardiac surgery at our institute were randomly assigned to two groups: Group A (in situ gel-coated CVC, n: 92) and Group B (control group, n:103). In Group A, after triple skin disinfection, the CVC was coated with a gel containing 0.05% Octenidine using a device. Patients with preexisting infections, such as endocarditis, were excluded. All explanted CVCs were examined microbiologically. All patients received 1.5 g of Cefuroxim perioperative. Result(s): All patients underwent elective surgery, with a mean age of 70.4 years; 26% were female. The procedures included coronary artery bypass grafting in 61%, isolated valve surgery in 33%, and combined operations in 4%. The mean duration of CVC placement was 5.97 days in both groups. On the day of CVC removal, mean CRP levels were 79.2 mg/L in Group A and 79.7 mg/L in Group B. Positive catheter cultures were found in 6 patients (6.5%) in Group A and 11 patients (10.7%) in Group B, corresponding to a 38.9% lower incidence in Group A. All positive tips grew Staphylococcus species. Mean leukocyte count was 10.1 G/L in all groups. Among patients with positive catheter tips, CRP averaged 81.0 mg/L with antibiotic use in 33% (Group A) and 79.2 mg/L with 54% antibiotic use (Group B). In patients with negative catheter tips, CRP was 79.2 mg/L, and antibiotics were used in 54.5%. Conclusion(s): Using an antiseptic gel to coat central venous catheters in cardiac surgery patients reduced the number of positive catheter cultures by almost 40% compared with uncoated catheters. These findings suggest that antibacterial gel coating may provide an effective additional layer of protection against CRBSI in this high-risk population. Despite perioperative antibiotics and the use of Chlorhexidine dressing, CVC contamination remains common. In this study, this problem during CVC insertion was addressed for the first time with a new medical device. <151> Accession Number 2046086501 Title Incidence and Associations of Acute Kidney Injury After Lung Resection Surgery: A Systematic Review and Meta-analysis. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Shan X.-S.; Yan J.; Wang Y.-Q.; Zhang Y.; Li X.-Y.; Koutentis C.; Popescu W.M.; Ji F.-H.; Liu H. Institution (Shan, Yan, Zhang, Li, Ji) Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, China (Shan, Yan, Zhang, Li, Ji) Institute of Anesthesiology, Soochow University, Suzhou, China (Shan, Liu) Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, United States (Wang) Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China (Koutentis) Department of Anesthesiology, One Brooklyn Health-Brookdale University Hospital Medical Center, Brooklyn, NY, United States (Popescu) Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States Publisher W.B. Saunders Abstract The incidence and clinical implications of acute kidney injury (AKI) following thoracic lung resection surgery remain insufficiently characterized. The authors conducted a systematic review to determine the incidence of AKI, identify risk factors for AKI, evaluate preventive interventions for AKI, and assess the associations of AKI with key postoperative outcomes. A systematic search of PubMed, Embase, and the Cochrane Library was conducted through June 25, 2025. The authors included observational and interventional studies that reported the incidence of AKI following lung resection, defined according to Risk, Injury, Failure, Loss, End-stage (RIFLE), Acute Kidney Injury Network (AKIN), or Kidney Disease: Improving Global Outcomes (KDIGO) consensus-based criteria. The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD420251142075). Twenty studies involving 19,918 patients were included. The pooled incidence of AKI was 5.31% (95% confidence interval [CI], 3.61%-6.70%), with mild AKI and moderate to severe AKI occurring in 5.51% and 0.96% of patients, respectively. AKI was significantly associated with prolonged hospital stay (mean difference, 0.92 days; 95% CI, 0.52-1.30 days) and increased short-term mortality (risk ratio, 5.60; 95% CI, 1.66-18.83). Goal-directed fluid therapy did not significantly reduce the risk of AKI (risk ratio, 0.64; 95% CI, 0.32-1.27). AKI is a common complication following thoracic lung resection surgery and is strongly associated with a broad spectrum of severe adverse postoperative outcomes. In patients undergoing lung resection, AKI should be considered as a highly significant prognostic indicator that requires early risk stratification and proactive preventive strategies. Copyright © 2026 Elsevier Inc. <152> Accession Number 651374559 Title SHORT-DURATION ANTIBIOTIC PROPHYLAXIS IN THE CONTEXT OF CARDIAC SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS. Source Brazilian Journal of Infectious Diseases. Conference: 24th Brazilian Congress of Infectious Diseases 2025. Florianopolis Brazil. 30(Supplement 1) (pp 59-60), 2026. Article Number: 105318. Date of Publication: 01 Mar 2026. Author Dantas C.E.F.; De Vasconcelos P.S.J.; Ribeiro L.D.; de Melo Botelho L.B.; Sales T.J.B.; Lima J.B.C.; dos Santos P.H.M.L.; de Souza Silva J.L.; Teodosio V.J.T.; de Freitas Barros Galvao L.; Bessone F.M.; de Macedo N.R.; Azevedo J.L.R. Institution (Dantas, De Vasconcelos, de Melo Botelho, Sales, Lima, dos Santos, de Souza Silva, Teodosio, de Freitas Barros Galvao, Bessone, de Macedo, Azevedo) Universidade de Pernambuco (UPE), PE, Recife, Brazil (Ribeiro) Faculdade Pernambucana de Saude (FPS), PE, Recife, Brazil Publisher Elsevier Editora Ltda Abstract Introduction/Objectives: Antibiotic prophylaxis (AP) is crucial in cardiac surgery. Although evidence supports short-duration AP (<48 h), long-duration practice (>48 h) persists. This systematic review with meta-analysis evaluates the protective efficacy of short-duration AP compared to long-duration AP, aiming to optimize postoperative infection prevention. Methodology: This systematic review and meta-analysis evaluated the efficacy of AP, focusing on duration. Following the PRISMA 2020 checklist and PICO criteria, with protocol registered on the PROSPERO platform (CRD420251071263). Two randomized clinical trials were included, totaling 795 participants (402 in the short-duration group and 393 in the long-duration group) and 92 surgical site infection (SSI) events. The meta package in RStudio was used for meta-analysis. Result(s): This meta-analysis included two studies (n = 795 patients) comparing reduced (<48 h) versus prolonged (>72 h) antibiotic prophylaxis regimens in cardiac surgery. The random-effects model showed no statistically significant difference in infection risk between groups (RR: 1.47; 95% CI: 0.99 -2.18; p = 0.054), with significant homogeneity (I2 = 0%, p = 0.387). Study-level analyses showed that only Koudieh et al. (2024) demonstrated increased risk with reduced prophylaxis (RR: 1.60; 95% CI: 1.03-2.47), while Gupta et al. (2010) showed no difference (RR: 1.02; 95% CI: 0.41-2.55). The heterogeneity test (Q = 0.75; p = 0.387) and low I2 suggest consistency across studies, although the borderline statistical significance (p = 0.05) indicates a possible clinical trend favoring prolonged regimens. Conclusion(s): This meta-analysis found no statistically significant difference in SSI risk between short- and long-duration AP in cardiac surgery, although a marginal trend favoring prolonged prophylaxis was observed (p = 0.054). Heterogeneity was null. Findings suggest that short-duration AP may be a comparable strategy; however, the observed trend and divergent study results indicate the need for more robust evidence to define protocols. <153> Accession Number 651376331 Title Intraoperative Hemoadsorption Reprograms Myeloid Activation and Cytokine Signaling in Patients Undergoing Cardiopulmonary Bypass. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Taghiyev Z.T.; Useini D.; Mkhlof S.; Singh V.; Karabacak E.C.; Chapugi B.; Kern L.C.; Senker A.; Skevaki C.; Boning A. Institution (Taghiyev, Karabacak, Chapugi, Kern, Senker, Boning) Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany (Useini) Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland (Mkhlof, Skevaki) Institute of Laboratory Medicine, University Hospital Giessen, Giessen, Germany (Singh) Department of Pediatric Hematology, Oncology and Immunodeficiencies, University Hospital Giessen, Giessen, Germany Publisher Georg Thieme Verlag Abstract Background: Cardiac surgery with cardiopulmonary bypass (CPB) provokes profound innate immune activation, which contributes to postoperative complications. Blood purification strategies have been proposed to modulate excessive inflammation, but their effects on myeloid subsets and cytokine signaling remain incompletely defined. Method(s): In this prospective randomized trial, 50 patients undergoing elective coronary artery bypass grafting with CPB were allocated to either standard management (n = 25) or intraoperative hemoadsorption (n = 25). Peripheral blood was sampled at baseline, after CPB, 8 hours, and 24 hours. Flow cytometry quantified CD64 on neutrophils, CD169 and HLA-DR on monocytes, and detailed immune cell subsets. Multiplex cytokine analysis was performed before and after CPB. Group differences, intra-group contrasts, slopes, and correlations were assessed. Result(s): Hemoadsorption induced a significant downregulation of neutrophil CD64 at 8 and 24 hours (p < 0.05) with steeper temporal slopes compared with controls. In contrast, CD169 and HLA-DR on monocytes declined more strongly in treated patients. Cytokine profiling demonstrated reduced proinflammatory mediators (IL-8, IL-1alpha, TNF-beta, TRAIL) and relatively increased IL-10, consistent with an anti-inflammatory shift. Correlation analysis linked suppression of monocyte markers to IL-10, GM-CSF, IFN-gamma, and IL-1beta. Cell subset analysis confirmed these findings: total monocytes decreased more strongly (after CPB: 0.31 +/- 0.14 vs. 0.40 +/- 0.15 x 10-9/L; p = 0.03), particularly intermediate monocytes (0.07 +/- 0.04 vs. 0.11 +/- 0.05; p = 0.02). Lymphocyte counts declined in both groups, but more prominently in the intervention group (0.8 +/- 0.3 vs. 1.0 +/- 0.4 x10-9/L; p = 0.05), especially CD4+ T-helper cells (0.41 +/- 0.18 vs. 0.53 +/- 0.21; p = 0.04). Conclusion(s): Intraoperative hemoadsorption during CPB promotes neutrophil activation while suppressing monocyte and CD4+ T-cell responses, accompanied by a cytokine shift toward IL-10. This divergent modulation of innate and adaptive immunity may represent a clinically relevant mechanism influencing postoperative immune competence and recovery. <154> Accession Number 651376417 Title Immune Perturbations After Cardiopulmonary Bypass: A Randomized Trial of Cytokine Adsorption. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Taghiyev Z.T.; Useini D.; Chapugi B.; Senker A.; Kern L.C.; Karabacak E.C.; Arneth B.; Mkhlof S.; Skevaki C.; Boning A. Institution (Taghiyev, Chapugi, Senker, Kern, Karabacak, Boning) Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany (Useini) Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland (Arneth, Mkhlof, Skevaki) Institute of Laboratory Medicine, University Hospital Giessen, Giessen, Germany Publisher Georg Thieme Verlag Abstract Background: Cardiopulmonary bypass (CPB) induces profound immune alterations, including lymphopenia and neutrophilia. Hemoadsorption has been proposed as a strategy to mitigate these inflammatory responses; however, its impact on immune cell dynamics remains insufficiently defined. Method(s): In a randomized study, 50 patients scheduled for elective cardiac surgery with CPB were allocated either to a group receiving intraoperative hemoadsorption (Cytosorb-Group, n = 25) or to a control group treated with the standard procedure (Control-Group, n = 25). Blood was collected at baseline (T0), after CPB (T1), 8 hours post-CPB (T2), and 24 hours post-CPB (T3). Leukocyte differentials and flow cytometry were performed. Analyses included within- and between-group comparisons and trajectory modeling. Result(s): Both groups displayed the characteristic postoperative immune shift. In the pooled cohort (n = 50), neutrophils increased from 60% [95% CI: 57-63] at baseline to 76% [73-79] at T2 (DELTA + 16%, p < 0.001), while lymphocytes declined from 28% [25-31] to 13% [11-15] (DELTA-15%, p < 0.001). Monocyte subsets redistributed transiently: classical monocytes fell from 83% [81-85] to 76% [73-79], intermediates rose from 6% [5-7] to 8% [7-9], and nonclassicals dropped from 11% [10-12] to 7% [6-8] (all p < 0.05). Between-group contrasts revealed only isolated differences, such as lower nonclassicals in the Cytosorb-Group at T2 (5.3% vs. 6.6%, adj. p = 0.04). Mixed-effects models confirmed no significant group x time interaction for neutrophils, lymphocytes, or monocyte subsets (all adj. p > 0.1). Conclusion(s): CPB induces profound but transient immune perturbations, most evident 8 hours postoperatively. Hemoadsorption was associated with minor differences in selected subsets but did not alter overall immune trajectories. Larger trials are required to determine whether such immunological effects translate into clinical benefit. <155> Accession Number 2046223583 Title Efficacy of ivabradine in heart rate reduction after cardiac transplantation: Systematic review and meta-analysis. Source World Journal of Cardiology. 17(12) (no pagination), 2025. Article Number: 113820. Date of Publication: 26 Dec 2025. Author Ahmed F.; Ali R.; Haider F.; Shah H.H.; Farhan K.; Jahangir K.; Kiyani M.; Khan M.S.; Afzaal Z.; Khan S.I.; Nizam M.A.; Usman M.; Gohar N.; Ahmed M.; Mirza T.R.; Sattar Y.; Taha A.; Almendral J.; Alenezi F. Institution (Ahmed, Almendral) Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, United States (Ali) Department of Medicine, Peoples University of Medical and Health Sciences, Sindh, Nawabshah, Pakistan (Haider) Department of Medicine, Allama Iqbal Medical College, Punjab, Lahore, Pakistan (Shah) Department of Medicine, Bayhealth Hospital, Kent Campus, Dover, DE, United States (Farhan) Department of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Sindh, Karachi, Pakistan (Jahangir) Department of Medicine, Dow Medical College, Sindh, Karachi, Pakistan (Kiyani) Department of Medicine, Medstar Georgetown University Baltimore Program, Baltimore, MD, United States (Khan) Department of Medicine, Jinnah Sindh Medical University, Sindh, Karachi, Pakistan (Afzaal, Usman, Gohar) Department of Medicine, Ameer-Ud-Din Medical College, Punjab, Lahore, Pakistan (Khan) Department of Medicine, Jefferson Torresdale Hospital, Philadelphia, PA, United States (Nizam) Department of Internal Medicine, Trinity Health Livonia Hospital, Michigan City, MI, United States (Ahmed) Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Mirza) Department of Medicine, Shalamar Medical and Dental College, Punjab, Lahore, Pakistan (Sattar) Department of Cardiology, West Virginia University, Morgantown, WV, United States (Taha) Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, United States (Alenezi) Department of Medicine, Duke University School of Medicine, Durham, NC, United States Publisher Baishideng Publishing Group Inc Abstract BACKGROUND Persistent sinus tachycardia affects up to 40% of patients after heart transplantation and is linked with graft dysfunction, impaired diastolic filling, and increased morbidity. Conventional rate-limiting therapies such as beta-blockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension. Ivabradine, a selective I(f) channel inhibitor, reduces heart rate (HR) without negative inotropic or hypotensive effects. AIM To evaluate the efficacy and safety of ivabradine in heart transplant recipients. METHODS A comprehensive search of PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar was conducted from inception to April 15, 2025. Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol, reporting HR, mortality, left ventricular mass (LVM), or safety. Data were independently extracted by two reviewers, and quality was assessed. Review Manager 5.4 performed pooled analyses using random-effects models. Mean differences (MD) or standardized MD (SMD) were calculated for continuous outcomes, and risk ratios for dichotomous outcomes. RESULTS Of 415 records identified, four studies comprising 264 patients (126 ivabradine, 138 control) met the inclusion criteria. Ivabradine significantly reduced resting HR compared with controls (MD = -11.06 beats per minute; 95%CI: -19.50 to -2.62; P < 0.00001; I2 = 93%). Sensitivity analysis demonstrated consistent findings (SMD = -6.74; 95%CI: -9.23 to -4.24; I2 = 0%). No significant difference in all-cause mortality was observed (MD = 0.52; 95%CI: 0.17-1.64; P = 0.27; I2 = 85%). Pooled analysis of LVM revealed no significant effect of ivabradine (MD = -3.57 g; 95%CI: -29.21 to 22.08; P = 0.79; I2 = 73%), with sensitivity analysis confirming neutrality. Adverse events were rare and mostly comparable between groups. CONCLUSION Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes, supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable. Despite potential clinical benefit, small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine's role in post-transplant care. Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. <156> Accession Number 651380059 Title Diagnostic accuracy of coronary CT angiography versus invasive coronary angiography for detecting coronary artery disease: a systematic review and Bayesian meta-analysis. Source BMC medical imaging. (no pagination), 2026. Date of Publication: 01 Jun 2026. Author Alqahtani N.G.; Moawad M.H.E.D.; Shati A.A.; Bisht O.; Abdul-Hafez H.A.; Shatoor A.S.; Alharasees M.; Elkelish A.; Alshanbari A.S.; Zabady A.H. Institution (Alqahtani, Shatoor) Department of Internal Medicine, Cardiology Section, College of Medicine, King Khalid University, Abha, Saudi Arabia (Moawad) Alexandria Main University Hospital, Alexandria, Egypt (Moawad) Faculty of Medicine, Suez Canal University, Ismailia, Egypt (Shati) Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia (Bisht) Coswig Heart Center, Coswig, Sachsen, 01640, Germany (Abdul-Hafez) Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine (Alharasees) Faculty of Medicine, Mutah University, Jordan (Elkelish) Biology Department, College of Science, Imam Mohammad ibn Saud Islamic University (IMSIU), P.O. Box 1690950, Riyadh, Saudi Arabia (Alshanbari) Ministry of Health, Makkah Health Cluster, Makkah, Saudi Arabia (Zabady) Faculty of Science, Damanhour University, Egypt Abstract BACKGROUND: The diagnostic performance of coronary computed tomography angiography, an emerging noninvasive modality used as an alternative to ICA for the assessment of coronary artery disease, is generally variable across studies and clinical settings. OBJECTIVE(S): The objective of this study is to systematically assess the diagnostic accuracy of coronary computed tomography angiography (CCTA) in comparison with invasive coronary angiography (ICA) in the detection of anatomically significant CAD. METHOD(S): A systematic review and meta-analysis were conducted according to PRISMA guidelines. A search of PubMed, Scopus, and Web of Science for eligible studies through December 2025 was conducted. Studies were included if they reported CCTA diagnostic accuracy data with ICA as the reference standard. The risk of bias was assessed using QUADAS-2. The pooled sensitivity and specificity, along with the likelihood ratios and diagnostic odds ratio (DOR), were estimated using a Bayesian bivariate model. Summary receiver operating characteristic curves and Fagan nomograms were generated to assess overall performance and clinical utility. RESULT(S): Twenty-seven studies encompassing 4461 patients were included in the quantitative synthesis. CCTA demonstrated high pooled sensitivity of 0.94 (95% posterior interval [PI] 0.892-0.969) and moderate specificity of 0.73 (95% PI 0.560-0.846). The pooled positive and negative likelihood ratios were 3.50 and 0.08, respectively, with a diagnostic odds ratio of 43.8, indicating strong overall discriminatory ability. Subgroup analyses showed higher accuracy in patients without prior coronary Intervention, while specificity was reduced in post-percutaneous coronary Intervention (PCI) or coronary artery bypass grafting (CABG) populations. A negative CCTA markedly reduced the post-test probability of CAD, supporting its value as a rule-out test. CONCLUSION(S): CCTA demonstrates high sensitivity and strong rule-out performance for anatomically significant CAD, particularly in appropriately selected low-to-intermediate-risk patients without prior coronary Intervention. However, its moderate specificity and reduced performance in complex post-PCI/CABG populations indicate that positive findings should be interpreted cautiously and may require confirmatory invasive or functional assessment. CLINICAL TRIAL NUMBER: Not applicable. Copyright © 2026. The Author(s). <157> Accession Number 651376364 Title Intraoperative Ticagrelor Removal Reduces Major Bleeding After Urgent CABG: A Pooled Analysis of the STAR-T Randomized Trial and the International STAR Registry. Source Thoracic and Cardiovascular Surgeon. Conference: 55th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Cologne Germany. 74(Supplement 1) (no pagination), 2026. Date of Publication: 01 Jan 2026. Author Schmoeckel M.; Mack M.; Storey R.; Whitlock R.; Taylor B.; Zias E.; Liu D.; Hassan K.; Thielmann M.; Meyer A.; Deneve N.; Sellke F.; Schneider D.; Thourani V.; Mazer D.; Douketis J.; Wendt D.; Matejic-Spasic M.; Weihong F.; Deliargyris E.; Gibson M. Institution (Schmoeckel) Cardiac Surgery LMU, Munchen, Germany (Mack) Department of Cardiothoracic Surgery, Baylor University Medical Centre, Dallas, United States (Storey) Division of Clinical Medicine, Sheffield, United Kingdom (Whitlock) HamiltonCanada (Taylor) Maryland CityUnited States (Zias) New YorkUnited States (Liu) BostonUnited States (Hassan) Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Hamburg, Germany (Thielmann) West-German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany (Meyer) Universitatsklinikum Heidelberg Klinik fur Herzchirurgie, Im Neuenheimer Feld, Heidelberg, Germany (Deneve) OLV Hospital, Aalst, Belgium (Sellke) ProvidenceUnited States (Schneider) VermontUnited States (Douketis) HamiltonCanada (Thourani) AtlantaUnited States (Mazer) TorontoCanada (Douketis) HamiltonCanada (Wendt) EssenGermany (Matejic-Spasic) CytoSorbents Europe, Belgrade, Serbia (Weihong) CytoSorbent, Princeton, United States (Deliargyris) CytoSorbents Inc., Princeton, United States (Gibson) TulsaUnited States Publisher Georg Thieme Verlag Abstract Background: Guidelines recommend ticagrelor discontinuation for at least 72 hours prior to CABG. A novel polymer hemoadsorption device is capable of removing ticagrelor during on-pump cardiac surgery. STAR-T was a North American randomized, double-blind, sham-controlled trial investigating intraoperative ticagrelor removal with this device to reduce perioperative bleeding in cardiac surgery. The International STAR Registry (STAR-R) collects real-world outcomes with antithrombotic drug removal by the same device. Method(s): STAR-T randomized patients 1:1 to the device or sham, whereas all STAR-R patients received the device. The device was integrated into the cardiopulmonary bypass (CPB) circuit. Inclusion/exclusion criteria from STAR-T were applied to STAR-R to identify patients on ticagrelor undergoing isolated CABG before washing out. Device-treated patients were pooled and compared to STAR-T controls. Patient-level data were analyzed with a primary endpoint of major bleeding defined as the composite of Universal Definition for Perioperative Bleeding (UDPB >= 3) or 24-hr chest tube drainage (CTD) >= 1 L. Result(s): The pooled cohort comprised 153 device-treated patients and 60 controls, with a mean age was 64.4 +/- 9.6 years and 84% males. Demographics and baseline characteristics were balanced, except for the time from last ticagrelor dose to CABG, which was significantly shorter in device-treated patients (28.8 +/- 16.4 vs. 38.6 +/- 14.6 hours, p < 0.001). Operation (4.3 +/- 1.3 vs. 4.2 +/- 1.2 hours, p = 0.710) and CPB (95.3 +/- 35.9 vs. 94 +/- 34.4 minutes, p = 0.801) durations were similar. Major bleeding was significantly reduced in device-treated patients compared with controls (16.3% vs. 30.0%, p = 0.02), corresponding to a number needed to treat of seven to prevent a major bleed. Multivariate logistic regression identified age and the use of the device as independent predictors of post-CABG major bleeding. Conclusion(s): Pooled data from a randomized trial and a real-world registry show that intraoperative ticagrelor removal with a novel device reduces major perioperative bleeding in patients undergoing CABG before completing the recommended washout. <158> Accession Number 651365961 Title Perioperative dexmedetomidine is associated with improved respiratory outcomes in patients undergoing cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source BMC anesthesiology. (no pagination), 2026. Date of Publication: 01 Jun 2026. Author Guo Y.; Wei Y.; Yu S. Institution (Guo) Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China (Wei) Department of Anesthesiology, Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China (Yu) Department of Anesthesiology, Second Affiliated Hospital, School of Medicine, Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China Abstract BACKGROUND: Over 2 million cardiac surgeries are performed annually, with significant risks such as systemic inflammation and postoperative pulmonary complications (PPCs). Dexmedetomidine has shown promise in reducing PPCs in thoracic surgeries. This review evaluates its effects on PPCs and respiratory outcomes in cardiac surgery. METHOD(S): A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to include randomized controlled trials comparing intravenous dexmedetomidine and other drugs in terms of respiratory outcomes in adult patients undergoing cardiac surgery. PRIMARY OUTCOME: PPC incidence. SECONDARY OUTCOMES: PaO2, PaCO2, SpO2, oxygenation index, respiratory index, time to extubation, length of ICU stay, and adverse events. Risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models. RESULT(S): Sixteen studies comprising 1,668 patients were included in this meta-analysis. The perioperative use of dexmedetomidine was associated with a reduced incidence of overall postoperative pulmonary complications (RR = 0.57; 95% CI: 0.38 to 0.87; P = 0.0078). Additionally, participants who received intravenous dexmedetomidine had a shorter ICU stay (MD = -0.56 h; 95% CI: -1.12 to -0.00; P = 0.0480). Furthermore, perioperative dexmedetomidine significantly improved postoperative SpO2 (MD = 0.46% points; 95% CI: 0.17 to 0.74; P = 0.0018) and respiratory index (MD = -0.16; 95% CI: -0.27 to -0.05; P = 0.0057). CONCLUSION(S): Perioperative dexmedetomidine may be associated with improved respiratory outcomes in cardiac surgery patients. However, the evidence for reduction in overall PPCs remains limited, and dexmedetomidine may increase the risk of bradycardia. Larger, high-quality RCTs are needed to confirm its safety and benefits. Copyright © 2026. The Author(s). <159> Accession Number 2046124975 Title Intraprocedural guidance using fluoroscopy alone for left atrial appendage closure: a systematic review and meta-analysis. Source Journal of Interventional Cardiac Electrophysiology. (no pagination), 2026. Date of Publication: 2026. Author Li J.; Fan S.; Zhang F.; Yan Y.; Zhang J.; Zhang E.; Lu J.; Wu D.; Lu F.; Xu J.; Ma W. Institution (Li, Fan, Zhang, Yan, Zhang, Zhang, Wu, Lu, Xu, Ma) Chest Hospital, Tianjin University, 70, Xi'an Road, Tianjin, China (Li, Fan, Zhang, Yan, Zhang, Zhang, Wu, Lu, Xu, Ma) Arrhythmia Department, Tianjin Chest Hospital, 70, Xi'an Road, Tianjin, China (Ma) Clinical School of Thoracic, Tianjin Medical University, 70, Xi'an Road, Tianjin, China (Lu) Department of Cardiology II, The Second Hospital of Hebei Medical University, Hebei, Shijiazhuang, China Publisher Springer Abstract Background: In some arrhythmia centers, intraprocedural guidance using fluoroscopy alone remains the mainstream approach for left atrial appendage closure (LAAC). This study aims to synthesize recent literature and assess the feasibility of fluoroscopy-guided LAAC performed without echocardiography. Method(s): A computer-based search was conducted in PubMed, Embase, and the Cochrane Library for studies comparing fluoroscopy alone versus fluoroscopy combined with echocardiography for LAAC, from the inception of each database to September 13, 2025. Summary analysis was conducted using Review Manager 5.4. Result(s): This meta-analysis included 7 studies with 2,472 patients, 1,358 in the Fluoroscopy group and 1,114 in the combined fluoroscopy-echocardiography group (Standard group). Both groups achieved high immediate procedural success rates, with a higher rate in the Standard group (RR 0.98, 95% CI 0.96-1.00, P = 0.030), but the difference was minimal. Fluoroscopy-guided LAAC increased fluoroscopy time (MD 1.89, 95% CI 1.61-2.17, P < 0.001) but shortened procedure time (MD -12.92, 95% CI -18.96 to -6.89, P < 0.001). Overall perioperative complications showed no significant differences between groups (RR 0.93, 95% CI 0.51-1.69, P = 0.810). In follow-up, the incidence of peri-device leak (PDL), device-related thrombosis (DRT), and stroke/TIA or death were similar between groups. Conclusion(s): Both intraprocedural guidance strategies for LAAC achieve high immediate procedural success rates. Although the Standard group showed a higher success rate, the advantage was minimal. The two strategies are comparable in terms of perioperative and follow-up complications. Overall, current evidence supports that fluoroscopy-guided LAAC alone is feasible by experienced operators in settings with limited resources. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <160> Accession Number 2046315793 Title Con: Viscoelastic Testing Should Not Be Used Routinely but Selectively in Cardiac Surgery. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Cameron M.; Awad T. Institution (Cameron) Department of Anesthesia, McGill University, Montreal, Canada (Awad) Department of Anesthesiology and Critical Care Medicine, University of Chicago, Chicago, IL, United States (Cameron) Department of Anesthesia, Jewish General Hospital, Canada Publisher W.B. Saunders Abstract Viscoelastic testing (VET) has become an important tool in cardiac surgery, particularly within bleeding management algorithms. However, evidence supporting its benefits largely pertains to patients with active bleeding rather than its use in all cases. VET does not reliably predict bleeding or transfusion requirements when performed preoperatively, and its indiscriminate application may lead to unnecessary blood product administration and increased costs. Randomized trials and meta-analyses consistently show that VET improves outcomes when integrated into structured blood management algorithms after bleeding is clinically evident. Established clinical predictors and standard laboratory tests remain effective for assessing bleeding risk, and recent expert guidelines explicitly discourage routine VET for all cardiac surgery patients. Selective use of VET in patients with suspected coagulopathy preserves its clinical benefits, minimizes harm, and aligns with evidence-based practice. Copyright © 2026 Elsevier Inc. <161> Accession Number 2046375932 Title Meta-Analysis of Transcatheter Versus Surgical Aortic Valve Replacement in Low Surgical Risk Patients: An Update. Source American Journal of Cardiology. 272 (pp 77-86), 2026. Date of Publication: 01 Aug 2026. Author Jarade C.; Levett J.Y.; Zolotarova T.; Filion K.B.; Toutounchi H.; Eisenberg M.J. Institution (Jarade) Faculty of Medicine, American University of Beirut, Lebanon (Levett, Eisenberg) Division of Cardiac Surgery, Department of Surgery, McGill University, Montreal, QC, Canada (Zolotarova, Filion, Toutounchi, Eisenberg) Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada (Filion, Eisenberg) Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada (Filion, Eisenberg) Department of Medicine, McGill University, Montreal, QC, Canada (Eisenberg) Division of Cardiology, Jewish General Hospital/McGill University, Montreal, QC, Canada Publisher Elsevier Inc. Abstract Transcatheter aortic valve replacement (TAVR) is increasingly considered as an alternative to surgical aortic valve replacement (SAVR) for low-risk patients with aortic stenosis. However, its long-term efficacy remains uncertain. This study aimed to compare clinical outcomes and procedural complications of TAVR versus SAVR in low-risk patients with aortic stenosis. We updated our 2019 systematic review by searching MEDLINE, EMBASE, and Cochrane Central (May 2019-April 2025) for randomized controlled trials (RCTs) comparing TAVR and SAVR in low-risk patients with aortic stenosis. We extracted outcomes at 30 days, 12 months, and >=5 year follow-up. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) 2 tool. Five RCTs (n = 4,532) were included. TAVR reduced 30-day all-cause mortality (RR: 0.45, 95% CI: 0.37-0.55), cardiovascular mortality (RR: 0.45, 95% CI: 0.38-0.54), atrial fibrillation (RR: 0.21, 95% CI: 0.10-0.41), and life-threatening bleeding (RR: 0.28, 95% CI: 0.13-0.58), but increased pacemaker implantation (RR: 3.10, 95% CI: 1.23-7.82). Mortality benefits persisted at 12 months. At >=5 years, results were inconclusive due to wide CIs across outcomes, including all-cause death (RR: 0.99, 95% CI: 0.72-1.35), cardiovascular death (RR: 0.93, 95% CI: 0.64-1.35), atrial fibrillation (RR: 0.44, 95% CI: 0.16-1.22), endocarditis (RR: 0.70, 95% CI: 0.33-1.45) and aortic reintervention (RR: 1.21, 95% CI: 0.59-2.49). TAVR shows early clinical benefits in low-risk patients with aortic stenosis, but long-term outcomes compared to SAVR remain uncertain. Individualized heart team decision-making remains essential. Copyright © 2026 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC license. http://creativecommons.org/licenses/by-nc/4.0/ <162> Accession Number 2046325526 Title Best evidence summary for phased management of thirst in post-coronary artery bypass grafting patients. Source Chinese Journal of Practical Nursing. 42(15) (pp 1160-1169), 2026. Date of Publication: 21 May 2026. Author Shan W.; Wang Q.; Li Y.; Cai L.; Chu X.; Chen C. Institution (Shan, Wang, Cai, Chu, Chen) Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China (Li) School of Nursing, Fudan University, Shanghai, China Publisher Chinese Medical Journals Publishing House Co.Ltd Abstract Objective To retrieve, evaluate, and synthesize evidence related to thirst management in post-coronary artery bypass grafting patients, and to develop a phased management protocol based on cardiac function recovery characteristics, providing evidence-based guidance for clinical practice. Methods Following the "5S" evidence pyramid model, the research team systematically searched major domestic and international guideline websites, professional society websites, and databases including the Joanna Briggs Institute Evidence-Based Health Care Center Database, Cochrane Library, PubMed, etc. The search period was set from January 1 st 2014 to December 31 st 2024. Results A total of 16 publications were included, comprising 6 guidelines, 3 systematic reviews, 2 clinical decisions and 2 evidence summaries, along with 1 scoping review, 1 scientific statement (expert consensus), and 1 randomized controlled trial. Twenty-four evidence statements were summarized across eight domains: organization and training, risk assessment, thirst assessment, intervention timing, pharmacological management, non-pharmacological management, fluid management, and monitoring and evaluation. Based on this evidence, a five-phase (immediate phase post-extubation, early phase post-extubation, recovery phase post-extubation, stabilization phase post-extubation, postoperative rehabilitation phase) thirst management protocol was developed. Conclusions This phased thirst management protocol for patients after coronary artery bypass grafting was developed based on high-quality evidence, with full consideration of cardiac function characteristics and fluid tolerance capacity at different postoperative stages. This protocol provides guidance for safe and effective clinical thirst management. Healthcare providers should selectively apply the relevant evidence based on individual patient conditions and the specific postoperative phase. Copyright 2026, Chinese Medical Association <163> Accession Number 2046302973 Title AI-enabled digital wound monitoring after cardiac surgery: a randomised controlled feasibility, safety, and acceptability trial. Source Journal of Hospital Infection. (no pagination), 2026. Date of Publication: 2026. Author Rochon M.; Tanner J.; Cariaga K.; Jurkiewicz J.; Beckhelling J.; Harris R.; Wilson K.; Dhoonmoon L.; Bolton S.; Bouttell J.; Davis D.; Shipolini A.; Magboo R.; Oezalp F.; Chester V. Institution (Rochon, Cariaga) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Tanner) University of Nottingham, Nottingham, United Kingdom (Jurkiewicz) Isla Care Ltd, London, United Kingdom (Beckhelling, Davis, Chester) Derby Clinical Trials Support Unit, Derby, United Kingdom (Harris) NIHR Research Support Service (RSS) Hub Delivered by the University of Leicester and Partners, Nottingham, United Kingdom (Wilson) Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom (Dhoonmoon) London North West University Healthcare, London, United Kingdom (Bolton, Bouttell) Centre for Healthcare Equipment and Technology Adoption (CHEATA), Nottingham, United Kingdom (Shipolini, Magboo) Barts Health NHS Trust, London, United Kingdom (Oezalp) The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom Publisher W.B. Saunders Ltd Abstract Background: Surgical site infection after cardiac surgery is a common cause of morbidity and unplanned healthcare use, with most infections developing after hospital discharge. Remote wound monitoring using smartphone technology and artificial intelligence (AI) may support earlier identification of complications. Aim(s): To evaluate the feasibility, acceptability, and safety of an AI-enabled digital wound monitoring platform plus usual care (Isla-AI) compared with usual care (UC) alone. Design, setting, and participants: This multi-centre, two-arm randomised controlled feasibility trial was conducted at two U.K. hospitals between August 2024 and January 2025. Adults undergoing cardiac surgery were randomised to receive Isla-AI or UC. The study was not powered to assess effectiveness. Result(s): 120 patients were randomised and participated (Isla-AI N = 62; UC N = 58). Feasibility targets were exceeded: 60% of eligible patients approached consented, 95% of Isla-AI participants submitted at least one image, and 92% completed the study. Ninety-eight percent of images were suitable for clinical assessment. Clinician agreement with AI priority flags was 87%. AI prioritisation performance was slightly better for patients with darker skin tones. More than half of participants required assistance to capture or submit wound images. Patient- and staff-acceptability of AI was largely favourable. Adverse and serious adverse event rates were similar across both groups. The proportion of patients accessing National Health Service (NHS) resources for wound-related problems and antibiotics was lower in the Isla-AI group. Conclusion(s): These findings support progression to a large, definitive multi-centre effectiveness trial, with further attention to equity, usability, and workflow integration. Trial registration: IRAS 338141; local project UHDB/2022/024. ISRCTN16900119. Clinicaltrials.gov: NCT06475703. Date registered: 20/06/2024. Copyright © 2026 The Author(s) <164> [Use Link to view the full text] Accession Number 2045808047 Title The efficacy and safety of serratus anterior plane block in patients undergoing cardiac surgery: A systematic review and meta-analysis. Source Medicine (United States). 105(11) (no pagination), 2026. Article Number: e48013. Date of Publication: 13 Mar 2026. Author Cui X.-B.; Cui M.-Z.; Yang Q.-J.; Liu Y.; Yi M.-Q.; Zhang X.-Y.; Yao Y.-T. Institution (Cui, Cui, Yi) Department of Anesthesiology and Perioperative Medicine, People's Hospital of Henan University, Henan Provincial People's Hospital, Zhengzhou, China (Yang, Liu, Zhang) Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan, Zhengzhou, China (Yao) Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (Yao) Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing, China (Yao) Department of Anesthesiology, Center of Outcomes Research, Critical Care and Pain Medicine, University of Texas, Houston, TX, United States (Yao) Outcomes research Consortium, Houston, TX, United States Publisher Lippincott Williams and Wilkins Abstract Background: - Serratus anterior plane block (SAPB) is a widely used fascial block that reduces postoperative pain and perioperative opioid consumption. This meta-analysis assessed the efficacy and safety of SAPB in cardiac surgery patients. Method(s): - We systematically searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang databases on May 10, 2024. Pooled relative risks and mean differences (MD) with 95% confidence intervals (CI) were calculated for dichotomous and continuous outcomes, respectively. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using Egger test. Subgroup analyses were stratified by study design (randomized controlled trials vs cohort studies) and patient age to explore methodological heterogeneity. Result(s): - Fifteen studies, encompassing 1169 adult and pediatric participants, were included. Overall, compared to general anesthesia (GA) alone, the SAPB + GA group significantly reduced intensive care unit length of stay (MD = -6.61 hours, 95% CI: -10.91 to -2.32), decreased postoperative analgesic consumption (MD = -4.20 mg morphine equivalents, 95% CI: -6.52 to -1.88), and lowered the risk of complications (relative risk = 0.63, 95% CI: 0.40-0.99). SAPB + GA also lowered postoperative Visual Analogue Scale pain scores (MD = -1.25, 95% CI: -1.74 to -0.75) and serum cortisol levels (MD = -35.43 nmol/L, 95% CI: -58.58 to -12.27). No local anesthetic toxicity or mortality was reported. Conclusion(s): - Perioperative SAPB combined with GA provides significant benefits in cardiac surgery, including accelerated intensive care unit discharge, reduced opioid use and pain scores, attenuated stress response (reduced cortisol), and favorable safety, which supports enhanced patient recovery. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc. <165> Accession Number 2046150005 Title Postoperative pericardial effusion on routine echocardiography: A review of incidence, progression, and management: To dissolve or to be resolved. Source Netherlands Heart Journal. (no pagination), 2026. Date of Publication: 2026. Author van Dinter S.; Wollersheim L.; Li W.; Donders R.; van Royen N.; Dieker H.-J.; Verhagen A. Institution (van Dinter, Li, Verhagen) Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands (Wollersheim) Department of Cardiothoracic Surgery, Frisius Medical Center, Leeuwarden, Netherlands (Donders) Department for Health Evidence, Section Biostatistics, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands (van Royen, Dieker) Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands Publisher Bohn Stafleu van Loghum Abstract Postoperative pericardial effusion (PPE) is a common finding after cardiac surgery, with reported incidences ranging widely from 2% to 85%. While most effusions resolve spontaneously, a subset progresses to cardiac tamponade requiring urgent intervention. This systematic review evaluated the true incidence of PPE and PPE-related reinterventions based on routine echocardiographic screening, and explored temporal evolution, symptomatology, and perioperative risk factors. A comprehensive search of Embase, PubMed, and Web of Science through May 2025 identified 26 eligible studies including 8,495 patients. Data extraction followed PRISMA guidelines and quality assessment with the JBI checklist. Random-effects meta-analysis demonstrated a pooled PPE incidence of 36% (95% confidence interval (CI) 25-49%), whereas only 3% (95% CI 2-4%) required reintervention, ranging from 2% after CABG to 6% after aortic surgery. Large effusions (> 2 cm) were associated with a substantially higher likelihood of intervention (54% [14-90%]), although spontaneous resolution remained common. Preventive strategies such as posterior pericardiotomy and posterior chest tube placement significantly reduced both PPE incidence and reintervention rates. Despite these findings, interpretation is limited by substantial heterogeneity in study design, definitions, and follow-up protocols. Standardized definitions, structured echocardiographic follow-up, and prospective studies are needed to improve risk stratification and guide clinical decision-making. Copyright © The Author(s) 2026. <166> [Use Link to view the full text] Accession Number 2045940011 Title Preoperative single-level ultrasound-guided superficial parasternal intercostal plane block and pulmonary recovery after cardiac surgery with sternotomy: a randomised controlled trial. Source European Journal of Anaesthesiology. (no pagination), 2026. Date of Publication: 2026. Author Huette P.; Daumin C.; Fontaine R.; Lefebvre T.; Tarpin P.; Beyls C.; Gubler B.; Mahjoub Y.; Ollier A.; Abou-Arab O. Institution (Huette, Daumin, Fontaine, Lefebvre, Tarpin, Beyls, Mahjoub, Abou-Arab) Department of Anaesthesiology and Critical Care Medicine, Amiens Picardy University Hospital, France (Huette, Tarpin, Beyls, Mahjoub) UR UPJV 7518 SSPC Research Unit, Jules Verne University of Picardie, France (Gubler) Immunology Department & EA4666-HEMATIM, Amiens University Hospital, Amiens, France (Ollier) Department of Biostatistics, Amiens Picardy University Hospital, France (Abou-Arab) Laboratoire MP3CV, CURS, Universite Picardie Jules Verne, France Publisher Lippincott Williams and Wilkins <167> Accession Number 2046331762 Title Impact of body mass index on outcomes of cardiac rehabilitation: a systematic review and meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1757861. Date of Publication: 2026. Author Tu S.; Ding C. Institution (Tu, Ding) Rehabilitation Medicine Department, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China Publisher Frontiers Media SA Abstract Objective - The effectiveness of cardiac rehabilitation (CR) after cardiac events and surgeries is well known. However, whether baseline body mass index (BMI) impacts CR outcomes is unclear. This first systematic review and meta-analysis of literature examined the difference in CR outcomes based on various BMI categories. Methods - The Web of Science, Embase, PubMed, and Scopus databases were searched until October 6, 2025, for all studies examining the outcomes of CR based on BMI. The primary outcome was the change in exercise capacity [as measured by changes in metabolic equivalents (METs)]. In contrast, secondary outcomes included changes in BMI, lipid profile, resting heart rate, and resting blood pressure. Results - Eighteen studies were included. In the comparison of obese vs. non-obese participants, pooled results showed no significant difference in the change in METs between the two groups. Subgroup analyses based on study design and obesity definition did not alter the overall findings. Among secondary outcomes, the change in BMI was not significantly different between the groups. Additionally, total cholesterol levels improved slightly more in non-obese individuals; however, there were no significant differences observed for high-density lipoprotein (HDL), triglycerides, heart rate, or blood pressure. In the comparison of overweight vs. normal BMI groups, no significant differences were observed for change in METs or BMI. Similarly, total cholesterol and HDL levels did not differ significantly between groups, although triglyceride reduction was greater among patients with a normal BMI. High heterogeneity was noted in most analyses. Conclusions - Our results indicate that pre-rehabilitation BMI does not affect improvements in exercise capacity and lipid profile in CR patients. Variations in CR protocols and high inter-study heterogeneity prohibit firm conclusions. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420251153489, identifier CRD420251153489. Copyright © 2026 Tu and Ding. <168> Accession Number 2046229001 Title Effects of Ulinastatin and Tranexamic Acid in Cardiac Surgery: A Systematic Review and Meta-Analysis. Source Journal of the College of Physicians and Surgeons Pakistan. 36(6) (pp 789-797), 2026. Date of Publication: 01 Jun 2026. Author Zhang X.; Lin H.; Xu H.; Yao Y. Institution (Zhang, Lin, Xu) Department of Anaesthesiology and Perioperative Medicine, Fuwai Central China Cardiovascular Hospital, Zhengzhou University Central China, Fuwai Hospital, Zhengzhou, China (Zhang) Laboratory of Transesophageal Echocardiography, Henan Provincial Clinical Research Centre for Cardiovascular Disease, China (Yao) Department of Anaesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China (Yao) Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing, China (Yao) Centre of Outcomes Research, Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Houston, United States (Yao) Outcomes Research Consortium, Houston, United States Publisher College of Physicians and Surgeons Pakistan Abstract Evidence suggests that both tranexamic acid (TXA) and ulinastatin (ULI) possess anti-inflammatory and blood-conserving properties. This study aimed to determine whether combining TXA and ULI yields additional benefits for patients undergoing cardiac surgery compared with the use of either medicine alone. This systematic review was conducted through comprehensive searches of PubMed, the Cochrane Library, EMBASE, CBM, CNKI, and WANFANG Data from their inception to December 2024 to identify all relevant clinical trials. Data from sixteen studies, encompassing 1,617 subjects, were synthesised using a random-effects meta-analysis. Primary outcomes included perioperative blood loss and blood transfusion requirements. Secondary outcomes included perioperative haemoglobin levels, coagulation function, platelet counts, and postoperative complications. This meta-analysis demonstrated that combination therapy with ULI and TXA significantly reduced total postoperative bleeding volume and RBC transfusion requirements compared to ULI monotherapy in cardiac surgery. However, no significant difference was observed compared to TXA alone. The combined regimen better preserved postoperative coagulation function, leading to significant improvements in prothrombin time, activated partial thromboplastin time, and D-dimer levels. The combination strategy may allow for reduced dosages of each drug, potentially lowering the thrombogenic risk associated with TXA. No significant adverse events were reported in the included studies. Therefore, the combination of ULI and TXA exhibits a synergistic effect on haemostasis and preservation of coagulation function, representing an optimised strategy for blood management in cardiac surgery. Copyright © 2026 College of Physicians and Surgeons Pakistan. All rights reserved. <169> Accession Number 2046236731 Title Driving pressure-guided ventilation during one-lung ventilation for thoracic surgery: a systematic review and meta-analysis. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1837064. Date of Publication: 2026. Author Yin X.; Du S. Institution (Yin) Department of Anesthesiology, Aerospace Center Hospital, Beijing, China (Du) Department of VIP Dental Service, Peking University Stomatological Hospital, Beijing, China Publisher Frontiers Media SA Abstract Background - Driving pressure-guided ventilation has been proposed as a physiologically rational lung-protective strategy during one-lung ventilation for thoracic surgery. However, no previous systematic review has specifically focused on trials in which driving pressure was the explicit primary ventilatory target during one-lung ventilation. We aimed to assess the effects of driving pressure-guided ventilation on postoperative pulmonary complications (PPCs) and related perioperative outcomes in adults undergoing thoracic surgery. Methods - We searched MEDLINE, Embase, CENTRAL, Web of Science, Scopus, and trial registries from inception to 19 March 2026. We included randomized controlled trials comparing explicit driving pressure-guided ventilation with conventional non-driving-pressure-guided ventilation during one-lung ventilation in adults undergoing thoracic surgery. Observational studies were summarised narratively. Random-effects meta-analyses were performed using restricted maximum likelihood estimation with Hartung-Knapp adjustment. Certainty of evidence was assessed using GRADE. The review was registered in PROSPERO (CRD420261329253). Results - Four randomized controlled trials (654 patients) were included in the primary analysis. The pooled effect on PPCs was not statistically significant in the primary random-effects analysis (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.26-1.35; p = 0.14; I2 = 49.7%). Exploratory supportive analyses-including a fixed-effect model (RR 0.61; p = 0.007), the pooled absolute risk difference (-7.6%; p = 0.027), and a broadened sensitivity analysis of six trials incorporating individualised PEEP strategies (RR 0.70; p = 0.12)-were directionally concordant but should not be interpreted as independent confirmation of effect, given the imprecision of the primary estimate and variation in baseline PPC risk. Four observational studies provided mixed supplementary evidence. The overall certainty of evidence was low according to GRADE, owing to inconsistency and imprecision. Conclusion - The primary randomized evidence did not demonstrate a statistically significant reduction in postoperative pulmonary complications, and the overall certainty of evidence was low. The available data are therefore hypothesis-generating. Larger, multicentre, and geographically diverse randomized trials with harmonised outcome definitions are needed to clarify whether driving pressure-guided ventilation improves postoperative outcomes and should be adopted more broadly in thoracic anaesthesia. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420261329253, Unique Identifier: CRD420261329253. Copyright © 2026 Yin and Du. <170> Accession Number 2046371342 Title Evaluation of the application effect of the One Cloud and Four Terminals full-chain intelligent nursing model in patients with chronic heart failure. Source Chinese Journal of Practical Nursing. 42(16) (pp 1210-1217), 2026. Date of Publication: 01 Jun 2026. Author Lu H.; Xu R.; Ling X.; Zou L.; Zeng X.; Mo L. Institution (Lu, Xu, Ling, Zou, Zeng, Mo) Department of Cardiovascular Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, China (Lu, Xu) Graduate School, Guangxi Medical University, Nanning, China Publisher Chinese Medical Journals Publishing House Co.Ltd Abstract Objective To investigate the application effect of the One Cloud and Four Terminals (cloud platform + physician terminal, nurse terminal, patient terminal, and family caregiver terminal) full-chain intelligent nursing model in patients with chronic heart failure (CHF). Methods A prospective randomized controlled trial was conducted on patients with confirmed CHF admitted to the ward of Department of Cardiovascular Surgery, First Affiliated Hospital of Guangxi Medical University, from March 2023 to January 2025. The control group was matched to the observation group using propensity score matching. The control group received routine intervention, while the observation group was administered the One Cloud and Four Terminals full-chain intelligent nursing model for 6 consecutive months. Differences in the Minnesota Living with Heart Failure Questionnaire (MLHFQ) scores, Self-Care of Heart Failure Index (SCHFI) scores, 6-minute walk distance, cardiopulmonary exercise test parameters [peak load power (WRpeak), peak oxygen pulse (VO<inf>2</inf>/HRpeak), peak oxygen uptake (VO<inf>2</inf>peak)], and readmission rates were compared between the two groups before and 6 months after the intervention. Results A total of 100 CHF patients were enrolled in both the control group and the observation group. The control group comprised 57 males and 43 females, with an age range of 46-76 (65.63 +/- 3.70) years. The observation group included 55 males and 45 females, aged 45-76(66.05 +/- 3.69) years. After 6 months of intervention, the control group exhibited the following outcomes: WRpeak (102.33 +/- 18.08) W, VO<inf>2</inf>/HRpeak (10.81 +/- 3.10) ml/beat, VO<inf>2</inf>peak (16.19 +/- 2.60) ml.kg-1.min-1, 6-minute walk distance (426.35 +/- 105.35) m, MLHFQ scores for physical, emotional, and other domains (16.05 +/- 3.30), (12.30 +/- 2.12), and (11.35 +/- 3.20) respectively, and total SCHFI score (69.33 +/- 8.37). These values were significantly different from those of the observation group during the same period: WRpeak (109.24 +/- 19.66) W, VO<inf>2</inf>/HRpeak (12.06 +/- 3.08) ml/beat, VO<inf>2</inf>peak (17.20 +/- 2.34) ml.kg-1.min-1, 6-minute walk distance (471.32 +/- 110.38) m, MLHFQ scores for physical, emotional, and other domains (10.73 +/- 3.41), (9.57 +/- 2.20), and (10.29 +/- 3.22) respectively, and total SCHFI score (78.35 +/- 9.33) (t values were 2.34-11.21, all P<0.05). The readmission rate was 27.00% (27/100) in the control group and 11.00% (11/100) in the observation group, with a statistically significant difference (chi2=8.32, P<0.05). Conclusions CHF patients receiving the One Cloud and Four Terminals full-chain intelligent nursing model demonstrate improved exercise tolerance and quality of life, reduced readmission rates, and enhanced self-management abilities. This provides an effective pathway for the intelligentization of nursing care for CHF. Copyright 2026, Chinese Medical Association

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