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

Total documents retrieved: 146 Results Generated From: Embase <1980 to 2026 Week 27> Embase Weekly Updates (updates since 2026-06-26) - (146 records) <1> Accession Number 2046569952 Title Postoperative pain management after VATS for spontaneous pneumothorax - a systematic review. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 377. Date of Publication: 01 Dec 2026. Author van Steenwijk Q.C.A.; Janssen L.; Hoogendoorn I.; Dickhoff C.; Braun J.; van den Broek F.J.C. Institution (van Steenwijk, Janssen, van den Broek) Department of Surgery, Maxima Medical Center, Veldhoven, Netherlands (Hoogendoorn) Department of Science and Medical Innovation, Maxima Medical Center, Veldhoven, Netherlands (Dickhoff, Braun) Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, Amsterdam, Netherlands (Braun) Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Publisher BioMed Central Ltd Abstract Background: Historically, thoracic epidural analgesia has been the standard for postoperative pain management after surgery for spontaneous pneumothorax. With the advent of enhanced recovery after thoracic surgery protocols, less invasive locoregional analgesic techniques are increasingly considered. Due to lack of high-quality evidence, current guidelines do not address optimal analgesic strategies in this population. This systematic review evaluated the effectiveness of various analgesic techniques following video-assisted thoracoscopic surgery for spontaneous pneumothorax. Method(s): Medline, Embase and Cochrane databases were searched until May 2025. Inclusion criteria were patients undergoing video-assisted thoracoscopic surgery for spontaneous pneumothorax, with clearly described postoperative analgesic management (e.g. epidural, locoregional, systemic) and pain scores (visual analgesic score or numeric pain rating score) within 48 h. The primary outcome was pain scores within 48 h postoperatively; secondary outcomes included adjunct analgesic use and complications. Risk of bias was assessed for the primary outcome. Result(s): Thirty studies comprising 3,203 patients were assessed: risk of bias was low in 3, moderate/some concerns in 24 and high in 3 studies. There were 10 comparative studies and 20 single-arm cohort studies applying solely systemic analgesia (n = 14) or locoregional analgesia (n = 6). No single-arm cohort study applied solely epidural analgesia. Postoperative pain scores within 48 h were higher after systemic analgesia only, compared to the addition of locoregional or epidural analgesia. No clear differences were observed in analgesia-related complications between the analgesic techniques. Conclusion(s): Locoregional or epidural analgesia as part of a multimodal regimen was associated with the lowest postoperative pain scores, although differences were small. Substantial heterogeneity and low certainty of evidence precluded definitive recommendations. This review provides a foundation for future research investigating optimal analgesic strategies following surgery for spontaneous pneumothorax. Copyright © The Author(s) 2026. <2> Accession Number 2046262985 Title 10-Year Randomized Outcomes of Transcatheter or Surgical Aortic Valve Replacement in Intermediate-Risk Aortic Stenosis. Source Journal of the American College of Cardiology. 87(23) (pp 3309-3321), 2026. Date of Publication: 16 Jun 2026. Author Thourani V.H.; von Stein P.; Mack M.J.; Nazif T.M.; Babaliaros V.; Alkhouli M.; Fischbein M.P.; Desai N.D.; Satler L.; Zidar F.J.; Kodali S.K.; Kron I.L.; Zajarias A.; Brinkman W.; Kapadia S.; Dewey T.M.; Gossl M.; Bodenhamer R.M.; Ma Y.; Cohen D.J.; Sharma R.; Pibarot P.; Hahn R.T.; Leon M.B.; Makkar R.R. Institution (Thourani) Piedmont Heart Institute, Atlanta, GA, United States (von Stein, Cohen, Hahn, Leon) Cardiovascular Research Foundation, New York, NY, United States (Mack, Brinkman) The Heart Hospital Baylor Scott and White Plano, Plano, TX, United States (Nazif, Kodali, Hahn, Leon) Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, United States (Babaliaros) Emory University Hospital, Atlanta, GA, United States (Alkhouli) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Fischbein) Stanford Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, United States (Desai) Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States (Satler) Section of Interventional Cardiology, Washington Hospital Center, Washington, DC, United States (Zidar) Austin Heart, Austin, TX, United States (Kron) Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States (Zajarias) Cardiovascular Division, Washington University/Barnes Jewish Hospital, St Louis, MO, United States (Kapadia) Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, United States (Dewey) Medical City Dallas Hospital, Dallas, TX, United States (Gossl) Valve Science Center, Allina Health Minneapolis Heart Institute, Minneapolis, MN, United States (Bodenhamer) University of Oklahoma College of Medicine, Oklahoma City, OK, United States (Ma) Edwards Lifesciences, Irvine, CA, United States (Cohen) St Francis Hospital and Heart Center, Roslyn, NY, United States (Sharma) Division of Cardiovascular Medicine, Stanford Health Care, Stanford, CA, United States (Pibarot) Quebec Heart & Lung Institute, Universite Laval, Quebec, QC, Canada (Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States Publisher Elsevier Inc. Abstract Background: Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement for symptomatic severe aortic stenosis, but long-term, comparative clinical outcomes and echocardiography data are lacking. Objective(s): Our goal was to compare 10-year clinical and echocardiographic outcomes after balloon-expandable TAVR or surgery in intermediate-risk surgical patients in the PARTNER 2A randomized trial. Method(s): Between 2011 and 2013, patients with severe, symptomatic aortic stenosis at intermediate surgical risk were randomized at 57 centers to TAVR with the balloon-expandable SAPIEN XT system (Edwards Lifesciences) or to surgery. Randomization was stratified by anatomical suitability for transfemoral (TF) or transthoracic (transapical/transaortic [TA/TAo]) access. Ten-year outcomes were evaluated in the valve implant population and included all-cause mortality, aortic valve reintervention, and core laboratory-adjudicated echocardiographic outcomes. To obtain 10-year data, patient reconsent at 5 years was required, and vital status sweeps were implemented to improve data completeness for all-cause mortality. Result(s): Among 1,910 randomized patients who received a valve, 974 underwent TAVR (TF: 749/974 [76.9%]) and 936 had surgery. Mean patient age was 81.6 years, 45.4% were women, and the mean Society of Thoracic Surgeons score was 5.8%. At 10 years, vital status was available for 881 of 974 patients (90.5%) and 838 of 936 patients (89.5%). All-cause 10-year mortality with vital status sweeps was 86.1% after TAVR and 82.8% after surgery (HR: 1.13; 95% CI: 1.02-1.25; P = 0.02). When stratified by access route, rates of all-cause mortality for TAVR and surgery in the TF group were similar (83.9% vs 82.1%, respectively; P = 0.27), whereas mortality was higher for TAVR in the TA/TAo group (93.2% vs 85.1%; P < 0.01; P for interaction = 0.03). Cumulative incidence rates of aortic valve reintervention at 10 years were 6.3% for TAVR and 1.6% for surgery (P < 0.001). Of the 24 TAVR and 35 surgical patients with available echocardiographic data at 10 years, mean gradients were 12.6 mm Hg and 12.7 mm Hg, respectively. Conclusion(s): At the 10-year follow-up, TAVR in intermediate-risk patients with the SAPIEN XT prosthesis compared with surgery was associated with lower survival rates, with differences predominantly observed in the TA/TAo access cohort. TAVR with the XT valve was also associated with significantly higher rates of aortic valve reintervention. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk [PII A]; NCT01314313). 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/ <3> Accession Number 2046231781 Title Intelligent therapeutic robotic-assisted surgery as the next frontier of precision oncology. Source Frontiers in Oncology. 16 (no pagination), 2026. Article Number: 1825904. Date of Publication: 2026. Author Satyam S.M.; Wali A.F.; El-Tanani M.; Sarfraz A.; Khalil I.; Alghoul W.I.; Bhat A.A.; Mansor I.; Alhammadi M.A.; Al-Shammari W.B.J.; Nasser R.A.S.; Menon A.; Alahmad O.M. Institution (Satyam, Sarfraz, Khalil, Alghoul, Bhat, Alhammadi, Al-Shammari, Nasser, Menon, Alahmad) Department of Pharmacology, Ras Al Khaimah (RAK) College of Medical Sciences, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates (Wali, El-Tanani) Ras Al Khaimah (RAK) College of Pharmacy, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates (Mansor) Department of Biotechnology, American University of Ras Al Khaimah, Ras Al Khaimah, United Arab Emirates Publisher Frontiers Media SA Abstract Robotic-assisted surgery has evolved over the past two decades from mechanically assisted laparoscopy into an increasingly intelligent, biologically responsive therapeutic modality. While early robotic systems primarily enhanced dexterity and visualization, contemporary platforms now integrate artificial intelligence, advanced imaging, real-time biosensing, and pharmacological interfaces, extending surgical capability beyond physical manipulation alone. Robotic-assisted surgery is thus emerging at the intersection of digital intelligence and molecular medicine, with the potential to sense, interpret, and modulate tumor biology during operative intervention. However, current literature remains largely procedure-centered and mechanically focused, offering limited synthesis of how robotic systems converge with pharmacology, artificial intelligence, and systems medicine to actively regulate oncologic processes. A cohesive, oncology-oriented framework integrating intelligent robotics with intraoperative drug delivery and real-time biological feedback is notably lacking. This narrative review critically consolidates recent advances in pharmacologically enabled robotic platforms, AI-driven intraoperative cognition, and emerging closed-loop surgical-pharmacological architectures. It examines next-generation systems incorporating localized drug delivery, molecular diagnostics, and real-time pharmacodynamic monitoring, while discussing translational pathways and regulatory considerations shaping semi-autonomous oncologic ecosystems. By reframing robotic-assisted surgery as a dynamic therapeutic science rather than a purely mechanical tool, this review highlights a new frontier in precision oncology that has the potential to enable individualized, adaptive, and predictive cancer interventions. Copyright © 2026 Satyam, Wali, El-Tanani, Sarfraz, Khalil, Alghoul, Bhat, Mansor, Alhammadi, Al-Shammari, Nasser, Menon and Alahmad. <4> Accession Number 2046026152 Title Comparing mitral transcatheter edge-to-edge repair and surgical intervention in mitral regurgitation: A meta-analysis. Source Journal of Cardiovascular and Thoracic Research. 18(1) (pp 4-14), 2026. Date of Publication: 2026. Author Mata E.; Garcia B.L.; Castro M.; Tinoco M.; Pinheiro L.; Portugues J.; Ferreira F.; Calvo L.; Ribeiro S.; Lourenco A. Institution (Mata, Garcia, Castro, Tinoco, Pinheiro, Portugues, Ferreira, Calvo, Ribeiro, Lourenco) Cardiology Department, Unidade Local de Saude de Alto Ave, Guimaraes, Portugal Publisher Tabriz University of Medical Sciences Abstract Surgery remains the standard treatment for severe mitral valve regurgitation (MR), but growing evidence highlights the potential role of mitral valve percutaneous edge-to-edge repair (M-TEER). This meta-analysis aims to compare 12-month all-cause mortality between M-TEER and surgical intervention (SMVI). A systematic search (October 2024) of PubMed, Cochrane, Scopus, and Web of Science identified randomized control trials (RCTs) and propensity-matched observational studies comparing 12-month all-cause mortality in MR patients treated with M-TEER or SMVI. An inverse variance random-effects meta-analysis assessed outcomes using risk ratios (RR) and 95% confidence intervals (CI). Two RCTs (MATTERHORN and EVEREST II) and three observational studies totaling 1,782 patients, were included in the final analysis. A non-significant trend of higher mortality at 30 days was observed in the SMVI group (RR: 0.72; CI: 0.26-2.00), along with higher complication rates mainly due to bleeding. At 12 months follow-up, SMVI was associated with a significantly lower risk of all-cause mortality (RR: 1.41; CI: 1.11-1.81), while the M-TEER group had more patients with MR grade 3 or higher (RR: 4.05; CI: 1.54-10.67), with a non-significant trend of higher rate of MR reintervention (RR 2.51; CI 0.83-7.66) at 12 months. Based on current evidence, M-TEER should continue to be reserved for patients with prohibitive high surgical risk. While propensity-matched cohorts were pooled for the study estimates, the limited available data from randomized trials, combined with heterogeneity in patient populations, particularly regarding MR etiology, underscores the need for further studies. Copyright © 2026 The Author(s). <5> Accession Number 2046590278 Title Prehabilitation in lung cancer patients undergoing lung resection surgery (Fit4LungNeo): study protocol. Source Contemporary Clinical Trials Communications. 52 (no pagination), 2026. Article Number: 101657. Date of Publication: 01 Aug 2026. Author Guedes da Silva D.P.; Bohn L.; Oliveira J.; Eusebio E.; Fernandes M.G.; Teixeira C.; Canelas H.; Fernandes P.; Leite-Moreira A.; Goncalves L.; Godinho A.S.; Monteiro J.L.; Kendall F. Institution (Guedes da Silva, Bohn, Oliveira, Kendall) Research Centre in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Heath (ITR), Faculty of Sport, University of Porto, Rua Placido da Costa, Porto, Portugal (Eusebio, Fernandes) Pulmonology Department ULS Sao Joao, Alameda Professor Hernani Monteiro, Porto, Portugal (Fernandes, Fernandes, Leite-Moreira) Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, Porto, Portugal (Teixeira, Canelas) Nutrition Department, Sao Joao, Alameda Professor Hernani Monteiro, Porto, Portugal (Teixeira) School of Biotechnology, Universidade Catolica Portuguesa (UCP), Rua de Diogo Botelho 1327, Porto, Portugal (Teixeira, Canelas) Faculty of Nutrition and Food Sciences, University of Porto, Rua Do Campo Alegre 823, Porto, Portugal (Canelas) School of Health Technologies, Polytechnic Institute of Braganca, Campus de Santa Apolonia, Braganca, Portugal (Fernandes, Leite-Moreira, Godinho, Kendall) Department of Cardiothoracic Surgery, ULS Sao Joao, Alameda Professor Hernani Monteiro, Porto, Portugal (Leite-Moreira) UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal (Goncalves, Kendall) School of Health Technologies of Tamega and Sousa, Polytechnic Health Institute of the North, CESPU, Rua Central de Gandra, 1317, Gandra, Portugal (Goncalves) H2M - Health and Human Movement Unit, School of Health Technologies of Vale Do Ave, Polytechnic Health Institute of the North, CESPU, Rua Jose Antonio Vidal, 81, Vila Nova de Famalicao, Portugal (Monteiro) Autonomous Management Unit of Surgery, ULS, Sao Joao, Alameda Professor Hernani Monteiro, Porto, Portugal Publisher Elsevier Inc. Abstract Background Lung resection is the gold standard and the most effective curative treatment for lung cancer, especially in early-stage non-small cell lung cancer, improving long-term survival and quality of life. The growing body of evidence from randomized controlled trials supports the efficacy of prehabilitation in reducing both the incidence and severity of postoperative pulmonary complications and shortening the length of hospital stay. Objective The general objective is to compare the effects of a single education session with different prehabilitation programs in patients undergoing lung resection surgery. Methods Two hundred lung cancer patients who are going to be submitted to a lung resection surgery will be randomized into: (1) Inspiratory Muscle Training Group (n = 50), Expiratory Muscle Training Group (n = 50), Global Exercise Training Group (n = 50), and Control Group (n = 50). All patients will receive a single session in-person education session and written information regarding healthy habits to follow before, during, and after hospital discharge, and those from the IMT-G, EMT-G, and GET-G will start their 2-week prehabilitation interventions at ULS Sao Joao. Patients will be evaluated at baseline, after completing the prehabilitation program (post-intervention assessment), and 30 days post-discharge (follow-up assessment). Discussion Despite diverse intervention strategies, prehabilitation consistently proves effective in bolstering patients' functional capacity. It may also help strengthen the respiratory muscles, which in turn affect lung function and cough effectiveness after thoracic surgery. This randomized trial has been designed to compare different prehabilitation programs and analyze their inherent costs. Copyright © 2026. Published by Elsevier Inc. <6> Accession Number 2046504513 Title Relationship between baseline patient-reported health status and patient-centered outcomes after transcatheter aortic valve replacement. Source American Heart Journal. 300 (no pagination), 2026. Article Number: 107495. Date of Publication: 01 Oct 2026. Author Tomii D.; Lanz J.; Heg D.; Thiele H.; Kim W.-K.; Joner M.; Mollmann H.; Conradi L.; Thilo C.; Toggweiler S.; Prendergast B.; Windecker S.; Pilgrim T. Institution (Tomii, Lanz, Windecker, Pilgrim) Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (Heg) Department of Clinical Research, University of Bern, Bern, Switzerland (Thiele) Heart Centre Leipzig, Leipzig University, Leipzig, Germany (Kim) Department of Cardiology, University of Giessen, Giessen, Germany (Joner) German Heart Centre, Technical University of Munich, Munich, Germany (Mollmann) Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany (Conradi) Department of Cardiovascular Surgery, University of Koln, Koln, Germany (Thilo) Department of Internal Medicine I, RoMed Klinikum Rosenheim, Germany (Toggweiler) Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland (Prendergast) Department of Cardiology, St. Thomas' Hospital, Cleveland Clinic, London, United Kingdom Publisher Elsevier Inc. Abstract Background Aortic stenosis (AS) impairs health-related quality of life but the prognostic impact of patient-reported health status prior to transcatheter aortic valve replacement (TAVR) is not fully established. Objectives To investigate the association of patient-reported health status at baseline with clinical outcomes and health status after transfemoral TAVR in patients with symptomatic severe AS. Methods In the investigator-initiated, multicenter SCOPE I randomized trial, patients underwent TAVR who provided baseline Kansas City Cardiomyopathy Questionnaire (KCCQ) assessment were included in this post hoc analysis. An integrated patient-centered outcome was defined as being alive with good health status (KCCQ overall summary score [KCCQ-OS] >= 75 without a decline of >10 points from baseline). Results Of 739 patients enrolled in SCOPE I, 692 were included in the present analysis. Median baseline KCCQ-OS was 54.9 (39.6-71.9) distributed as follows: KCCQ-OS < 25-74 (10.7%), 25 to 49-222 (32.1%), 50 to 74-271 (39.2%), and >= 75-125 (18.1%). At 3 years after TAVR, higher baseline KCCQ-OS was associated with a greater likelihood of being alive with good health status (KCCQ-OS 50-75 vs 0-25: adjusted odds ratio 2.25, 95% confidence interval [CI] 1.12-4.54; 75-100 vs 0-25: adjusted odds ratio 5.15, 95% CI 2.33-11.3). Restricted cubic spline modelling demonstrated an approximately linear relationship between baseline KCCQ-OS and all-cause mortality, and alive with good health status. Conclusions In this post hoc analysis of SCOPE I, better baseline patient-reported health status was associated with a higher probability of being alive with good health status up to 3 years after TAVR. Clinical trial registration https://www.clinicaltrials.gov/study/NCT03011346 . Copyright © 2026 The Author(s). <7> Accession Number 2046600081 Title Impact of cardiac amyloidosis on survival in aortic stenosis patients undergoing TAVR: a systematic review and reconstructed time-to-event meta-analysis. Source Egyptian Heart Journal. 78(1) (no pagination), 2026. Article Number: 49. Date of Publication: 01 Dec 2026. Author Almaadawy O.; Mostafa N.; Elbataa A.; Mohamed Hamed B.; Sarhan M.; Mohyeldin E.; Kamel O.; Asad A.; Dahik B.; Ismael Elnady M.; Ashraf Husain M.; Elshahat A.; Mansour A.; Eskander C.; Ahmed M. Institution (Almaadawy) Department of Cardiovascular Medicine, Saint Louis University, St. Louis, United States (Mostafa) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Elbataa, Mohamed Hamed, Ashraf Husain, Elshahat, Mansour) Faculty of Medicine, Al Azhar University, Cairo, Egypt (Sarhan) Faculty of Medicine, Zagazig University, Zagazig, Egypt (Mohyeldin) Faculty of Medicine, Menoufia University, Menoufia, Egypt (Kamel) Faculty of Physical Therapy, South Valley University, Qena, Egypt (Asad, Dahik) Ankara Yildirim Beyazit University, Ankara, Turkey (Ismael Elnady) The Wright Center for Graduate Medical Education, Scranton, United States (Eskander) Department of Medicine, University of Florida, Gainesville, United States (Ahmed) Department of Cardiovascular Medicine, University of Florida, Gainesville, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: New evidence suggests a relatively high prevalence of occult cardiac amyloidosis (CA) among patients with aortic stenosis (AS). While transcatheter aortic valve replacement (TAVR) is an established treatment for AS, the impact of concomitant CA on long-term outcomes remains unclear. We conducted a systematic review and meta-analysis to evaluate survival and procedural outcomes of TAVR in AS patients with and without CA. Method(s): PubMed, Scopus, Web of Science, Google Scholar, and the Cochrane Library were searched through 21 April 2026. Studies comparing outcomes of TAVR in patients with and without CA and reporting Kaplan-Meier survival curves were included. Individual patient survival data were extracted from Kaplan-Meier curves and reconstructed for pooled analysis. Secondary outcomes were analyzed using random-effects meta-analysis. Result(s): Seven studies including 2747 patients were analyzed. In the primary analysis, which included both definitive and probability-based definitions of CA, CA was associated with increased all-cause mortality following TAVR (HR: 1.58; 95% CI 1.23, 2.03; P < 0.001). However, in a sensitivity analysis restricted to studies with confirmed CA, this association was no longer significant (HR: 1.32, 95% CI 0.84, 2.07, P = 0.226). There were no significant differences in pacemaker implantation (OR: 1.33; 95% CI 0.69, 2.56; P = 0.40) or more than mild aortic regurgitation (OR: 0.96; 95% CI 0.25, 3.78; P = 0.96). Conclusion(s): The association between CA mortality after TAVR in AS patients is highly dependent on how CA is defined. While analyses including screening-based cohorts suggest increased risk, this was not observed in analyses of studies with confirmed CA. These findings highlight the impact of differing diagnostic approaches in CA and underscore the need for future studies to use standardized criteria and prospective designs to clarify the independent prognostic role of confirmed CA. Copyright © The Author(s) 2026. <8> Accession Number 2046487703 Title Percutaneous left atrial appendage closure in non-valvular atrial fibrillation with concomitant heart failure: a systematic review and meta-analysis of periprocedural and long-term outcomes. Source Current Medical Research and Opinion. (no pagination), 2026. Date of Publication: 2026. Author Yusuf M.; Milla C.; Chandra L.A.; Ievan Hakim D.; Subali A.D.; Aditya M.R.; Mulia R.H.; Kizzandy K.; Susilo H.; Kencono Wungu C.D.; Papageorgiou P. Institution (Yusuf, Chandra, Ievan Hakim, Subali, Aditya, Mulia, Kizzandy) Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia (Milla) Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia (Susilo) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia (Kencono Wungu) Department of Physiology and Medical Biochemistry, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia (Kencono Wungu) Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia (Papageorgiou) Department of Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece Publisher Taylor and Francis Ltd. Abstract Objective: Heart failure (HF) frequently coexists with non-valvular atrial fibrillation (NVAF) and may adversely affect outcomes after percutaneous left atrial appendage closure (LAAC). However, data on the safety and efficacy of LAAC in this high-risk subgroup remain inconsistent. Method(s): A comprehensive search of PubMed, Cochrane Library, ScienceDirect, Epistemonikos, and MedRxiv was conducted from inception to August 2025 for studies comparing outcomes of LAAC in NVAF patients with versus without HF. Random-effects meta-analyses were performed to estimate pooled odds ratios (ORs) for periprocedural outcomes, and hazard ratios (HRs) or ORs for long-term outcomes, with 95% confidence intervals (CIs). Result(s): Forty studies comprising 351,266 patients were included, with thirty-three contributing to quantitative synthesis. Compared with patients without HF, those with HF had higher odds of periprocedural major adverse events (OR 1.17, 95% CI 1.03-1.32), periprocedural mortality (OR 2.41, 95% CI 1.84-3.16), and major bleeding (OR 1.26, 95% CI 1.08-1.45). No significant differences were observed for periprocedural stroke or pericardial effusion. During long-term follow-up, HF was associated with increased all-cause mortality (HR 1.83, 95% CI 1.50-2.22), major adverse events (HR 1.21, 95% CI 1.00-1.46), and device-related thrombus (OR 1.45, 95% CI 1.17-1.79). Rates of long-term stroke, major bleeding, and peri-device leak were similar between groups. Conclusion(s): In NVAF patients undergoing LAAC, HF confers higher procedural risk and worse long-term survival, while protection against thromboembolism and major bleeding appears comparable. These findings underscore the need for careful patient selection, optimized procedural care, and individualized post-implant antithrombotic strategies. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <9> Accession Number 2047045817 Title Dose-Matched Parasternal Intercostal Plane Block With or Without Serratus Anterior Plane Block for Analgesia Following Cardiac Surgery: A Randomized Controlled Observer-Blinded Trial. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Guran Aytug E.; Kaynarca O.; Doganozu A.C.; Terzi E.Z.; Zengin M.; Unal D. Institution (Guran Aytug, Kaynarca, Doganozu, Terzi, Zengin, Unal) Department of Anesthesiology and Reanimation, Etlik City Hospital, The University of Health Sciences, Ankara, Turkey Publisher W.B. Saunders Abstract Objectives: To compare the effects of the parasternal intercostal plane (PIP) block alone versus the PIP block in combination with the serratus anterior plane block (SAPB) on opioid consumption in patients undergoing coronary artery bypass grafting (CABG). Design(s): Prospective, randomized, controlled, observer-blinded study. Setting(s): Tertiary training and research hospital. Participant(s): Adult patients scheduled for elective CABG surgery via median sternotomy with bilateral thoracic drains. Intervention(s): Patients were randomized into two groups; 40 mL of 0.25% bupivacaine was used in both groups. In the PIP group, a bilateral PIP block was performed with 20 mL of 0.25% bupivacaine on each side. In the PIP-SAPB group, a bilateral PIP block and bilateral SAPB were performed and 10 mL of 0.25% bupivacaine was administered to each PIP block and SAPB site. The primary outcome was total tramadol consumption within the first 24 hours after extubation. Measurements and Main Results: Seventy-two patients were analyzed (PIP group, n = 37; PIP-SAPB group, n = 35). Tramadol consumption was significantly lower in the PIP-SAPB group (median, 135 mg; interquartile range [IQR], 115-192.5 mg) than in the PIP group (median, 320 mg; IQR, 210-400 mg), corresponding to a Hodges-Lehmann median difference of 150 mg (95% confidence interval, 80-220 mg; p < 0.001). Numeric Rating Scale pain scores at the sternotomy site were similar between groups, whereas scores were significantly lower at the thoracic drain site in the PIP-SAPB group. Conclusion(s): Combining the SAPB with the PIP block does not further reduce sternotomy-related pain; however, it significantly decreases postoperative opioid consumption by effectively controlling drain-related pain. The observed opioid-sparing effect and improved patient comfort indicate that this approach is clinically feasible and aligns with multimodal, component-based analgesia strategies. Copyright © 2026 Elsevier Inc. <10> Accession Number 2042872311 Title Reconstructed Patient-Level Meta-analysis of Prophylactic Left Atrial Appendage Closure During Cardiac Surgery. Source Canadian Journal of Cardiology. 42(6) (pp 1329-1337), 2026. Date of Publication: 01 Jun 2026. Author Dong A.; Lee G.; Krishna V.; Whitlock R.; Kiankhooy A.; Bowdish M.; Chikwe J.; Tam D.Y. Institution (Dong, Krishna, Kiankhooy, Bowdish, Chikwe, Tam) Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States (Lee, Tam) Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada (Whitlock) Population Health Research Institute, Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada Publisher Elsevier Inc. Abstract Background The benefit of prophylactic concomitant left atrial appendage closure (LAAC) in cardiac surgery patients without preoperative atrial fibrillation is unclear. We aim to evaluate whether LAAC reduces the risk of late stroke in patients without preoperative atrial fibrillation. Methods A systematic search was conducted through July 2025 for studies investigating LAAC vs no LAAC in cardiac surgery patients without atrial fibrillation. Random-effects meta-analysis was performed, and Kaplan-Meier curves were digitized to reconstruct individual patient data. Primary outcome was stroke at 5 years. Median follow-up time was 3.8 years (interquartile range 2.1-4.6 years). Results One randomised controlled trial and 6 observational studies were included with 4306 LAAC and 4129 no-LAAC patients. LAAC vs no-LAAC patients were similar in preoperative characteristics including age (66 vs 65 years; P = 0.8), sex (30% vs 29% female,- P = 0.8), and CHA<inf>2</inf>DS<inf>2</inf>-VASc scores (2.7 vs 2.6; P = 0.9). There was no difference in 30-day mortality (1.2% vs 1.1%, relative risk [RR] 1.04, 95% confidence interval [CI] 0.64-1.69; P = 0.42; I 2 = 0%). Postoperative atrial fibrillation was significantly higher after LAAC (31.1% vs 26.1%, RR 1.20, 95% CI 1.03-1.39; P < 0.01; I 2 = 72%). Using reconstructed patient level data, 5-year freedom from stroke improved after prophylactic LAAC (95.9% vs 94.4%, hazard ratio 0.66, 95% CI 0.52-0.83; P = 0.0004). The number needed to treat was 67 to prevent 1 stroke. Conclusions In patients without atrial fibrillation undergoing cardiac surgery, prophylactic LAAC was associated with a lower observed risk of stroke. These exploratory findings warrant confirmation in ongoing large multicentre randomised clinical trials. Copyright © 2025 Canadian Cardiovascular Society. <11> 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. <12> Accession Number 2046183339 Title Magnitude and pattern of breathing effort during spontaneous breathing trials after cardiac surgery: a physiological model of sustained breathing effort despite diaphragm dysfunction. Source Critical Care. 30(1) (no pagination), 2026. Article Number: 298. Date of Publication: 01 Dec 2026. Author Telias I.; Grassi A.; Sklar M.C.; Junhasavasdikul D.; Grieco D.L.; Dres M.; Piraino T.; Castellvi-Font A.; Pham T.; Melo L.; Artigas R.M.; Mazer C.D.; Goligher E.C.; Brochard L. Institution (Telias, Castellvi-Font, Goligher) Department of Medicine, Division of Respirology and Critical Care Medicine, University Health Network and Sinai Health System, Toronto, Canada (Telias, Grassi, Sklar, Piraino, Melo, Mazer, Goligher, Brochard) Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Telias, Sklar, Piraino, Melo, Mazer, Brochard) Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada (Grassi) Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Canada (Sklar, Mazer) Department of Anesthesia, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada (Junhasavasdikul) Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Grieco) Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione "Policlinico Universitario A. Gemelli", Rome, Italy (Dres) UMRS 1158 Neurophysiologie Respiratoire Experimentale et Clinique, Institut National de la Sante et de la Recherche Medicale, Sorbonne Universite, Paris, France (Dres) Service de Medecine Intensive- Reanimation, AP-HP. Sorbonne Universite. Pitie-Salpetriere Hospital, Paris, France (Piraino) Department of Anesthesia, McMaster University, Hamilton, ON, Canada (Castellvi-Font) Critical Care Department and Hospital del Mar Research Institute (HMRI), Hospital del Mar, Barcelona, Spain (Pham) Service de medecine intensive-reanimation, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, AP-HP, Hopital de Bicetre, Hopitaux Universitaires Paris-Saclay, Universite Paris-Saclay, Le Kremlin- Bicetre, France (Pham) Inserm U1018, Equipe d'Epidemiologie respiratoire integrative, CESP, UVSQ, Univ. Paris-Sud, Universite Paris-Saclay, Villejuif, France (Artigas) Surgical Intensive Care Unit, Hospital Clinic de Barcelona, Barcelona, Spain (Artigas) CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain (Artigas) Institut d'Investigacions Biomediques August Pi I Sunyer, Barcelona, Spain (Mazer) Departments of Anesthesiology and Pain Medicine, Physiology, and Pharmacology and Toxicology, University of Toronto, Toronto, Canada (Goligher) Toronto General Hospital Research Institute, Toronto, ON, Canada (Goligher) Department of Physiology, University of Toronto, Toronto, ON, Canada (Telias) Toronto Western Hospital - University Health Network, 399 Bathurst St., Room 2McL 411C, Toronto, ON, Canada Publisher BioMed Central Ltd Abstract Background: After cardiac surgery, patients are liberated from mechanical ventilation despite diaphragm dysfunction and atelectasis; understanding their breathing pattern can help interpreting conditions with diaphragm dysfunction and defining a tolerable range of effort under mechanical ventilation. Method(s): Prospective physiological study describing the magnitude and pattern of breathing effort after cardiac surgery. Three spontaneous breathing trial modalities performed in random order, including two un-assisted (continuous positive airway pressure 0 cmH<inf>2</inf>O -CPAP0- and T-piece) and one assisted (pressure-support 5/PEEP 5 cmH<inf>2</inf>O- PS5PEEP5). Airway, esophageal, and gastric pressures were recorded and diaphragm ultrasound was performed. Airway occlusion pressure (P<inf>0.1</inf>) was also measured. Difference in magnitude of respiratory effort between conditions was explored through linear mixed-models with Tukey adjustment for pairwise comparisons. Association between pre-defined clinical variables (opioid dose, body mass index, and chest wall compliance) as well as measures of diaphragm function with expiratory muscle activity was explored through mixed-effects models. Result(s): Thirty patients were included. Maximum inspiratory pressure during a Mueller maneuver was - 29.8 +/- -12.6 cmH<inf>2</inf>O. Estimated mean (CI95%) global inspiratory effort (pressure-time product per minute) during un-assisted modalities for the population was 138.5 (120.6,156.3) cmH<inf>2</inf>O*sec/min. With increasing support, drive decreased as well as pressure-time product per minute (median PS5PEEP5: 101, CPAP0 129, T-piece 135 cmH<inf>2</inf>O*sec/min, p < 0.001 for PS5PEEP5 vs. other modalities), and transdiaphragmatic pressure (PS5PEEP5 median 4.1, CPAP0 median 6.6, T-piece median 6.0 cmH<inf>2</inf>O respectively, p < 0.001 for PS5PEEP5 vs. other modalities). During mechanical ventilation, expiratory muscle effort (i.e., gastric pressure rise) contributed on average to 31-37% of the drop in esophageal pressure during inspiration, being lower after extubation. Gastric pressure rise was directly associated with a higher intraoperative dose of opioids (p = 0.004) and inversely with measures of respiratory muscle function (p = 0.001). Tension-time indices lied within the higher end of a non-fatiguing range. All patients were successfully extubated. Conclusion(s): Stable patients after cardiac surgery show an increase in respiratory drive and inspiratory effort with increasing load despite signs consistent with diaphragm dysfunction. Expiratory muscle use is common, it is associated with decreased diaphragm activity, higher intraoperative dose of opioids and decreases after extubation. Copyright © The Author(s) 2026. <13> Accession Number 2046706371 Title Measuring Value in Surgery: A Scoping Review of Economic Indices Across Specialties. Source Journal of Surgical Research. 325 (pp 32-63), 2026. Date of Publication: 01 Sep 2026. Author Nguyen K.; Lala E.; Yamanouchi K.; Pattison S.; Bansal A.; Balu A.; Ali M.A.; Louie P.K. Institution (Nguyen) School of Medicine, Tulane University, New Orleans, Louisiana, United States (Nguyen, Yamanouchi, Bansal, Ali, Louie) Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Franciscan Health, Seattle, WA, United States (Lala, Pattison) School of Medicine, University of Washington, Seattle, WA, United States (Yamanouchi) Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan (Balu) Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States Publisher Academic Press Inc. Abstract Introduction: Escalating health-care costs and increasing patient complexity underscore the need for standardized, comparable measures of surgical value. Despite numerous proposed indices, methodological heterogeneity limits cross-specialty comparison. This scoping review aims to (1) characterize trends in value index utilization, (2) assess variability in index components, (3) identify specialty-specific and bibliometric patterns, and (4) propose a preliminary conceptual model to guide index selection. Method(s): A Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews-guided scoping review of PubMed, Embase, and Google Scholar (July 2025) identified 2015-2025 studies evaluating surgical value. Eligible English-language, peer-reviewed studies applied quantitative value indices, while reviews, case reports, and nonoperative studies were excluded. Two reviewers screened independently, and data on specialty, index type, and components were extracted. Bibliometric analysis mapped keyword clusters and citation trends. Result(s): Of 342 included studies, 11 distinct indices were identified. The most frequently reported indices were incremental cost-effectiveness ratio (n = 189, 55.3%), time-driven activity-based costing (n = 93, 27.2%), and net monetary benefit (n = 27, 7.9%), followed by return on investment (n = 23, 6.7%) and operative value index (n = 6, 1.8%); net health benefit, net present value, and procedure value index each accounted for under 1% of studies (n <= 6). General, orthopedic, and cardiothoracic surgery were the most represented specialties. Bibliometric analysis identified orthopedic-predominant keyword clusters and citation bursts in replacement and quality of life. Substantial heterogeneity in index selection across specialties motivated development of a preliminary conceptual model for index selection. Conclusion(s): This first scoping review of surgical value metrics reveals pervasive heterogeneity and introduces a preliminary conceptual model intended to organize index selection and motivate future validation efforts toward comparable, evidence-based value assessment. Copyright © 2026 Elsevier Inc. <14> Accession Number 2045724852 Title Could behaviour change interventions be incorporated into cardiac rehabilitation programmes for insomnia and poor sleep quality management? A scoping review. Source Sleep and Breathing. 30(3) (no pagination), 2026. Article Number: 169. Date of Publication: 01 Jun 2026. Author White E.; Atef H. Institution (White, Atef) School of Allied Health Professions and Pharmacy (SAHPaP), Keele University, Staffordshire, United Kingdom Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: Cardiovascular disease (CVD) is caused by modifiable and non-modifiable risk factors and is consistently recognised as a leading cause of morbidity and mortality. Poor sleep caused by sleep disorders such as insomnia are linked to increased mortality in patients with CVD, yet it is routinely overlooked as a cause to treat. Furthermore, despite the impact of sleep disorders, management strategies are notably underrepresented in cardiac care guidelines and cardiac rehabilitation. Aim of review: This scoping review aimed to assemble recent published literature to explore how behaviour change interventions could be utilised as a method to integrate sleep management strategies into state-of-the-art cardiac rehabilitation for patients with cardiovascular disease. Method(s): Four medical databases (Cochrane Library, MEDLINE, PsycINFO and CINAHL+) were searched using a PICO framework, publishing a total of 782 results. Of the 782 records identified, 23 were included to inform this review, including an additional article found from bibliography searching. A variety of study designs were identified, including randomised controlled trials, pilot trials, secondary data analysis and systematic reviews. Result(s): Cognitive behavioural therapy emerged as the most consistently effective intervention, particularly in group and web-based formats. Brief behavioural treatment for insomnia was also identified as an emerging flexible and easily adaptable approach, also producing promising reductions in insomnia severity. Conclusion(s): Behaviour change interventions demonstrate significant potential for improving sleep outcome measures and insomnia severity when tested among patients living with CVD. Evidence gaps include heterogeneity in intervention protocols and sample populations. Future studies must involve key stakeholders to better shape the suggested interventions. Also, they should consider this whilst exploring the role of tele-health and the need for flexibility for strategies to be implemented into cardiac rehabilitation. Copyright © The Author(s) 2026. <15> Accession Number 2042352791 Title Cardiopulmonary effects of vasopressin versus norepinephrine in patients undergoing cardiac surgery: A single-center, cluster-randomized crossover trial. Source Journal of Thoracic and Cardiovascular Surgery. 171(6) (pp 1265-1274.e2), 2026. Date of Publication: 01 Jun 2026. Author Geube M.; Abraham A.; Kelava M.; Bustamante S.E.; Alfirevic A.; Assaad S.; Shah K.; Maldonado Y.; Zhang K.; Hohlfelder B.; Malackany N.; Wakefield B.; Pettersson G.B.; Tong M.Z.; Sessler D.; Skubas N.; Duncan A. Institution (Geube, Abraham, Kelava, Bustamante, Alfirevic, Assaad, Maldonado, Wakefield, Skubas, Duncan) Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio, United States (Shah) Department of Quantitative Sciences, Cleveland Clinic, Cleveland, Ohio, United States (Zhang) Department of Anesthesiology, Boston Children's Hospital/Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, United States (Hohlfelder) Department of Pharmacy, Inpatient Pharmacy, Cleveland Clinic Foundation, Cleveland, Ohio, United States (Malackany) Department of Anesthesiology, Spartanburg Regional Healthcare System, Spartanburg, SC, United States (Pettersson, Tong) Department of Cardiothoracic Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States (Sessler) Department of Clinical and Outcomes Research, University of Texas Health System, Houston, Tex, United States Publisher Elsevier Inc. Abstract Background: Laboratory research suggests that vasopressin restores systemic arterial pressure without significantly increasing pulmonary artery pressures, compared with norepinephrine. We therefore tested the hypotheses that treatment of intraoperative vasoplegia with vasopressin rather than norepinephrine induces less pulmonary hypertension and improves right ventricular function during cardiac surgery. Method(s): Our single-center, cluster-randomized multiple crossover trial enrolled patients undergoing elective cardiac surgery who developed systemic hypotension (mean arterial pressure <70 mm Hg) and cardiac index >2.2 L/min/m2. Randomization was performed in 1-week blocks (total of 46 weeks) where vasopressin or norepinephrine were assigned as the initial vasopressor. Our primary outcome was the time-weighed average mean pulmonary artery pressure to systemic mean arterial pressure ratio and our secondary outcome was right ventricular free wall strain by transesophageal echocardiography, both measured between start and end of chest closure. A predefined subanalysis examined the effect of norepinephrine versus vasopressin in patients with preoperative pulmonary hypertension. Result(s): We analyzed 153 patients, 70 assigned to vasopressin and 83 assigned to norepinephrine. There were no significant differences in mean pulmonary artery pressure to systemic mean arterial pressure ratio (0.02; 95% CI, -0.02 to 0.05; P =. 646) or in right ventricular free wall strain (3.45%; 95% CI, 0.17% to 6.73%; P =. 078) in patients given vasopressin versus norepinephrine infusion. There was no evidence of an interaction between preoperative pulmonary hypertension status and mean pulmonary artery pressure to systemic mean arterial pressure ratio (interaction P value =. 781) or right ventricular strain (interaction P value =. 780). Conclusion(s): We found no evidence to support the preferential use of vasopressin over norepinephrine in patients undergoing cardiac surgery. Copyright © 2025 The American Association for Thoracic Surgery <16> [Use Link to view the full text] Accession Number 2040385646 Title Comparative Effectiveness of TAVI Platforms and Surgical Aortic Valve Replacement: A Network Meta-Analysis of Randomized Controlled Trials. Source Circulation: Cardiovascular Interventions. 18(10) (pp e015387), 2025. Date of Publication: 01 Oct 2025. Author Moroni F.; Lamelas P.; Izcovich A.; Foroutan F.; Fremes S.E.; Alba A.C.; Agoritsas T.; Whitlock R.; Denicolai M.; Mendiz O.; Mamas M.A.; Bagur R. Institution (Moroni) Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, United States (Lamelas, Foroutan, Agoritsas) Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Whitlock) Department of Surgery (R.W.), McMaster University, Hamilton, Ontario, Canada (Lamelas, Mendiz) Division of Cardiology, Fundacion Favaloro, Buenos Aires, Argentina (Izcovich) Department of Internal Medicine, Hospital Aleman and Faculty of Medicine, Universidad del Salvador, Buenos Aires, Argentina (Foroutan) Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (Fremes) Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook HSC, University of Toronto, Canada (Alba) Peter Munk Cardiac Centre, Division of Cardiology and Heart Transplantation, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada (Agoritsas) Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Switzerland (Agoritsas) MAGIC Evidence Ecosystem Foundation, Oslo, Norway (Whitlock) Population Health Research Institute, Hamilton, Ontario, Canada (Denicolai) Interventional Cardiology, Division of Cardiology, Hospital Italiano de Buenos Aires, Argentina (Mamas) Keele Cardiovascular Research Group, Division of Cardiology, Keele University, United Kingdom (Mamas) National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, United Kingdom (Bagur) London Health Sciences Centre, Division of Cardiology, Department of Medicine (R.B.), Western University, London, Ontario, Canada (Bagur) Department of Epidemiology and Biostatistics (R.B.), Western University, London, Ontario, Canada Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Evidence informing clinical guidelines assumes that all transcatheter aortic valve implantation (TAVI) devices have similar effectiveness, in other words, displaying a class effect across TAVI valves. We aimed to assess the comparative effectiveness of different TAVI platforms relative to other TAVI counterparts or surgical aortic valve replacement (SAVR). METHOD(S): - MEDLINE/Embase/CENTRAL were searched from inception until April 2025, for randomized controlled trials comparing outcomes with different commercially available TAVI devices relative to other TAVI counterparts or SAVR. The certainty of the evidence was assessed following the Grading of Recommendations, Assessment, Development, and Evaluations approach. We performed a frequentist network meta-analysis to generate treatment effect estimates. All-cause, cardiovascular mortality, and stroke were considered critically important patient-centered outcomes. RESULT(S): - We identified 11 randomized controlled trials with 9946 participants and reporting outcomes between 1 to 10 years. TAVI with CoreValve-Evolut was associated with a similar risk of all-cause (absolute risk difference [ARD], 31/1000 from -12 to 79), and cardiovascular mortality (ARD, -8/1000 from -39 to 28) compared with SAVR (moderate certainty). Compared with SAVR, TAVI with SAPIEN and ACURATE neo were associated with an increased risk of all-cause (ARD, 109/1000 from 56 to 169, high certainty and ARD, 123/1000 from 9 to 277, moderate certainty, respectively) and cardiovascular mortality (ARD, 58/1000 from 18 to 105, high certainty and ARD, 105 from 7 to 247, moderate certainty, respectively). Moderate and high-certainty evidence showed that all TAVI platforms were associated with an increased risk of reinterventions and pacemaker implant versus SAVR. Compared with TAVI with CoreValve-Evolut, SAPIEN was associated with higher all-cause (ARD, 75/1000 from 13 to 147, high certainty) and cardiovascular mortality (ARD, 66/1000 from 15 to 130, high certainty), same scenario for ACURATE neo (ARD 113/1000 from 13 to 259, high certainty). CONCLUSION(S): - TAVI with CoreValve-Evolut is probably associated with similar mortality to SAVR. TAVI with SAPIEN and ACURATE neo were associated with increased risk of mortality compared with SAVR and CoreValve-Evolut. The current body of evidence from randomized controlled trials goes against the hypothesis of a class effect across TAVI valves. REGISTRATION: - URL: https://www.crd.york.ac.uk; Unique identifier: CRD42024512026. Copyright © 2025 American Heart Association, Inc. <17> Accession Number 2046658058 Title Acute brain injury in adult post-cardiotomy cardiogenic shock patients receiving central vs. peripheral VA-ECMO: A single-center experience and systematic review with meta-analysis. Source Perfusion (United Kingdom). (no pagination), 2026. Date of Publication: 2026. Author Ryu J.; Lin Y.; Woo H.Y.(.; Hamid A.; Malfitano M.; Sutariya P.; Lu J.; Crasta M.; Mahmood A.; Ahmed Y.B.; Spann M.; Whitman G.J.R.; Cho S.-M. Institution (Ryu) Soonchunhyang University College of Medicine, Cheonan, South Korea (Lin, Woo, Malfitano, Ahmed, Whitman, Cho) Division of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States (Hamid, Sutariya, Lu, Mahmood) College of Medicine, Drexel University, Philadelphia, PA, United States (Crasta) Lake Erie College of Osteopathic Medicine, Erie, PA, United States (Spann) Informationist Services, Johns Hopkins School of Medicine, Baltimore, MD, United States Publisher SAGE Publications Ltd Abstract Background: Postcardiotomy cardiogenic shock (PCS) is a life-threatening complication after adult cardiac surgery that frequently necessitates venoarterial extracorporeal membrane oxygenation (VA-ECMO). Central and peripheral VA-ECMO cannulation strategies generate distinct hemodynamic and perfusion profiles; however, whether these differences translate into varying risks of acute brain injury (ABI) remains uncertain. We therefore compared ABI risk according to cannulation strategy in adults with PCS requiring VA-ECMO, with secondary objectives to determine the overall prevalence of ABI and characterize its major subtypes. Method(s): We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus through April 15, 2025, for studies reporting ABI in adult PCS patients receiving VA-ECMO. ABI outcome was defined as ischemic stroke, intracranial hemorrhage, hypoxic-ischemic brain injury, seizures, unspecified stroke, and brain death. Random-effects meta-analysis was performed, incorporating a contemporary single-center cohort from Johns Hopkins Hospital (2020-2025). Result(s): The primary meta-analysis included seven cohorts (six published studies plus Johns Hopkins cohort; n = 2536), while secondary analyses included 17 cohorts (16 published studies plus Johns Hopkins cohort). Included patients (mean age = 65 years, BMI = 28 kg/m2, 61% male) underwent central VA-ECMO cannulation in 32% and peripheral cannulation in 68%. The pooled risk of ABI did not differ by cannulation strategy (risk ratio [RR], 1.01; 95% CI, 0.85-1.21; I2 = 0%), with similar ABI prevalence across groups (p = 0.99). Ischemic stroke and unspecified stroke were the most reported subtypes. Conclusion(s): In adults with PCS supported by VA-ECMO, the risk of ABI was not significantly associated with cannulation strategy. These findings suggest that cannulation approach alone is unlikely to be the primary determinant of neurological risk in this population, underscoring the need for systematic neuroprotective strategies regardless of cannulation configuration. Copyright © The Author(s) 2026 <18> Accession Number 2046467375 Title Clinical spectrum, cardiac phenotypes, and outcomes of FHL1-related cardiomyopathies: a systematic review. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 518. Date of Publication: 01 Dec 2026. Author Bobbio E.; Caiazza M.; Pisacane F.; Viscovo I.; Gentile A.; Monda E.; De Falco C.; Esposito D.; Borrelli F.; Losi M.; Bossone E.; Chen S.N.; Frisso G.; Calabro P.; Esposito G.; Lombardi R.; Limongelli G. Institution (Bobbio, Caiazza, Pisacane, Viscovo, Monda, Limongelli) Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Monaldi Hospital, via Leonardo Bianchi 1, Naples, Italy (Pisacane) UOC Patologia Clinica, AORN dei Colli, via Leonardo Bianchi 1, Naples, Italy (Gentile, De Falco, Borrelli, Losi, Esposito, Lombardi) Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, Naples, Italy (Gentile, Chen, Lombardi) Division of Cardiology, University of Colorado School of Medicine, 12505 E. 16th Avenue, Anschutz Inpatient Pavilion 2, Aurora, CO, United States (Esposito) Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden (Esposito) Department of Endocrinology at Sahlgrenska University Hospital, University of Gothenburg, Bla Straket 8, Gothenburg, Sweden (Bossone) Department of Public Health, University of Naples Federico II, Via Pansini 5, Naples, Italy (Bossone) Heart Centre of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia (Frisso) Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via Pansini 5, Naples, Italy (Calabro, Limongelli) Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, Caserta, Italy (Limongelli) Institute of Cardiovascular Science, University College London, Gower Street, London, United Kingdom (Bobbio) Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Bobbio) Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Publisher BioMed Central Ltd Abstract Background: Mutations in the Four-and-a-Half LIM Domains 1 (FHL1) gene are increasingly recognized as a rare cause of inherited cardiomyopathies, often associated with skeletal myopathy and adverse cardiac outcomes. The phenotypic spectrum and clinical implications of FHL1 variants remain poorly defined. Objective(s): To systematically review published cases of FHL1-related cardiomyopathy and characterize the clinical, genetic, and pathological features. Method(s): We conducted a systematic literature search in PubMed and EMBASE up to July 2025 using predefined criteria to identify studies reporting clinical cases of patients with FHL1 mutations and cardiac involvement. Data on genotype, phenotype, cardiac and neuromuscular features, and clinical outcomes were extracted and synthesized. Result(s): Twenty-two studies were included, comprising 114 patients with pathogenic or likely pathogenic FHL1 mutations. Most patients were male (69%), with a median age of onset of 18 (IQR 10-26) years. Cardiac involvement consisted in left ventricular hypertrophy (56%), followed by arrhythmias (51%), and conduction abnormalities (8%). The incidence of sudden cardiac death was 7%, and heart transplantation was reported in 5% of patients. Skeletal muscle involvement was present in 75%, ranging from mild contractures to more severe myopathic phenotypes with functional impairment. Creatine kinase levels were variably elevated. Truncating variants were reported in several severe cardiac presentations in young males, while isolated cardiac disease occurred with selected variants. Conclusion(s): FHL1-related cardiomyopathy is a rare but important diagnosis. Genetic testing should be considered in patients with cardiac hypertrophy and neuromuscular features. Further research is needed to define prognostic markers and guide management. Copyright © The Author(s) 2026. <19> Accession Number 2019145161 Title Comparison of Rhomboid Intercostal Block, Erector Spinae Plane Block, and Serratus Plane Block on Analgesia for Video-Assisted Thoracic Surgery: A Prospective, Randomized, Controlled Trial. Source International Journal of Clinical Practice. 2022 (no pagination), 2022. Article Number: 6924489. Date of Publication: 2022. Author Zhang J.-G.; Jiang C.-W.; Deng W.; Liu F.; Wu X.-P. Institution (Zhang, Wu) Department of Infectious Disease, The First Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, China (Zhang) Departments of Critical Care Medicine, Linyi People's Hospital, Shandong, Linyi, China (Zhang, Liu) Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Jiangxi, Nanchang, China (Jiang, Deng) Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Zhejiang, Jiaxing, China Publisher Wiley-Hindawi Abstract Background. Thoracic surgery is one of the most painful surgical steps. An important tool for managing postoperative pain is effective postoperative analgesia. This research aimed at comparing the analgesic roles of three new fascial block techniques in the postoperative period after video-helped thoracoscopic operation (VATS). Methods. We randomly allocated ninety patients into three teams experiencing ultrasound-directed serratus plane block, erector spinae plane block, and the rhomboid intercostal block, respectively. 0.4% ropivacaine of 20 mL was received by all groups. Outcomes. At 0-12 hours, sufentanil consumption was significantly lower in the RIB (35.2 +/- 3.3 mg) and ESP (35.4 +/- 2.8 mg) groups than that in the SAB (43.3 +/- 2.7 mg) group P<0.001, and no obvious diversity in sufentanil consumption was shown between the RIB and ESP groups P=0.813. At 12-24 hours, sufentanil consumption was greatly lower in the RIB and ESP groups than that in the SAB group P<0.001, and no great diversity in sufentanil consumption was found between the RIB and ESP groups P=0.589. No great diversity in sufentanil consumption was shown between the RIB (50.4 +/- 1.4 mg), ESP (50.4 +/- 1.5 mg), and SAB (51.0 +/- 1.7 mg) groups at 24-48 hours P=0.192. At 6, 12, 18, and 24 hours, the postoperative dynamic NRS scores were significantly lower in the RIB and ESP groups than in the SAB group (P<0.05 for all contrasts). Nevertheless, no great diversity was observed in postoperative pain marks at 0.5, 1, 3, 6, 12, 18, 24, 36, and 48 hours after the surgery across the three groups. No statistical diversity was found in the postoperative NRS mark between groups RIB and ESP within 48 hours after surgery in case of active patients (P<0.05 for all contrasts). At 24 hours after surgery, a significant difference in IL-1beta and IL-6 inflammatory factor concentrations was found between RIB and ESP compared with SAB block (P<0.05 for all contrasts). However, no great diversities were observed in IL-1beta, and IL-6 inflammatory factor concentrations between RIB, ESP, and SAB at 24 hours preoperatively and at 48 hours postoperatively (P<0.05 for all comparisons). Conclusion. The dosage of sufentanil can be effectively reduced by ultrasound-directed rhomboid intercostal block and erector spinae plane block within 24 hours after VATS surgery, and pain can be relieved effectively within 24 hours by comparing with serratus plane block. Copyright © 2022 Jian-Guo Zhang et al. <20> Accession Number 650496832 Title Reported Causes of Device Embolization Following Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Source The Permanente journal. 30(2) (pp 46-57), 2026. Date of Publication: 15 Jun 2026. Author Echefu G.C.; Adabale O.; Isa T.S.; Bond A.; Nayyar M.; Ibebuogu U.N. Institution (Echefu, Isa, Bond, Nayyar) Department of Cardiovascular Medicine, University of Tennessee Health Sciences Center, College of Medicine, Memphis, TN, United States (Adabale, Ibebuogu) Department of Cardiovascular Medicine, University of Colorado, Health, Parkview Medical Center, Pueblo, CO, United States Abstract In the last 2 decades, transcatheter aortic valve replacement (TAVR) has become widely adopted for the treatment of aortic valve stenosis, and prosthetic valve embolization (PVE) is one of the rarely reported, but often catastrophic, complications of this procedure. The authors performed an updated systematic review of contemporary studies to determine the prevalence of post-TAVR PVE and its associated risk factors. A systematic search was conducted in multiple databases for all relevant published studies from 2014 to August 2024. Studies reporting on embolization were included. Data extracted encompassed participants' characteristics, study characteristics, and clinical outcomes. Pooled event rates were calculated using the random effects method. In the final analysis, 34 studies reported 501 cases of device embolization, of which 50% were male with a mean age of 80.7 +/- 3.16 years while the other 50% were female. The rate of PVE was 1.4%. About 80% of the embolization occurred in the intraprocedural period, with 61% of the embolized valves requiring surgical treatment. The prevalence of embolization across included studies was 1.4%, with most embolization occurring during the procedure. The chance of mortality is significantly heightened at about 18% to 20% at 30 days and ~30% at 1 year in some series, compared with much lower baseline rates for uncomplicated TAVR. Prosthetic valve embolization complicates TAVR procedures, increasing procedural complexity, with over 50% of instances resulting in conversion to surgical intervention. Given that this complication is rare (~1%), the overall risk is low in the general TAVR population, but for the individual, it is serious and warrants aggressive management. <21> 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 <22> Accession Number 2046534417 Title Robot-Assisted Thoracic Surgery Versus Video-Assisted Thoracic Surgery for Lung Resection: A Systematic Review and Meta-Analysis. Source International Journal of Medical Robotics and Computer Assisted Surgery. 22(3) (no pagination), 2026. Article Number: e70191. Date of Publication: 01 Jun 2026. Author Maghrabi A.; Altoukhi S.M.; Alghamidi F.A.S.; Alshammari M.M.; Alharbi W.M.; Hanbazazah M.A.; Almasoudi M.M.; Jamjoum G. Institution (Maghrabi) Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Maghrabi) Thoracic Surgery Division, Department of Surgery, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia (Altoukhi, Alharbi) College of Medicine, University of Jeddah, Jeddah, Saudi Arabia (Alghamidi) College of Medicine, King Khalid University, Abha, Saudi Arabia (Alshammari) College of Medicine, University of Hail, Hail, Saudi Arabia (Hanbazazah) College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia (Almasoudi) College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia (Jamjoum) Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia (Jamjoum) Gastrointestinal Oncology Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia Publisher John Wiley and Sons Ltd Abstract Background: Lung resection is a standard treatment for lung cancer. Video-assisted thoracoscopic surgery (VATS) is widely used as a minimally invasive approach. Recent advancements in robotic technology enhances the safety and efficacy of robot-assisted thoracic surgery (RATS). This systematic review and meta-analysis compared the clinical outcomes of RATS and VATS in lung resection. Method(s): PubMed, ClinicalTrials.gov, and the Cochrane Library were searched from inception to June 2025. Primary outcomes were lymph node yield and operative time. Secondary outcomes included R0 resection, postoperative complications, and recurrence. Data were analysed using Review Manager v5.4.1 with random-effects models. Result(s): Twenty-nine studies involving 66,406 patients were included. RATS significantly improved lymph node yield (MD 4.54; 95% CI 2.91-6.17) and showed shorter operative time (MD -6.09; 95% CI -13.20-1.03). RATS was associated with higher R0 resection rates, fewer complications, and lower recurrence. Conclusion(s): The findings support the safety and oncologic effectiveness of RATS. Copyright © 2026 John Wiley & Sons Ltd. <23> Accession Number 2046443191 Title A Systematic Review of the Clinical Impact of GLP-1 Receptor Agonists in Hidradenitis Suppurativa. Source American Journal of Clinical Dermatology. (no pagination), 2026. Date of Publication: 2026. Author Visan M.-A.; Carroll E.; Ryan S.-L.; Pender E.; Costache D.-O.; Caruntu C.; Hughes R.; Kirby B. Institution (Visan, Carroll, Ryan, Pender, Hughes, Kirby) Dermatology Department, St. Vincent's University Hospital, Dublin, Ireland (Visan, Caruntu) Physiology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (Visan, Costache) Dermatology Department, Carol Davila Central Military Emergency University Hospital, Bucharest, Romania (Carroll, Pender, Hughes, Kirby) School of Medicine, Charles Institute of Dermatology, University College Dublin, Dublin, Ireland (Costache) Dermatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (Caruntu) Prof. Dr. N. Paulescu National Institute of Diabetes, Nutrition, Metabolic Diseases, Bucharest, Romania Publisher Adis Abstract Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease which imposes a significant burden in terms of pain, disability, and comorbidities. Obesity and metabolic dysfunction are highly prevalent in HS, contributing to disease severity. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely used in type 2 diabetes and obesity, have shown additional anti-inflammatory properties that may be relevant in HS.However, data on their clinical benefit remain limited. Method(s): We performed a systematic review of PubMed/MEDLINE, Scopus, Web of Science, and Embase through June 2025, following PRISMA guidelines. Studies reporting outcomes in HS patients treated with GLP-1RAs were included. Information on clinical severity, quality of life, metabolism, inflammatory markers, and healthcare use were extracted. Findings were critically assessed and summarized descriptively, with pooled analysis applied where outcomes were consistently reported. This review was registered with PROSPERO (CRD420251110220). Result(s): Nineteen studies including 67,568 patients were identified. Pooled analysis showed that 60% of patients achieved clinical improvement in Hurley stage (95% CI 52-67). Dermatology Life Quality Index (DLQI) improved by a mean of -3.83 points (95% CI -5.14 to -2.51). Clinical benefit was observed despite modest weight reduction (mean BMI change -2.64 kg/m2). Inflammatory and metabolic markers improved, with significant reductions in mean C-reactive protein (-1.35 mg/L, 95% CI -2.33 to -0.36) and HbA1c (-0.39%, 95% CI -0.59 to -0.18). Large real-world cohorts showed decreased antibiotic and corticosteroid use and lower hospitalization rates, though results for biologic use, surgical procedures, and cardiovascular outcomes were mixed. Two studies reported reduced risk of major adverse cardiovascular events, while one HS-diabetes cohort suggested persistent excess cardiovascular risk compared with diabetes-only controls. Conclusion(s): This systematic review suggests that GLP-1RAs are associated with improvements in HS severity, quality of life, metabolic and inflammatory parameters, and may additionally reduce healthcare utilization and cardiometabolic risk, observed alongside weight loss. However, current evidence remains limited and heterogeneous, and the relative contribution of weight-dependent and weight-independent effects cannot be determined. Prospective studies and controlled trials are needed to clarify the role of GLP-1RAs in HS management. Copyright © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026. <24> [Use Link to view the full text] Accession Number 2045464901 Title 1429: ANESTHETIC DEVIATIONS IN CARDIAC PATIENTS WITH NONCARDIAC SURGERY: SYSTEMATIC REVIEW OF CASES. Source Critical Care Medicine. 54(3S) (no pagination), 2026. Date of Publication: 01 Mar 2026. Author Moinuddin A.; Fayyaz S.; Vetharaniyaseyon G.; Rajput A.; Alsafadi M.; Pasha T.; Sogoli K. Institution (Moinuddin) NapervilleILUnited States (Fayyaz, Vetharaniyaseyon, Alsafadi, Pasha, Sogoli) McMaster University (Rajput) Chicago College of Osteopathic Medicine Publisher Lippincott Williams and Wilkins <25> Accession Number 2045650924 Title Cerebral embolic protection devices for transcatheter aortic valve replacement: A meta-analysis and trial sequential analysis. Source American Heart Journal. 299 (no pagination), 2026. Article Number: 107449. Date of Publication: 01 Sep 2026. Author Elbenawi H.; Hassan I.; Abdelgalil M.S.; Hanna M.; Almotawally S.; Fayed M.; Mohamed K.A.; Elnaggar H.; Abouainain L.; Hamed B.M.; Ibrahim A.; Khatib A.A.; Elhelw M.; Hassan E.; Eisa M.; Zaaya M.; Ibrahim R.; Goldsweig A.M.; Saad M.; Alfonso F.; Alkhouli M.; Elgendy I.Y. Institution (Elbenawi, Alkhouli) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Hassan) DeBakey Heart & Vascular Center, Houston Methodist Academic Institute, Houston, TX, United States (Abdelgalil, Almotawally) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Hanna) Department of Cardiology, Assiut University, Assiut, Egypt (Fayed) Department of Neurology, University of Florida, Gainesville, FL, United States (Mohamed) Department of Internal Medicine, Hartford Hospital, Hartford, CT, United States (Elnaggar) Faculty of Medicine, Mansoura University, Dakahlia, Mansoura, Egypt (Abouainain) Faculty of Medicine, University of Jordan, Amman, Jordan (Hamed) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Ibrahim) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Khatib) Department of Internal Medicine, MedStar Health, Baltimore, MD, United States (Elhelw) Department of Internal Medicine, University of Kentucky, Lexington, KY, United States (Hassan) Department of Internal Medicine, Ascension Saint Agnes Hospital, Baltimore, MD, United States (Eisa) Internal Medicine Department, Rochester General Hospital, Rochester, NY, United States (Zaaya) Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States (Ibrahim) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States (Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center and University of Massachusetts-Baystate, Springfield, MA, United States (Saad) Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, United States (Alfonso) Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autonoma de Madrid, Madrid, Spain (Elgendy) Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY, United States Publisher Elsevier Inc. Abstract Background Transcatheter aortic valve replacement (TAVR) is associated with periprocedural stroke risk due to embolic debris. The efficacy and safety of cerebral embolic protection devices (CEPDs) remain uncertain, with conflicting results between trials. We performed a meta-analysis of randomized controlled trials (RCTs) of current-generation CEPDs for TAVR. Methods Electronic databases were searched for RCTs comparing clinical outcomes with routine CEPD use vs no CEPD use. Outcomes of interest included any stroke, disabling stroke, and all-cause mortality. Risk ratios (RR) or mean differences with 95% confidence intervals (CIs) were pooled using random-effects models. The analysis was complemented by meta-regression and trial sequential analyses. Results The meta-analysis included 8 RCTs (5 filter-based and 3 shield-based) with 11,596 patients. CEPD use was not associated with a lower incidence of any stroke (RR 0.92; 95% CI 0.75-1.14), disabling stroke (RR 0.80; 95% CI 0.55-1.15), new magnetic resonance imaging-detected lesions (RR 1.00; 95% CI 0.93-1.07), or all-cause mortality (RR 1.04; 95% CI 0.71-1.51). Trial sequential analysis provided conclusive meta-analytic evidence and affirmed the absence of CEPD benefit. Meta-regression showed no significant association between stroke risk and patient-level covariates, including age, sex, or the presence of diabetes, prior stroke, or atrial fibrillation (all P ' .05). Conclusions Current-generation CEPD devices during TAVR did not significantly reduce the risk of any stroke, disabling stroke, or all-cause mortality. Trial sequential analysis indicates that, at least with available data, cumulative evidence appears sufficient to question the predefined benefit thresholds for existing systems. These findings suggest the lack of routine use of current-generation CEPD in TAVR. Copyright © 2026 . <26> 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. <27> 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. <28> Accession Number 2035666214 Title Neurovascular complications in Loeys-Dietz syndrome: a comprehensive systematic review and case report. Source Acta Neurologica Belgica. 126(2) (pp 451-466), 2026. Date of Publication: 01 Apr 2026. Author Al-Salihi M.M.; Al-Jebur M.S.; Mozahem N.; Nicol K.; Elazim A.A.; Ayyad A.; Saha R. Institution (Al-Salihi) Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, MO, United States (Al-Jebur) College of Medicine, University of Baghdad, Baghdad, Iraq (Mozahem, Nicol, Saha) Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States (Elazim) Department of Neurology, University of South Dakota, Sioux Falls, SD, United States (Ayyad) Department of Neurosurgery, Hamad General Hospital, Doha, Qatar (Ayyad) Department of Neurosurgery, Jordan University Hospital, Amman, Jordan Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: Loeys-Dietz syndrome (LDS) is a rare genetic disorder characterized by profound systemic vascular vulnerability, with complex neurovascular manifestations that remain incompletely understood. This systematic review aimed to comprehensively map the spectrum of neurovascular complications in LDS, synthesize existing literature, identify potential genetic and phenotypic correlations contributing to disease severity, and present our case report to illustrate real-world clinical challenges and management complexities. Method(s): Following PRISMA guidelines, a comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library from database inception to March 2025. Studies were systematically screened using predefined inclusion/exclusion criteria. The Joanna Briggs Institute Critical Appraisal Checklists were employed for quality assessment. Result(s): Twenty-five studies, including 13 retrospective cohort studies and 12 case reports, were ultimately included. The review revealed a significant neurovascular disease burden in LDS. Intracranial aneurysm prevalence ranged from 19.4 to 30%, with an average size of 3.6 mm. Genetic mutations in TGFBR1, TGFBR2, and SMAD3 genes were strongly associated with vascular complications. Arterial dissections were documented in 22.2% of patients, with neurovascular events spanning pediatric to adult populations. Our case report illustrated the syndrome's complex multisystemic manifestations, demonstrating bilateral embolic infarcts with hemorrhagic components. Conclusion(s): This systematic review provides a comprehensive characterization of neurovascular complications in LDS, emphasizing the critical need for specialized, genetic-specific risk stratification and longitudinal monitoring. The findings underscore the complex relationship between genetic mutations and vascular pathophysiology, highlighting potential molecular intervention strategies. Copyright © The Author(s) under exclusive licence to Belgian Neurological Society 2025. <29> Accession Number 2046641768 Title Hypotension prediction index in surgical patients: A systematic review and meta-analysis of randomized controlled trials. Source Medicine (United States). 105(24) (pp e49257), 2026. Date of Publication: 12 Jun 2026. Author Xie C.-m.; Shen M.-q.; Yao Y.-t.; Yang K.; He L.-x.; Dai Z. Institution (Xie, Shen, Yang, He, Dai) Department of Anesthesiology, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 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 Publisher Lippincott Williams and Wilkins Abstract Background: - The Hypotension Prediction Index (HPI) is a machine-learning-derived early-warning algorithm that uses real-time arterial pressure waveform features to prospectively identify episodes of intraoperative hypotension (IOH) - defined as mean arterial pressure < 65 mm Hg sustained for >= 1 minute. IOH is a common hemodynamic complication in surgical patients and is associated with impaired end-organ perfusion and an increased risk of postoperative morbidity. To rigorously evaluate the predictive performance of HPI and its impact on IOH, we conducted a systematic review and meta-analysis of randomized controlled trials, adhering strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Method(s): - A systematic literature search was conducted across multiple electronic databases from their inception to April 10, 2026. The search strategy employed a combination of keyword terms, including "hypotension, " "prediction, " "index, " "surgery, " and "randomized controlled trial." Primary outcomes were the time-weighted average, area under the threshold, incidence, and duration of IOH. Secondary outcomes included intraoperative fluid administration, estimated blood loss, urine output, use of vasopressors and inotropes, and postoperative acute kidney injury (AKI). Pooled effect estimates were calculated using odds ratios for dichotomous outcomes and weighted mean differences for continuous outcomes, with corresponding 95% confidence intervals. Result(s): - Eighteen randomized controlled trials (RCTs) involving 2279 noncardiac surgical patients and 1 RCT enrolling 130 cardiac surgical patients were included in the analysis. Following standardized data conversion, meta-analytic results demonstrated that HPI-guided hemodynamic management significantly reduced IOH across multiple complementary metrics: time-weighted average (WMD = -0.19, 95% CI: -0.25 to - 0.12), area under the threshold (WMD = -55.17, 95% CI: -73.62 to - 36.71), incidence (WMD = -2.42, 95% CI: -3.36 to - 1.49), cumulative duration (WMD = -10.61, 95% CI: -14.11 to - 7.11), all P < .00001. Similarly, the HPI-guided group reduced intraoperative fluid administration and phenylephrine utilization. In contrast, the incidence of AKI showed no statistically significant difference (OR = 0.83, 95% CI: 0.64 to 1.07, P = .16). Conclusion(s): - Current evidence shows that HPI-directed hemodynamic management effectively reduces IOH and decreases intraoperative fluid administration and phenylephrine utilization. However, these physiological improvements did not translate into clinical benefits for postoperative AKI. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, Inc. <30> Accession Number 2045854763 Title Response by Turi et al to Letters Regarding Article, "Effect of Remote Ischemic Preconditioning on Myocardial Injury in Noncardiac Surgery: The PRINCE Randomized Clinical Trial". Source Circulation. 153(19) (pp e1302-e1303), 2026. Date of Publication: 12 May 2026. Author Turi S.; Oliva F.M.; Labanca R.; Landoni G.; Pontillo D. Institution (Turi, Oliva, Labanca, Landoni, Pontillo) Department of Anesthesia and Intensive Care, IRCCS (Istitituto di Ricovero e Cura a Carattere Scientifico) San Raffaele Scientific Institute, Milan, Italy (Landoni) School of Medicine, Vita-Salute San Raffaele University, Milan, Italy Publisher Lippincott Williams and Wilkins <31> Accession Number 2027899522 Title Glycoprotein inhibitors as a first line rescue treatment after unsuccessful recanalization of endovascular thrombectomy: A systematic review and meta-analysis. Source Interventional Neuroradiology. 32(3) (pp 931-942), 2026. Date of Publication: 01 Jun 2026. Author Brake A.; Heskett C.; Alam N.; Fry L.; Le K.; Mahnken J.D.; Abraham M. Institution (Brake) Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States (Brake, Heskett, Fry, Le) School of Medicine, University of Kansas, Kansas City, KS, United States (Alam, Mahnken) Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, United States (Abraham) Department of Neurology, University of Kansas Health System, Kansas City, KS, United States Publisher SAGE Publications Inc. Abstract Background: Intracranial atherosclerotic disease (ICAD) is a major cause of stroke with a high rate of re-occlusion following mechanical thrombectomy (MT). Among the available rescue options, glycoprotein IIb/IIIa inhibitors (GPI) have shown promise as a potential therapeutic strategy. This systematic review and meta-analysis examine studies exploring the use of glycoprotein inhibitors as a first-line treatment for refractory occlusion or high-grade stenosis following EVT in the setting of ICAD. Method(s): A systematic review and meta-analysis were performed. Studies using GPI as the first-line rescue treatment (GPI-rt) after failed thrombectomy or in the setting with high-grade stenosis (>50%) were included. The primary outcome of interest was good clinical outcomes (defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days). Secondary outcomes of interest were successful recanalization (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), and mortality by 90 days. Result(s): Our study processed 2111 articles, which yielded eight relevant studies for review, four single and four double arm. These studies comprised 763 patients, divided into GPI-rt (535 patients) and non-GPI-rt (228 patients) cohorts. The GPI-rt group had higher rates of mRS <= 2 at 90 days (58.5% vs 38.9%, p = 0.002) and lower mortality rates (7.8% vs 17.5%, p = 0.04) compared to the non-GPI-rt cohort. mTICI 2b-3 rates and rates of sICH were not significantly different between the cohorts. Conclusion(s): First line GPI-rt demonstrates significant clinical benefit and significantly lower mortality without a rise in rates of sICH. GPI are a potential first line rescue treatment of ICAD. Copyright © The Author(s) 2024 <32> Accession Number 2046489432 Title Baseline Ejection Fraction as a Modifier of Beta-Blocker Therapeutic Effects in Post-Acute Coronary Syndrome Patients With Non-Reduced Ejection Fraction: A Systematic Review and Meta-Analysis. Source Cardiovascular Therapeutics. 2026(1) (no pagination), 2026. Article Number: 2988999. Date of Publication: 2026. Author Mirhosseini S.A.; Sadrzadeh S.A.; Semirani-Nezhad D.; Rajabi E.; Mohammadi H.; Shaabanpoor Haghighi A.; Jamali M.A.; Moshfeghinia R.; Ranjbar M.; Azami P.; Gupta R.; Aronow W.S.; Attar A. Institution (Mirhosseini, Azami) Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Mirhosseini, Azami, Attar) Department of Cardiovascular Medicine, TAHA Clinical Trial Group, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Sadrzadeh, Mohammadi, Shaabanpoor Haghighi, Jamali, Moshfeghinia) Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Semirani-Nezhad) Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Rajabi) Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Ranjbar) MD-MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of (Gupta) Department of Cardiology, St. Luke's University Health Network, Bethlehem, PA, United States (Aronow) Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, United States Publisher John Wiley and Sons Inc Abstract Background: Beta-blockers are regarded as one of the primary treatment options for acute coronary syndrome (ACS) patients with reduced left ventricular ejection fraction (LVEF). However, there is ongoing debate about their therapeutic efficacy in patients with non-reduced LVEF (>= 40%). Objective(s): To determine the impact of long-term beta-blocker administration on major adverse cardiovascular events (MACE) in ACS patients with LVEF >= 40%. Method(s): A thorough literature search across four databases was conducted to identify eligible studies comparing beta-blocker therapy with placebo or no medication in addition to standard ACS pharmacotherapy. The outcomes of interest included all-cause mortality and MACE (comprising cardiovascular mortality, recurrent myocardial infarction [Re-MI], stroke, rehospitalization for heart failure, and revascularization). Based on LVEF values, patients were divided into three groups: (1) LVEF > 40%, (2) 40% < LVEF < 50%, and (3) LVEF >= 50%, and the random-effects meta-analysis estimated the risk ratios (RRs), hazard ratios (HRs), and 95% confidence intervals (CIs). Result(s): Five randomized controlled trials (RCTs) and 19 observational studies met the inclusion criteria. Within the RCTs, beta-blocker use was associated with a non-significant 6% reduction in MACE (RR = 0.94, 95%CI = 0.87-1.02, I2 = 19.1%). The pooled analyses of observational studies showed no significant overall impact of beta-blocker use on endpoint outcomes. Subgroup analyses revealed a reduction in MACE (HR = 0.75, 95%CI = 0.59-0.95, I2 = 0%) and Re-MI (HR = 0.45, 95%CI = 0.23-0.89) in patients with LVEF 40%-49%; however, these findings were derived primarily from observational data. Patients with LVEF >= 50% did not appear to benefit from long-term beta-blocker use. Conclusion(s): Long-term beta-blocker use did not show a significant benefit in patients with preserved ejection fraction (LVEF >= 50%). Observational data suggested a possible reduction in MACE and Re-MI in the LVEF 40%-49% subgroup; however, this finding requires confirmation in dedicated RCTs. Future larger RCTs are needed to clarify the role of beta-blockers in this borderline population. Copyright © 2026 Seyed Alireza Mirhosseini et al. Cardiovascular Therapeutics published by John Wiley & Sons Ltd. <33> Accession Number 2044068343 Title EBM BLS: Pitavastatin Reduces Cardiovascular Events in People Living with HIV With Low-to-Moderate Cardiovascular Risk. Source Journal of General Internal Medicine. 41(8) (pp 2379-2381), 2026. Date of Publication: 01 Jun 2026. Author Atluri S.; Rao R. Institution (Atluri) School of Medicine, Baylor College of Medicine, Houston, TX, United States (Rao) The Margaret M. And Albert B. Alkek Department of Medicine, Baylor College of Medicine, Houston, TX, United States Publisher Springer <34> Accession Number 2038217211 Title Efficacy of previous failure on subsequent procedural outcomes of chronic total occlusion percutaneous coronary intervention: A systematic review and meta-analysis. Source Pakistan Journal of Medical Sciences. 42(6) (pp 1550-1561), 2026. Date of Publication: 01 Jun 2026. Author Sun W.; Wu A.; Luo C. Institution (Sun, Luo) Department of Cardiovascular, Changxing County People's Hospital, Zhejiang Province, Huzhou, China (Wu) Department of Electrocardiogram Room, Changxing County People's Hospital, Zhejiang Province, Huzhou, China Publisher Professional Medical Publications Abstract Objective: The current study aimed to review evidence on the effects of prior failed percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) on subsequent reattempted procedures. Methodology: Studies published on the databases of PubMed, Embase, Scopus, and Web of Science comparing outcomes of prior failed CTO-PCI with first-attempt CTO-PCI were included. Random-effects meta-analysis was conducted for baseline characteristics, success rates, and complications. Result(s): Six studies were included with 15,803 patients of which 3248 (20.6%) had prior failed PCI for CTO. Patients with prior failed CTO-PCI had significantly lower age, higher Japanese-CTO scores, higher incidence of tortuous vessels, increased contrast volume, and higher fluoroscopy time. The retrograde approach was more frequently used in prior failed cases. Meta-analysis showed that procedural (OR: 0.50 95% CI: 0.32, 0.77 I2=89%) and technical success (OR: 0.69 95% CI: 0.53, 0.88 I2 =68%) was significantly lower in cases with prior failed CTO-PCI as compared to those undergoing first attempt CTO-PCI. There was no difference in the risk of major adverse cardiac events (OR: 1.14 95% CI: 0.62, 2.09 I2=47%) and individual complications between the two groups. Conclusion(s): Evidence suggest that cases with prior failed CTO-PCI may have significantly lower procedural and technical success rates as compared to those undergoing first-attempt CTO-PCI. There may be no difference in the risk of complications between the two groups. High heterogeneity precludes strong conclusions. Further studies are needed to improve the quality of evidence. Copyright © 2026, Professional Medical Publications. All rights reserved. <35> 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) <36> Accession Number 2046871255 Title Impact of Residual Mitral Regurgitation and Gradient After M-TEER: 1-Year Outcomes From the CLASP IID Trial. Source JACC: Cardiovascular Imaging. 19(7) (pp 795-806), 2026. Date of Publication: 01 Jul 2026. Author Narang A.; Hausleiter J.; Lim D.S.; Smith R.L.; Zahr F.; Chadderdon S.; Puthumana J.; Makkar R.; Makar M.M.; Stephan von Bardeleben R.; Ruf T.F.; Gossler T.; Kipperman R.M.; Rassi A.N.; Ku I.A.; Nabauer M.; Szerlip M.; Wang Z.; Goldman S.; Hawthorne K.M.; Koulogiannis K.; Marcoff L.; Gillam L.D.; Davidson C.J. Institution (Narang, Puthumana, Davidson) Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, United States (Hausleiter, Nabauer) Klinikum der Universitat Munchen, Munich, Germany (Lim) University of Virginia Health System Hospital, Charlottesville, VA, United States (Smith, Szerlip, Wang) Baylor Scott and White The Heart Hospital, Plano, TX, United States (Zahr, Chadderdon) Oregon Health and Science University, Portland, OR, United States (Makkar, Makar) Cedars-Sinai Medical Center, Los Angeles, CA, United States (Stephan von Bardeleben, Ruf, Gosler) University Medical Centre Mainz, Mainz, Germany (Kipperman, Koulogiannis, Marcoff, Gillam) Atlantic Health System Morristown Medical Center, Morristown, NJ, United States (Rassi, Ku) Kaiser Permanente San Francisco Medical Center, San Francisco, CA, United States (Goldman, Hawthorne) Lankenau Medical Center, Wynnewood, PA, United States Publisher Elsevier Inc. Abstract Background: Reduction of mitral regurgitation (MR) in mitral transcatheter edge-to-edge repair (M-TEER) improves patient outcomes and is balanced against elevated mitral valve gradients (MVGs). Objective(s): This study sought to evaluate impact of residual MR and MVG on echocardiographic and clinical outcomes post-M-TEER. Method(s): One-year outcomes from the randomized CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) were analyzed by discharge MR and MVG. Result(s): Of the 284 patients with available discharge echocardiogram, 72.5% (n = 206) achieved an optimal result (MR <=1+ and MVG <=5 mm Hg) and 27.5% (n = 78) achieved a suboptimal result (MR <=1+ and MVG >5 mm Hg, MR >=2+ and MVG <=5 mm Hg, or MR >=2+ and MVG >5 mm Hg). Optimal result patients had significantly improved pulmonary vein flow and tricuspid annular plane systolic excursion and experienced significantly higher freedom from major adverse events (MAEs) (89.5% vs 79.7%; P = 0.023), mortality (94.1% vs 85.4%; P = 0.016), and the composite of mortality, heart failure hospitalization, or reintervention (88.6% vs 78.7%; P = 0.022) at 1 year. Within suboptimal result patients, freedom from clinical events was higher with MR <=1+ and MVG >5 mm Hg compared with MR >=2+ and MVG <=5 mm Hg at 1 year (MAEs: 87.7% vs 75.5%; mortality: 90.9% vs 84.6%; composite: 87.9% vs 72.5%). Conclusion(s): In the CLASP IID trial, an optimal result was associated with improved hemodynamics with significantly higher freedom from MAEs, all-cause mortality, and composite events at 1 year. Within a suboptimal result, achieving MR <=1+ and MVG >5 mm Hg demonstrated better 1-year prognosis compared with achieving MR >=2+ and MVG <=5 mm Hg, suggesting a clinical benefit of optimizing MR over preserving lower gradients. (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID]; NCT03706833) Copyright © 2026 American College of Cardiology Foundation <37> Accession Number 629599809 Title Protocol for the electroencephalography guidance of anesthesia to alleviate geriatric syndromes (ENGAGES-Canada) study: A pragmatic, randomized clinical trial. Source F1000Research. 8 (no pagination), 2023. Article Number: 1165. Date of Publication: 2023. Author Deschamps A.; Saha T.; El-Gabalawy R.; Jacobsohn E.; Overbeek C.; Palermo J.; Robichaud S.; Dumont A.A.; Djaiani G.; Carroll J.; Kavosh M.S.; Tanzola R.; Schmitt E.M.; Inouye S.K.; Oberhaus J.; Mickle A.; Ben Abdallah A.; Avidan M.S. Institution (Deschamps) Department of Anesthesiology and Pain Medicine, Montreal Heart Institute and Universite de Montreal, Montreal, QC, Canada (Saha, Tanzola) Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Kingston, ON, Canada (El-Gabalawy) Department of Clinical Health Psychology, Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada (Jacobsohn) Departments of Anesthesia and Internal Medicine, University of Manitoba, Winnipeg, MB, Canada (Overbeek, Palermo) Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada (Robichaud) Montreal Heart Institute, Montreal, QC, Canada (Dumont) Montreal Health Innovation Coordinating Center, Montreal Heart Institute, Montreal, QC, Canada (Djaiani, Carroll) Department of Anesthesia, University of Toronto, Toronto, ON, Canada (Kavosh) Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada (Schmitt, Inouye) Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States (Oberhaus, Mickle, Ben Abdallah, Avidan) Department of Anesthesiology, Washington University School of Medicine, St-Louis, MO, United States Publisher F1000 Research Ltd Abstract Background: There is some evidence that electroencephalography guidance of general anesthesia can decrease postoperative delirium after non-cardiac surgery. There is limited evidence in this regard for cardiac surgery. A suppressed electroencephalogram pattern, occurring with deep anesthesia, is associated with increased incidence of postoperative delirium (POD) and death. However, it is not yet clear whether this electroencephalographic pattern reflects an underlying vulnerability associated with increased incidence of delirium and mortality, or whether it is a modifiable risk factor for these adverse outcomes. Method(s): The Electroe ncephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES-Canada) is an ongoing pragmatic 1200 patient trial at four Canadian sites. The study compares the effect of two anesthetic management approaches on the incidence of POD after cardiac surgery. One approach is based on current standard anesthetic practice and the other on electroencephalography guidance to reduce POD. In the guided arm, clinicians are encouraged to decrease anesthetic administration, primarily if there is electroencephalogram suppression and secondarily if the EEG index is lower than the manufacturers recommended value (bispectral index (BIS) or WAVcns below 40 or Patient State Index below 25). The aim in the guided group is to administer the minimum concentration of anesthetic considered safe for individual patients. The primary outcome of the study is the incidence of POD, detected using the confusion assessment method or the confusion assessment method for the intensive care unit; coupled with structured delirium chart review. Secondary outcomes include unexpected intraoperative movement, awareness, length of intensive care unit and hospital stay, delirium severity and duration, quality of life, falls, and predictors and outcomes of perioperative distress and dissociation. Discussion(s): The ENGAGES-Canada trial will help to clarify whether or not using the electroencephalogram to guide anesthetic administration during cardiac surgery decreases the incidence, severity, and duration of POD. Registration: ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02692300 NCT02692300) 26/02/2016 Copyright: © 2023 Deschamps A et al. <38> Accession Number 2046518209 Title TAVR vs. SAVR in Patients With Severe Aortic Stenosis and Chronic Kidney Disease Undergoing Dialysis: A Comprehensive Meta-Analysis. Source Cardiology Research and Practice. 2026(1) (no pagination), 2026. Article Number: 9451268. Date of Publication: 2026. Author Mylavarapu M.; Kiyani M.; Tanwar N.; Reddy M.; Garcia I.; Karnan N.; Rao N.L.; Kodali L.S.M.; Borra N. Institution (Mylavarapu) Department of Cardiology, Endeavor Health Cardiovascular Institute, Endeavor Health Glenbrook Hospital, Glenview, IL, United States (Mylavarapu) Division of Cardiology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, United States (Kiyani) Department of Internal Medicine, MedStar Health, Georgetown University, Washington, DC, United States (Tanwar) Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States (Reddy) Department of Internal Medicine, Mysore Medical College & Research Institute, Karnataka, Mysuru, India (Garcia) Department of Family Medicine, University of Southern California School of Medicine, Los Angeles, CA, United States (Karnan) Department of Internal Medicine, MercyOne North Iowa Medical Center, Mason City, IA, United States (Rao) Department of Internal Medicine, Adventist Health Bakersfield, Bakersfield, CA, United States (Kodali) Department of Public Health & Health Sciences, University of Michigan - Flint, Flint, MI, United States (Borra) Department of Internal Medicine, Kamineni Academy of Medical Sciences & Research Center, Telangana, Hyderabad, India Publisher John Wiley and Sons Ltd Abstract Background: Patients with chronic kidney disease (CKD) undergoing dialysis who also suffer from severe aortic stenosis (AS) present a complex management challenge. Both transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are treatment options, but comparative outcomes in this specific, high-risk population continue to remain unclear. Aim(s): This study aims to compare TAVR and SAVR postoperative clinical outcomes in patients with severe AS and CKD undergoing dialysis. Method(s): According to PRISMA guidelines, a comprehensive search was conducted across various databases such as PubMed, EMBASE, Scopus, and Google Scholar. Original studies that compared the clinical outcomes between TAVR and SAVR in patients with severe AS and CKD undergoing dialysis were included in the study. Result(s): Ten studies, all retrospective, involving 28,625 (14,625 TAVR and 14,000 SAVR) patients with severe AS and CKD undergoing dialysis who underwent TAVR or SAVR were included in this study. Patients who underwent TAVR had significantly lower odds of in-hospital mortality (OR 0.49; 0.29, 0.84; p = 0.01) and shorter length of stay (LOS) (SMD -2.59; 95% CI -5.04, -0.14; p <= 0.04). However, the TAVR group had significantly higher odds of permanent pacemaker implantation (OR 2.25; 95% CI 1.71-2.94; p < 0.00001). Conclusion(s): In patients with severe AS and CKD undergoing dialysis, TAVR is associated with lower in-hospital mortality and shorter LOS, suggesting a favorable early safety profile and recovery in this population. Copyright © 2026 Maneeth Mylavarapu et al. Cardiology Research and Practice published by John Wiley & Sons Ltd. <39> Accession Number 2044447014 Title Randomized, sham-controlled trial of intraoperative ticagrelor removal to reduce perioperative bleeding. Source Journal of Thoracic and Cardiovascular Surgery. 172(1) (pp 128-137.e4), 2026. Date of Publication: 01 Jul 2026. Author Mack M.J.; Whitlock R.; Chu M.W.A.; Taylor B.; Zias E.A.; Liu D.; Protos A.N.; Rokkas C.; Pelletier M.; Choi C.W.; Saha T.; Sellke F.W.; Schneider D.J.; Thourani V.H.; Douketis J.; Mazer C.D.; Fan W.; Deliargyris E.N.; Gibson C.M. Institution (Mack) Cardiovascular Surgery, Baylor Scott & White Health, Dallas, Tex, United States (Whitlock) Cardiovascular Surgery, Population Health Research Institute, Hamilton, Canada (Chu) Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, Canada (Taylor) Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Md, United States (Zias) Department of Cardiothoracic Surgery, NYU Langone School of Medicine, New York, NY, United States (Liu) Department of Cardiac Surgery, Beth Israel Deaconess Medical Center, Boston, Mass, United States (Protos) Division of Cardiac Surgery, University of Mississippi Medical Center, Jackson, Miss, United States (Rokkas) Division of Cardiac Surgery, University of Wisconsin, Madison, Wis, United States (Pelletier) Division of Cardiac Surgery, Yale School of Medicine, New Haven, Conn, United States (Choi) Division of Cardiothoracic Surgery, Virtua Health, Cherry Hill, NJ, United States (Saha) Division of Cardiac Anesthesia, Kingston General Hospital, Kingston, Canada (Sellke) Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI, United States (Schneider) Department of Medicine, Cardiovascular Research Institute, University of Vermont, Burlington, VT, United States (Thourani) Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA, United States (Douketis) Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Canada (Mazer) Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Canada (Fan, Deliargyris) CytoSorbents Corporation, Princeton, NJ, United States (Gibson) Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass, United States (Gibson) Baim Institute for Clinical Research, Boston, Mass, United States Publisher Elsevier Inc. Abstract Objective: Patients on ticagrelor who are undergoing cardiac surgery before completing guideline-recommended washout are at high risk for severe bleeding. This study evaluated whether a novel drug removal device reduces bleeding in patients operated within 2 days from ticagrelor discontinuation. Method(s): Eligible patients were randomized 1:1 to intraoperative DrugSorb-ATR or sham control. Primary safety end point was adverse events at 30 days. Efficacy was assessed by composite end points comprising bleeding events using Universal Definition of Perioperative Bleeding (UDPB) and 24-hour chest tube drainage (CTD) in the overall and isolated coronary artery bypass grafting (CABG) populations with a hierarchical win ratio (WR) method. Result(s): In total, 140 patients were randomized; 132 had surgery and received a study device; and 92% were isolated CABG. Mean age was 65 +/- 5 years, and 15% were female. The primary safety end point was met, with similar adverse events reported between groups. The primary efficacy end point was not met in the overall or CABG populations (Win ratio [WR], 1.07; 95% CI, 0.72-1.58; P = .748 and WR, 1.33; 95% CI, 0.86-2.04; P = .202 respectively). The supplementary efficacy end point was met in the CABG population (WR, 1.59; 95% CI, 1.02-2.46, P = .041) with significant reductions also shown in large CTD bleeding events (P = .016) and major bleeding, a composite of severe bleeding events or 24-hour CTD >=1 L (P = .041). The number needed to treat to prevent a major bleed was 6. Conclusion(s): Intraoperative use of DrugSorb-ATR is safe in patients operated within 2 days of ticagrelor discontinuation. Although the primary end point was not met in the overall population, there were significant reductions in severe bleeding events in the prespecified CABG population. Copyright © 2026 The Authors <40> Accession Number 2035038244 Title Dual ProGlide vs ProGlide and Angio-Seal for Femoral Access Hemostasis After Transcatheter Aortic Valve Replacement: A Randomised Comparative Trial. Source Canadian Journal of Cardiology. 41(1) (pp 12-20), 2025. Date of Publication: 01 Jan 2025. Author Yeh C.-F.; Kao H.-L.; Ko T.-Y.; Chen C.-K.; Tsai C.-H.; Huang C.-C.; Chen Y.-H.; Chan C.-Y.; Lin M.-S. Institution (Yeh, Kao, Ko, Chen, Tsai, Huang, Chen, Lin) Division of Cardiology, Department of Internal Medicine and Cardiovascular Centre, National Taiwan University Hospital, Taipei, Taiwan (Republic of China) (Ko, Chen) Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan (Republic of China) (Chen) Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan (Republic of China) (Chan) Division of Cardiovascular Surgery, Department of Surgery and Cardiovascular Centre, National Taiwan University Hospital, Taipei, Taiwan (Republic of China) Publisher Elsevier Inc. Abstract Background: Vascular complications increase morbidity and mortality after transcatheter aortic valve replacements (TAVR), often related to failures in vascular closure devices (VCDs). We intended to compare the dual Perclose ProGlide (PP) strategy and the hybrid combination of PP and Angio-Seal (AS) for femoral access hemostasis after TAVR. Method(s): A randomised controlled trial with 257 patients comparing dual PP with 1 PP and 1 AS (AS+PP) for vascular closure after transfemoral TAVR was conducted. The primary end point was the composite of TAVR access site-related vascular complications and life-threatening type 2/3 or 1 bleeding according to the Valve Academic Research Consortium 3. Secondary end points included additional VCD use and significant peripheral ischemia related to arteriotomy closure within 1 year. Modified VCD failure, defined as failure to achieve hemostasis within 5 minutes or requiring additional endovascular manoeuvres, was also recorded. Result(s): The AS+PP combination yielded lower rates of the primary end point (18.2% vs 29.8%; P = 0.0381), vascular complication (18.2% vs 29.8%; P = 0.0381), additional VCD use (0.8% vs 19.0%; P < 0.0001), and modified VCD failure (9.9% vs 33.1%; P < 0.0001) than the dual PP. Bleeding complication rates were similar between the 2 groups. Three-month follow-up vascular duplex tests showed similar common femoral artery (CFA) diameters and peak systolic velocities (PSVs) between the 2 groups, but those with additional intervention had higher PSVs and smaller CFA diameters than those without. Conclusion(s): Combined PP+AS for large-bore femoral access hemostasis after TAVR promises to be more effective and safer than dual PP in terms of vascular complications. Moreover, additional intervention for vascular complications resulted in smaller CFA diameters. Clinical Trial Registration: NCT05491070 Copyright © 2024 Canadian Cardiovascular Society <41> Accession Number 2041100083 Title Association Between Perioperative Sleep Disorders and Post-Operative Delirium in Cardiac Surgeries: A Systematic Review and Meta-Analysis. Source Journal of Sleep Research. 35(3) (no pagination), 2026. Article Number: e70241. Date of Publication: 01 Jun 2026. Author Varpaei H.; Deka P.; Robbins L.B.; Farhadi K.; Reeves M.; Mowbray F.; Quan S.F. Institution (Varpaei, Deka, Robbins, Mowbray) College of Nursing, Michigan State University, East Lansing, MI, United States (Deka) College of Nursing, Wayne State University, Detroit, MI, United States (Farhadi) Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Reeves) Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States (Quan) Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States Publisher John Wiley and Sons Inc Abstract Post-operative delirium (POD) is an acute deterioration in cognitive function and highly prevalent after cardiac surgery (CS; up to 55%). Perioperative sleep disorders (PSD) are also commonly noted in surgical patients (up to 60%). The primary aim of our systematic review is to determine the association between PSD and POD in CS patients during their hospital stay. We searched five databases (PubMed, CINAHL, Web of Science, Scopus, and EMBASE) to identify studies evaluating the association between PSD and POD amongst CS (any open-heart CS) patients, without time and geographic restriction. Original articles that focused on adults undergoing cardiac surgeries and assessed sleep and POD were included. We conducted a meta-analysis using a random effects model to determine the effect of sleep quality on POD. Thirty-three studies were included (63% observational designs); most studies originated from China (33%). The most frequently used subjective and objective sleep assessment tools were the Pittsburgh Sleep Quality Index (PSQI) (33%) and polysomnography (18%). After pooling observational data, we identified an incidence of POD ranging from 3.6% to 73%. Increased PSQI scores (standard threshold > 5) were associated with a greater likelihood of POD occurrence (standardised mean difference [SMD] = 0.73, p > 0.05). Lower total sleep time (SMD = -0.68, p < 0.05) was associated with an increased risk of POD. Poor sleep quality, insomnia, and sleep-disordered breathing are prevalent forms of PSD and are major risk factors for POD following CS. Additional research is warranted to clarify when sleep quality normalises after cardiac surgery and how targeted interventions can accelerate this recovery. Copyright © 2025 The Author(s). Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society. <42> Accession Number 2046437396 Title Routine Versus Selective Temporary Epicardial Pacing Wire Placement: A Scoping Review. Source Surgery Today. (no pagination), 2026. Date of Publication: 2026. Author Akele O.; Osuji E.; Patel V.; Kamal M.; Kiernan P.; Dhakal R.; Khoury M.E.; Shahani R. Institution (Akele, Patel, Kamal, Kiernan) Department of Medicine, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, United States (Osuji) Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, United States (Dhakal) Department of Medicine, Staten Island University Hospital, Staten Island, NY, United States (Khoury) Department of Cardiology, Staten Island University Hospital, Staten Island, NY, United States (Shahani) Department of Cardiothoracic Surgery, Staten Island University Hospital Heart Institute, Staten Island, NY, United States Publisher Springer Abstract Temporary epicardial pacing wires (TEPWs) are used widely for rhythm management in cardiac surgery. However, their routine placement is being debated increasingly because of low utilization and potential procedural risks. We compared routine versus selective TEPW placement practices and assessed the utilization, complications, and predictors of pacing need. A scoping review was conducted in accordance with the PRISMA-ScR guidelines. We searched PubMed, Embase, Scopus, and Cochrane Library until June 2025. Studies were included if they examined TEPW strategies in adult or pediatric cardiac surgery and reported outcomes related to wire use, complications, or predictors of pacing need. Eleven studies involving 16,874 patients (14,957 adults, 1,917 children) were included. Routine placement rates ranged from 73.5% to 89.9%, but utilization was low at 2.9%-29.6%. Selective strategies showed higher utilization of 30%-100% with fewer unused wires. Predictors of the need for TEPW included intraoperative arrhythmias, prolonged CPB, and complex procedures. Complications were rare. Thus, routine TEPW placement often leads to unnecessary wire use. Selective strategies based on intraoperative and clinical predictors may optimize patient care. Developing a risk-based tool could enhance decision-making and reduce procedural burden. Copyright © The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd. 2026. <43> Accession Number 2046549740 Title Left Ventricular Guidewire Pacing Is Associated With Lower Pacing Lead-Related Cardiac Tamponade During Transfemoral TAVI: A Systematic Review and Meta-Analysis. Source Journal of Interventional Cardiology. 2026(1) (no pagination), 2026. Article Number: 2519641. Date of Publication: 2026. Author Ferreira Gomes R.; Montenegro M.; Cantarelli F.; Pessoa de Melo E.; Guimaraes J. Institution (Ferreira Gomes, Montenegro, Cantarelli, Pessoa de Melo, Guimaraes) Universidade de Pernambuco (UPE), Pernambuco, Recife, Brazil Publisher John Wiley and Sons Inc Abstract Background: Rapid pacing is required during transcatheter aortic valve implantation (TAVI) to facilitate valve deployment. Conventional right ventricular (RV) temporary pacing requires transvenous lead placement and has been associated with mechanical complications, including cardiac perforation. Left ventricular (LV) guidewire pacing has emerged as an alternative strategy that may avoid lead-related injury. We performed a systematic review and meta-analysis to compare clinical and procedural outcomes between LV guidewire pacing and RV temporary pacing during TAVI. Method(s): MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Web of Science were searched through February 15, 2026. Comparative studies evaluating LV guidewire pacing versus RV temporary pacing during TAVI were included. The primary endpoint was global cardiac tamponade. Prespecified mechanistic analyses evaluated pacing lead-related and annular rupture-related tamponade. Secondary endpoints included all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), stroke, major vascular complications, bleeding, permanent pacemaker implantation, and procedural metrics. Random-effects meta-analyses were performed using Mantel-Haenszel models. Result(s): Five studies (one randomized controlled trial and four observational cohorts) comprising 2840 patients (1910 LV and 930 RV) were included. Global cardiac tamponade occurred in 1.1% of LV patients and 2.5% of RV patients (OR 0.45; 95% CI 0.18-1.16; p = 0.08). In mechanistic analyses, pacing lead-related tamponade was significantly reduced with LV pacing (OR 0.09; 95% CI 0.02-0.56; p = 0.03), whereas annular rupture-related tamponade did not differ between strategies. The pooled absolute risk reduction for pacing lead-related cardiac tamponade was approximately 1.2%, corresponding to an estimated number needed to treat of 83. A signal toward lower all-cause mortality was observed in pooled analyses, largely driven by observational cohorts. Major vascular complications and bleeding showed nonsignificant trends favoring LV pacing. Permanent pacemaker implantation did not differ significantly between strategies. LV pacing was associated with shorter procedural duration (mean difference -5.83 min; 95% CI -7.08 to -4.58; p < 0.001). Conclusion(s): LV guidewire pacing during transfemoral TAVI was associated with a lower risk of pacing lead-related cardiac tamponade and shorter procedural duration. This benefit appears to be mechanism-specific and should not be extrapolated to annular rupture or other nonlead-related causes of tamponade. Although LV guidewire pacing may simplify procedural workflow, its use should be individualized according to baseline conduction risk and the availability of rapid bailout pacing strategies. Copyright © 2026 Rafael Ferreira Gomes et al. Journal of Interventional Cardiology published by John Wiley & Sons Ltd. <44> 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) <45> Accession Number 651054877 Title Simultaneous bispectral index and near-infrared spectroscopy monitoring to evaluate two induction protocols in elective cardiovascular surgery. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 28 Apr 2026. Author Eke H.; Toprak B.; Bozkurt E.D. Institution (Eke) Department of Anesthesia and Reanimation, Mersin City Education and Research Hospital, Korukent Mah. 96015 Street Mersin Integrated Health Campus, Toroslar, Mersin, Turkey (Toprak) Department of Cardiovascular Surgery, Mersin City Education and Research Hospital, Korukent Mah. 96015 Street Mersin Integrated Health Campus, Toroslar, Mersin, Turkey (Bozkurt) Department of Anesthesia and Reanimation, Zonguldak Ataturk State Hospital, Constitutional Monarchy Uzun Mehmet St. No: 5, Zonguldak Center Zonguldak, Turkey Abstract BACKGROUND: Laryngoscopy and intubation provoke strong sympathetic activation and may cause hemodynamic instability in cardiovascular surgery patients. Maintaining adequate hypnotic depth and cerebral oxygenation during induction is essential. Although BIS and NIRS are widely used, their simultaneous behavior during induction in a homogeneous cardiovascular surgery population is not well established. OBJECTIVE(S): To compare thiopental-low-dose fentanyl and midazolam-high-dose fentanyl induction protocols regarding their effects on BIS, regional cerebral oxygen saturation (rSO2), and hemodynamic responses during the peri-intubation period. METHOD(S): This prospective, randomized study included 30 adults undergoing elective cardiovascular surgery. Patients received thiopental (5-7 mg/kg) + fentanyl (1.5 microg/kg) or midazolam (0.1 mg/kg) + fentanyl (5 microg/kg). BIS, bilateral rSO2, arterial pressures, heart rate, and end-tidal CO2 were recorded at four time points: before induction (T0), two minutes after induction (T1), immediately after intubation (T2), and two minutes post-intubation (T3). Statistical comparisons were performed within and between groups (p < 0.05). RESULT(S): Both protocols demonstrated similar BIS patterns: a marked decrease after induction, a rise at intubation, and a decline thereafter. rSO2 increased significantly at T1-T2 and decreased at T3 in both groups. Hemodynamic responses showed parallel post-induction decreases and intubation-related increases. No significant intergroup differences were identified in BIS, rSO2, or major hemodynamic variables. CONCLUSION(S): Thiopental-low-dose fentanyl and midazolam-high-dose fentanyl induction yield comparable effects on hypnotic depth, cerebral oxygenation, and hemodynamic stability. Combined BIS-NIRS monitoring provides complementary information and may enhance peri-intubation safety in cardiovascular surgery. Copyright © 2026. The Author(s). <46> 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. <47> Accession Number 651028985 Title Perioperative management of pulmonary arterial hypertension in children undergoing congenital heart surgery: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 25 Apr 2026. Author Ikwuanusi E.; Rajah T.; Scandrett K.; Asamane E.A.; Volpi S. Institution (Ikwuanusi) University Hospitals Birmingham, Birmingham, United Kingdom (Rajah) Birmingham Medical School, University of Birmingham, Birmingham, United Kingdom (Scandrett) University of Birmingham, Birmingham, United Kingdom (Asamane) School of Medicine, Keele University, Keele, Newcastle, ST5 5BG, UK (Volpi) Department of Cardiac Surgery, St. Thomas' Hospital London, London, United Kingdom Abstract BACKGROUND: Children with pre-existing pulmonary arterial hypertension (PAH) undergoing surgery for congenital heart disease (CHD) are at an increased risk of morbidity and mortality, primarily due to complications associated with increased pulmonary arterial pressures. Despite the clinical significance of this risk, no comprehensive review of perioperative strategies to manage pre-existing PAH in paediatric CHD patients undergoing cardiac surgery exists. This systematic review aims to address this gap. METHOD(S): A comprehensive systematic literature search was conducted on Scopus, Medline, Embase, PubMed, Cochrane Library and grey literature; studies were screened using eligibility criteria. Data was extracted using a pre-tested standard form and the methodological quality appraised using the RoB 2 tool. A meta-analysis was used to analyse, summarise, and interpret the extracted data. RESULT(S): Ten randomised controlled studies were included in this review, comprising 520 patients, ages ranged from 0.21 to 13.8 years across 6 countries. All studies reported a greater decrease in postoperative mean pulmonary arterial pressure (mPAP) in the intervention groups compared to the control groups. Although perioperative management did not significantly reduce postoperative PAP (pooled mean difference, -0.44; 95% CI: -4.62-3.73; I2 = 88.73%), their use resulted in statistically significant decreases in mean ICU stays (pooled mean difference, -1.08; 95% CI: -1.90-0.25, p-value = 0.01; I2 = 86.21%) and ventilation times (pooled mean difference, -13.29; 95% CI: -25.78 -0.80, p - value = 0.04; I2 = 97.47%) compared to controls. Sildenafil was the most used intervention, with a significantly greater reduction in PAP compared to other management strategies (pooled mean difference, -6.27; 95% CI: -8.982- -3.57, p-value < 0.001; I2 = 49.84%). Among studies reporting pulmonary hypertensive crises and mortality, the prevalence of pulmonary hypertensive crises was 6.18% in the control group versus 3.43% in the treatment group. Mortality rates were 1.27% in the control group and 0.54% in the treatment group, respectively. CONCLUSION(S): PAH Perioperative management strategies yielded no reductions in postoperative mPAP, but significantly reduced other key clinical outcomes including mean ICU stay and ventilation times in children undergoing cardiac surgery for CHD. Integrating perioperative interventions in the management of PAH may improve overall clinical outcomes, despite minimal impact on mPAP. <48> 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/ <49> Accession Number 2045301656 Title Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Ventricular Premature Complexes (TREAT-PVC): A Randomized Clinical Trial. Source JACC: Clinical Electrophysiology. 12(6) (pp 1260-1272), 2026. Date of Publication: 01 Jun 2026. Author Wu N.; Cai C.; Jiang Q.; Li C.; Guo H.; Yang J.; Shi L.; Gu Z.; Yang G.; Cui C.; Liu H.; Liu W.; Shen Y.; Chen M.; Po S.S. Institution (Wu, Cai, Yang, Cui, Liu, Liu, Shen, Chen) Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (Jiang) Department of Cardiology, the Third Affiliated Hospital of Soochow University, Changzhou, China (Li) Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China (Guo) Department of Cardiology, Jiangsu Province Official Hospital, Nanjing, China (Yang) Department of Cardiology, Jiangnan University Medical Center, Wuxi, China (Shi) Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China (Shi, Gu) Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China (Po) Section of Cardiovascular Diseases, University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma City, United States Publisher Elsevier Inc. Abstract Background: Low-level tragus stimulation (LLTS) of the auricular branch of the vagus nerve at the tragus reduces atrial fibrillation burden. Its efficacy on premature ventricular complexes (PVCs) is unknown, however. Objective(s): The goal of this study was to evaluate the efficacy of daily LLTS on PVC burden in patients with idiopathic PVC. Method(s): TREAT-PVC (LLTS to Treat Premature Ventricular Contractions) is a sham-controlled, double-blind, randomized trial. Eligible patients with >10% PVC burden were randomized 1:1 to receive LLTS vs sham stimulation to the earlobe (20 Hz, 1 mA below the discomfort threshold; 1 hour daily). The primary outcome was reduction of PVC burden at 6 months assessed by using 10-day ambulatory electrocardiographic monitoring. Result(s): Among 100 randomized patients, 96 were included into final analysis (N = 48 for each group) with no significant adverse effects. Baseline characteristics were balanced between groups (PVC burden: LLTS = 18.7%; sham = 16.7%). Adherence to the study protocol was similar between the 2 groups (LLTS = 85.4%; sham = 89.6%). At 6 months, both groups showed reduced PVC burden assessed by 10-day monitoring (LLTS median value: 18.7% to 11.1% [P < 0.01]; sham median value: 16.7% to 12.6% [P < 0.01]), although with no differences between the 2 groups. Skin sympathetic nerve activity and inflammatory markers (tumor necrosis factor-alpha, interleukin-1, and interleukin-6) remained unchanged in both groups. Heart rate variability parameters showed similar significant changes in each group (higher low-frequency, high-frequency, and very-low-frequency power; and a lower low-frequency/high-frequency ratio), suggesting that autonomic balance shifted toward parasympathetic dominance. However, there were no differences between the 2 groups (P > 0.05 for all parameters). Conclusion(s): LLTS and sham stimulation produced parallel results, indicating the presence of significant placebo effects. Future transcutaneous neuromodulation studies should include placebo effects into sample size calculation. (LLTS to Treat Premature Ventricular Contractions [TREAT-PVC]; NCT04909528) Copyright © 2026 American College of Cardiology Foundation <50> Accession Number 2046649048 Title From legacy to future: A global bibliometric analysis of the Ross procedure over 60 years. Source Asian Cardiovascular and Thoracic Annals. (no pagination), 2026. Article Number: 02184923261458925. Date of Publication: 2026. Author Cubas W.S.; Alfabeto A.; Kawaguchi Y.; Guo L.-R.; Chu M.W.A. Institution (Cubas, Alfabeto, Kawaguchi, Guo, Chu) Division of Cardiac Surgery, Department of Surgery, Western University, London, ON, Canada Publisher SAGE Publications Inc. Abstract Background: The Ross procedure, introduced in 1967, transformed cardiac surgery. This study presents one of the first global bibliometric analyses, to the best of our knowledge, mapping research trends, collaborations, and authorship to identify future directions in this field. Method(s): A global bibliometric analysis of Ross procedure publications (1967-2025) was performed using Scopus and PubMed. Data processed in R (bibliometrix, biblioshiny) explored productivity, collaborations, authorship, and thematic evolution. Future publication trends to 2050 were forecast using a linear extrapolation model with 95% confidence intervals. Result(s): A total of 2370 Ross procedure publications were identified (1967-2025), showing an 8.1% average annual growth rate. Original articles dominated (65%), followed by reviews/meta-analyses (13.9%) and case reports (13.5%). Among 6228 authors (69.5% male), collaboration averaged 4.9 coauthors/document, with 12.6% international partnerships. The USA (32.3%), the Netherlands (19.3%), and Germany (14.5%) led in productivity. Top institutions were Erasmus University Medical Center (4.3%), Mount Sinai Health System (3.0%), and University Heart Center Lubeck (2.2%). Major journals included Annals of Thoracic Surgery (13.5%), Journal of Thoracic and Cardiovascular Surgery (12.2%), and European Journal of Cardio-Thoracic Surgery (7.6%). Faculty surgeons authored 66% of first-author papers. Main research themes involved allograft reintervention, durability, suture technique, failure, and postoperative complications. Linear regression predicted 164 annual publications by 2050. Conclusion(s): This analysis reveals an exponentially increasing and sustained global interest in the Ross procedure, which continues to shape cardiac surgery worldwide. The findings highlight growing research output, robust international collaboration, and a focus on clinical innovation, ensuring ongoing advancements in surgical techniques, patient outcomes, and global cardiovascular surgical excellence. Copyright © The Author(s) 2026 <51> Accession Number 2046323059 Title Real-Time Heart Team for Revascularization in Complex Coronary Artery Disease. Source Journal of the American College of Cardiology. 87(24) (pp 3467-3479), 2026. Date of Publication: 23 Jun 2026. Author Lin S.; Su X.; Ma H.; Dou K.; Song L.; Zhao H.; Qian J.; Liu S.; Xu F.; Wang X.; Yang Y.; Su P.; Jin Z.; Wang Y.; Zheng Z. Institution (Lin, Su, Zheng) National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Lin, Liu, Xu, Wang, Yang, Zheng) Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Ma) Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Dou, Song, Zhao, Qian) Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Su) Department of Cardiac Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (Jin) Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Wang) Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Publisher Elsevier Inc. Abstract Background: The routine implementation of heart teams for patients with complex coronary artery disease (CAD) is challenging due to the insufficient multidisciplinary specialist resources for face-to-face discussion. A real-time heart team during the angiography, based on an online meeting, offers the potential to efficiently integrate resources. Objective(s): In this study, we sought to evaluate the implementation value and safety of a "real-time heart team" decision making approach. Method(s): This noninferiority randomized controlled trial enrolled patients with de novo left main or 3-vessel CAD at 3 cardiac centers. Patients were randomly assigned to the conventional heart team group (discussed by a face-to-face meeting after the angiography) or the real-time heart team group (discussed by an online meeting during the angiography). Implementation value outcomes included care efficiency (waiting time for treatment, recatheterization, specialist workload, and economic outcomes) and process evaluation metrics (discussion adequacy, surgeon participation, and shared decision making). The safety outcomes were a composite of 1-year major adverse cardiovascular and cerebrovascular events (MACCE) (including all-cause mortality, myocardial infarction, stroke, unplanned revascularization, and readmission due to reangina) and revascularization decision making. Result(s): Overall, 490 complex CAD patients were included, with 245 patients in each group. Waiting time for final therapy (median: 2 days [Q1-Q3: 0-7 days] vs 5 days [Q1-Q3: 2-10 days]; P < 0.001), recatheterization rate (12.5% vs 98.9%; P < 0.001), specialist high workload rate (5.3% vs 29.0%; P < 0.001), and percutaneous coronary intervention (PCI) hospitalization cost (percentage of decrease: 18.0%; P < 0.001) were significantly reduced in the real-time group. More discussion time spent (4.0 +/- 1.8 min vs 3.4 +/- 1.6 min), better specialist satisfaction (based on NASA Task Load Index scale), more chief surgeon participation (26.5% vs 18.8%), but less multidisciplinary synchronous shared decision making (2.0% vs 11.5%) were found in the real-time group. The real-time heart team group was noninferior to the conventional group in 1-year MACCE (8.2% vs 10.6%; risk difference: -2.45%; 95% CI: -7.61%-2.71%; P for noninferiority < 0.001). The proportions of PCI, coronary artery bypass grafting, and medical therapy were similar between the 2 groups (P = 0.892). Conclusion(s): Compared with the conventional heart team, the real-time heart team significantly improved care efficiency and process evaluation metrics, with similar clinical outcomes and decision making. However, insufficient shared decision making and intercenter generalizability should be optimized before widespread implementation of this approach. (Feasibility and Effectiveness of a Real-Time Heart Team Approach in Complex CAD [EHEART; NCT05514210]). Copyright © 2026 by the American College of Cardiology Foundation. Published by Elsevier. <52> 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. <53> Accession Number 2041613608 Title Percutaneous femoral access closure and prognosis following transcatheter aortic valve replacement: A systematic review and meta-analysis. Source Journal of Vascular Access. 27(3) (pp 906-913), 2026. Date of Publication: 01 May 2026. Author Simonetti F.; Cassese S.; Rheude T.; Alvarez-Covarrubias H.; Pellegrini C.; Kastrati A.; Joner M.; Xhepa E. Institution (Simonetti, Cassese, Rheude, Alvarez-Covarrubias, Pellegrini, Kastrati, Joner, Xhepa) Klinik fur Herz- und Kreislauferkrankungen, TUM Klinikum Deutsches Herzzentrum, Technical University of Munich, Munich, Germany (Simonetti) Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (Kastrati, Joner) DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany Publisher SAGE Publications Ltd Abstract Background: The impact of different percutaneous femoral access closure strategies on mortality and bleeding after transcatheter aortic valve replacement (TAVR) has been less studied. The aim of this study is to investigate whether different percutaneous femoral access closure strategies might affect systemic outcomes in patients undergoing TAVR. Method(s): In this systematic review and meta-analysis, randomized trials comparing a suture-based closure (suture group) with a plug-based or suture/plug-based closure (control group) for hemostasis of the femoral access in patients undergoing TAVR were included. The primary endpoint of the study was all-cause death. Secondary endpoints included any bleeding (defined according Valve Academic Research Consortium (VARC) criteria) and unplanned endovascular or surgical repair at the access site. All endpoints were calculated at the longest available follow-up. Result(s): Four studies with a total of 1429 TAVR patients (suture-based group, n = 707; control group, n = 722) were available for quantitative synthesis. There was no statistically significant difference in all-cause death in patients who underwent TAVR with suture-based closure compared to the control group (risk ratio-RR = 1.04, 95% confidence interval-CI 0.60-1.82; p = 0.83). Similarly, there was no statistically significant difference between treatment groups for any bleeding and unplanned endovascular or surgical repair at the access site. However, there was a significant treatment effect for VARC bleeding type 2 associated with the use of a plug-based or suture/plug-based closure in the control group (p for interaction = 0.01). Conclusion(s): In the context of contemporary TAVR procedures, percutaneous closure of the femoral access using any suture or plug-based strategy has no impact on hard clinical outcomes such as death from any cause. Copyright © The Author(s) 2025. 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). <54> Accession Number 2045571733 Title Effects of prehabilitation programmes on postoperative outcomes in older adults undergoing major abdominal, cardiac or vascular surgery: a systematic review. Source Aging Clinical and Experimental Research. 38(1) (no pagination), 2026. Article Number: 120. Date of Publication: 01 Dec 2026. Author Buckinx F.; Rousseau A.-F.; Louis E.; De Roover A.; Detry O.; Durieux R.; Gillain S.; Kaba A.; Kaux J.-F.; Tchana-Sato V.; Bruyere O. Institution (Buckinx, Bruyere) Research Unit in public health, epidemiology and health economics, University of Liege, Liege, Belgium (Kaux, Bruyere) Department of Physical Activity and Rehabilitation Sciences, University of Liege, Liege, Belgium (Rousseau) Intensive Care Department, University Hospital of Liege, Liege, Belgium (Rousseau) Research Unit for a Life-Course Perspective on Health & Education (RUCHE), University of Liege, Liege, Belgium (Louis) Hepato-Gastroenterology and Digestive Oncology Department, University Hospital of Liege, Liege, Belgium (De Roover, Detry) Department of Abdominal Surgery and Transplantation, University Hospital of Liege, Liege, Belgium (Durieux, Tchana-Sato) Division of Cardiovascular and Thoracic Surgery, University Hospital of Liege, Liege, Belgium (Gillain) Geriatric Department, University Hospital of Liege, Liege, Belgium (Kaba) Department of Anaesthesiology, Service of Abdominal Surgery, University Hospital of Liege, Liege, Belgium (Kaux) Department of Physical Medicine, Rehabilitation and Sports Traumatology FIMS Collaborative Centre of Sports Medicine, FIFA Medical Centre of Excellence, SportS2, Liege, Belgium Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: Older adults undergoing major abdominal, cardiac, or vascular surgery are highly vulnerable to postoperative complications, prolonged hospitalisation, functional decline, and mortality. Sarcopenia and frailty reduce physiological reserve, underscoring the potential role of prehabilitation in improving resilience to surgical stress and postoperative outcomes. Objective(s): To evaluate the effects of exercise-based prehabilitation, alone or combined with nutritional, psychological, or educational components, on postoperative outcomes, including complications, length of stay, readmissions, mortality, quality of life, and economic indicators, as well as on body composition, functional reserve, and biological markers, in adults aged >= 65 years undergoing major abdominal, cardiac, or vascular surgery. Method(s): Medline, Scopus and EMBASE were searched for Randomised Controlled trials assessing prehabilitation programmes in older adults undergoing major abdominal, cardiac or vascular surgery. Data on study characteristics, interventions, outcomes, and methodological quality were extracted and synthesized narratively. Result(s): Nine studies (n = 36-182; mean/median age 68-82) were included. Interventions lasted 2-6 weeks and involved exercise alone or multimodal programmes, delivered in-person, remotely, or via hybrid approaches. Vascular surgery studies showed modest reductions in complications and hospital stay, whereas abdominal surgery studies generally reported no significant improvements, except for isolated reductions in severe complications or gains in functional reserve. No studies involving cardiac surgery were identified. Conclusion(s): Prehabilitation in older adults remains understudied, especially in frail patients, the oldest old, and cardiac surgery. Robust trials are needed to assess individualized, multimodal, sarcopenia-targeted interventions and to integrate biological markers to clarify underlying mechanisms. Copyright © The Author(s) 2026. <55> Accession Number 2045548439 Title Oral Anticoagulation With or Without Antiplatelet Therapy in Chronic Coronary Syndrome. Source JACC: Cardiovascular Interventions. 19(10) (pp 1294-1306), 2026. Date of Publication: 25 May 2026. Author Galli M.; Vinciguerra M.; Laudani C.; Occhipinti G.; D'Amario D.; Iaconelli A.; Franchi F.; Greco E.; Frati G.; Sciarretta S.; Capodanno D.; Gorog D.A.; Lopes R.D.; Gibson C.M.; Mehran R.; Angiolillo D.J. Institution (Galli, Frati, Sciarretta) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (Galli) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (Vinciguerra, Greco) Department of Health and Life Sciences, European University of Rome, Rome, Italy (Vinciguerra) Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy (Laudani, Franchi, Angiolillo) Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, United States (Laudani, Capodanno) Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico Rodolico - San Marco, University of Catania, Catania, Italy (Occhipinti) Institut Clinic Cardiovascular, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (D'Amario) Department of Translational Medicine, Division of Cardiology, Universita del Piemonte Orientale, AOU Maggiore della Carita, Novara, Italy (Iaconelli) Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (Iaconelli) School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom (Frati, Sciarretta) IRCCS NeuroMed, Pozzilli, Italy (Gorog) University of Hertfordshire, Hertfordshire, Hatfield, United Kingdom (Gorog) National Heart and Lung Institute, Imperial College, London, United Kingdom (Lopes) Brazilian Clinical Research Institute, Sao Paulo, Brazil (Lopes) Duke University School of Medicine, Durham, NC, United States (Gibson) Baim Institute for Clinical Research, Harvard Medical School, Harvard University, Boston, MA, United States (Mehran) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States Publisher Elsevier Inc. Abstract Background The optimal antithrombotic therapy for patients with chronic coronary syndrome (CCS) who also require long-term oral anticoagulation (OAC) remains uncertain. Objectives The aim of this study was to evaluate the safety and efficacy of OAC monotherapy compared with OAC plus single antiplatelet therapy (SAPT) in CCS patients with an indication for long-term anticoagulation. Methods Randomized trials comparing OAC monotherapy with OAC plus SAPT in patients with CCS and indication for long-term OAC from the PubMed, Cochrane Central, Web of Science, and Scopus databases up to November 10, 2025 were included in this systematic review and meta-analysis. HRs and 95% CIs were estimated through a random-effects meta-analytical framework. The primary efficacy endpoint was trial-defined major adverse cardiovascular events, and the primary safety endpoint was any bleeding. Results Six trials comprising 5,924 patients were included. The median follow-up duration was 2.3 years (Q1-Q3: 1.3-2.9 years), the median CHA<inf>2</inf>DS<inf>2</inf>-VASc score was 4.2 (Q1-Q3: 4.0-4.6), and the median time from revascularization to randomization 3.8 years (Q1-Q3: 3.2-4.4 years). Compared with OAC plus SAPT, OAC monotherapy showed similar rates of major adverse cardiovascular events (6.8% vs 8.2%; HR: 0.85; 95% CI: 0.64-1.09; I 2 =23%) and reduced risk of bleeding (8.9% vs 16.1%; HR: 0.49; 95% CI: 0.44-0.55; I 2 =8%). OAC monotherapy also reduced cardiovascular death (HR: 0.69; 95% CI: 0.48-0.97; I 2 =0%), net adverse clinical events (HR: 0.60; 95% CI: 0.47-0.78; I 2 =66%), and major bleeding (HR: 0.46; 95% CI: 0.32-0.66; I 2 =47%) compared with OAC plus SAPT. There were no significant differences in myocardial infarction, stroke, or all-cause mortality. Conclusions In patients with CCS requiring long-term OAC, OAC monotherapy was associated with reduced bleeding, cardiovascular death, and net adverse clinical events compared with OAC plus SAPT. (Anticoagulation Alone vs Anticoagulation Plus Antiplatelet Therapy in Atrial Fibrillation With Stable Coronary Disease: A Meta-Analysis of Randomized Trials; CRD420251174643 ). Copyright © 2026 The Authors. <56> Accession Number 2046476007 Title Beta-Blockers After Myocardial Infarction With Preserved and Mildly Reduced Ejection Fraction: A Meta-Analysis With Trial Sequential Analysis. Source European Journal of Clinical Investigation. 56(6) (no pagination), 2026. Article Number: e70238. Date of Publication: 01 Jun 2026. Author Maremmani M.; Gianfico P.; Templin C.; Montecucco F.; Liberale L.; Kraler S.; Schweiger V.; Berti S.; Emdin M.; Di Vece D. Institution (Maremmani) Department of Cardiology, Sant'Andrea Hospital, La Spezia, Italy (Gianfico) Department of Cardiology, Vita-Salute San Raffaele University, Milan, Italy (Templin, Di Vece) Department of Internal Medicine B, University of Medicine Greifswald, Greifswald, Germany (Templin, Kraler) Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland (Montecucco, Liberale, Di Vece) Department of Internal Medicine, University of Genoa, Genoa, Italy (Montecucco, Liberale) IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy (Schweiger) Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Berlin, Germany (Berti, Emdin) Fondazione Toscana Gabriele Monasterio, Pisa, Italy (Emdin) Health Science Interdisciplinary Center, Scuola Superiore Sant'anna, Pisa, Italy Publisher John Wiley and Sons Inc Abstract Aims: We aimed to evaluate the efficacy of beta-blockers after myocardial infarction (MI) across left ventricular ejection fraction (LVEF) strata and to assess the conclusiveness of the available evidence using trial sequential analysis (TSA). Method(s): PubMed, Embase and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) evaluating beta-blockers in post-MI patients with LVEF >= 40%. A time-to-event meta-analysis was performed for the primary composite (as defined by each trial) and for individual endpoints. The Mantel-Haenszel method was used to pool risk ratios (RR) for major adverse cardiovascular events (MACE; death, MI or heart failure), including LVEF-stratified analyses. TSA estimated the required information size (RIS) and generated adjusted significance and futility boundaries, assuming a 5% type I error and 90% power. Result(s): Across 19,826 post-MI patients (17,941 with LVEF >= 50% and 1885 with LVEF 40%-49%), beta-blockers did not reduce time to the primary endpoint (HR 0.92, 95% CI 0.85-1.01; p = 0.08; I2 = 35%) or mortality. In patients with preserved LVEF (>= 50%), beta-blocker therapy did not reduce the risk of death or MACE (RR 0.96, 95% CI 0.87-1.05; I2 = 42%), with TSA confirming futility. Among those with mildly reduced LVEF (40%-49%), beta-blockers reduced MACE (RR 0.74, 95% CI 0.58-0.94; I2 = 0%), although TSA failed to establish conclusiveness (RIS of 5717 [14.4%]). A significant interaction by LVEF subgroup was observed for cardiac death (p = 0.03). Conclusion(s): beta-blockers conferred no benefit in post-MI patients with preserved LVEF, with conclusive evidence of futility, whereas therapy was associated with reduced MACE in those with mildly reduced LVEF, pending confirmation in further adequately powered randomized trials. Copyright © 2026 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd. <57> Accession Number 2046299434 Title beta-Blockers after myocardial infarction with preserved or mildly reduced left ventricular ejection fraction: Fragility of contemporary evidence. Source American Heart Journal Plus: Cardiology Research and Practice. 67 (no pagination), 2026. Article Number: 100810. Date of Publication: 01 Jul 2026. Author Zuin M.; Chopard R.; Drachman D.E.; Rigatelli G.; De Luca L.; Temporelli P.L.; De Caterina R.; Piazza G. Institution (Zuin) Department of Translational Medicine, University of Ferrara, Ferrara, Italy (Zuin) Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy (Zuin, Rigatelli) Department of Cardiology, Madre Teresa Di Calcutta Hospital, AULSS 6, Ospedali Riuniti Padova Sud, Monselice, Italy (Chopard) Department of Cardiology, Centre Hospitalier Universitaire de Besancon, Besancon, France (Chopard) SINERGIES Laboratory, University Marie and Louis Pasteur, Besancon, France (Chopard) F-CRIN, INNOVTE Network, Saint-Etienne, France (Drachman) Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States (De Luca) Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Temporelli) Exercise and Cardiorespiratory Signals Laboratory, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Italy (De Caterina) Cardiology Division, Pisa University Hospital, University of Pisa, Pisa, Italy (Piazza) Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States (Piazza) Thrombosis Research Group, Brigham and Women's Hospital Harvard Medical School, Boston, MA, United States Publisher Elsevier Inc. Abstract Background: beta-Blockers have been traditionally prescribed after acute myocardial infarction (MI), but contemporary evidence in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF >=40%) have not provided consistent results. We assessed the robustness of the evidence for the efficacy of beta-blocker therapy in this population using contemporary randomized controlled trials (RCTs) and pooled analyses. Method(s): We systematically searched PubMed, Scopus, and Embase through August 1, 2025, for phase 3-4 RCTs evaluating beta-blockers in patients with LVEF >=40% during index MI hospitalization. Primary outcomes included robustness of each trial's primary endpoint; secondary outcomes included all-cause and cardiovascular mortality, recurrent MI, heart failure hospitalization, and unplanned revascularization. Fragility index (FI) and fragility quotient (FQ) were calculated. Data were pooled using random-effects meta-analysis. Result(s): Four trials (REDUCE-AMI, CAPITAL-RCT, BETAMI-DANBLOCK, REBOOT) with 19,245 patients were included. Event rates were low across the various outcomes with limited robustness: FI and FQ values indicated high sensitivity to small changes in events. BETAMI-DANBLOCK suggested modest benefit for recurrent MI, while REDUCE-AMI and REBOOT showed no significant effect. Pooled analysis revealed a 9% relative risk reduction and 0.9% absolute risk reduction for the composite of death, recurrent MI, or heart failure hospitalization (number needed to treat = 111; FI = 5). Conclusion(s): In patients with MI and LVEF >=40%, beta-blocker therapy confers only modest absolute benefits, with trial results that are fragile. Routine use in this population may not provide consistent or clinically meaningful benefit, underscoring the need for individualized therapy. Copyright © 2026 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <58> Accession Number 2046716260 Title Negative Pressure Wound Therapy for Prevention and Treatment of Poststernotomy Complications in Adult Cardiac Surgery: A Systematic Review With Quantitative Synthesis. Source American Journal of Cardiology. 272 (pp 160-166), 2026. Date of Publication: 01 Aug 2026. Author Pollanen S.; Lee A.D.; McGuinty J.; Jeong S.; Chronis N.; Mukovozov I. Institution (Pollanen, Lee, McGuinty, Jeong, Chronis) Faculty of Medicine, University of Toronto Temerty, Toronto, ON, Canada (Mukovozov) Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada (Mukovozov) Toronto Dermatology Centre, Toronto, ON, Canada (Mukovozov) Division of Dermatology, Women's College Hospital, Toronto, ON, Canada Publisher Elsevier Inc. Abstract Sternal wound complications following cardiac surgery increase reoperation risk, prolong hospitalization, and complicate postoperative cardiovascular recovery, yet optimal prevention strategies remain poorly defined. We performed a systematic review with quantitative synthesis of 31 studies enrolling 6,420 adult cardiac surgery patients to evaluate the usefulness of negative pressure wound therapy (NPWT) compared with conventional dressings for preventing and managing poststernotomy wound complications. The pre-specified primary analysis focused on prophylactic NPWT applied over closed sternotomy incisions, since open and closed-incision applications represent fundamentally distinct populations with non-comparable outcomes. Within this primary analysis, prophylactic foam-based closed-incision NPWT (ciNPT) in high-risk sternotomy patients showed the most consistent reduction in surgical site infection, with relative risk estimates of 0.25 to 0.94 across 7 studies enrolling 2,178 patients. Evidence for therapeutic NPWT in established sternal wound infections was directionally favorable but derived exclusively from observational studies. Interstudy heterogeneity precluded robust aggregate pooled conclusions. In conclusion, prophylactic ciNPT may be reasonable to consider in selected high-risk patients pending randomized trial confirmation. Crown Copyright © 2026 Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <59> Accession Number 2046695400 Title Achieving completed revascularization via inferior mini-sternotomy versus conventional median sternotomy for CABG in patients with multivessel CAD (the ACRIS-MICABG trial): Rationale and design of a multicentre, randomized controlled trial. Source Contemporary Clinical Trials. 167 (no pagination), 2026. Article Number: 108362. Date of Publication: 01 Aug 2026. Author Ju F.; Li B.; Wu H.; Sun H. Institution (Ju, Li, Wu, Sun) Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China Publisher Elsevier Inc. Abstract Introduction: A critical barrier to advancing minimally invasive coronary artery bypass grafting (CABG) lies in achieving complete revascularization (CR) in multivessel disease (MVD) patients. Contrasting with other minimally invasive approaches, inferior mini-sternotomy (IMS) offers distinct advantages in addressing complex multivessel disease and concomitant cardiac pathologies, which is similar to conventional median sternotomy (CMS) approach. The primary aim of this trial is to test the hypothesis that the CR rates of IMS-CABG could approximate that of CMS-CABG in MVD patients. Methods and analysis: This study is a prospective, multicenter, open-label, randomized controlled, blinded endpoint, non-inferiority trial conducted across four sites in China. 260 patients aged 18-80 are randomly assigned to either the intervention or control arm. All operations are performed through IMS in the intervention arm and CMS in the control arm. The primary outcome is postoperative complete revascularization assessed by postoperative coronary computed tomography angiography (CCTA). Patient enrollment began at the first hospital in May 2023 and is expected to be completed by August 2025. Ethics and dissemination: The Ethics Committee at Fuwai Hospital has approved this study. Expedited ethical approval was obtained for the other three subsidiary centers after that.Trial Registration Information.ClinicalTrials.gov (NCT05835167). Copyright © 2026 Published by Elsevier Inc. <60> Accession Number 2045578059 Title Patient Blood Management: a systematic review of current international guidelines. Source British Journal of Anaesthesia. 137(1) (pp 74-88), 2026. Date of Publication: 01 Jul 2026. Author Dreher D.; Honnef G.; Zoidl P.; Auinger D.; Heuschneider L.; Zajic P.; Rief M.; Bornemann-Cimenti H. Institution (Dreher) Medical University Graz, Graz, Austria (Honnef, Zoidl, Auinger, Heuschneider, Zajic, Rief, Bornemann-Cimenti) Department of Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria Publisher Elsevier Ltd Abstract Background: Patient Blood Management (PBM) is a multidisciplinary strategy to optimise patient outcomes by preserving autologous blood and reducing unnecessary transfusion. Although PBM initiatives exist worldwide, the consistency of national guideline recommendations remains unclear. This review compared international PBM programmes and explored reasons for variation. Method(s): A systematic review was conducted in accordance with PRISMA guidelines. In March 2024, Medline, Cochrane Library, and Google Scholar were searched for publications from the past 20 years, supplemented by governmental and institutional sources. Guidelines were assessed using the International Centre for Allied Health Evidence checklist. Laws, nationally implemented guidelines, or documents with ministerial involvement were included for a comparative text analysis if they addressed defined PBM elements, were freely accessible, and met quality criteria. The review was registered on PROSPERO and completed in 2025. Result(s): Forty national and institutional guidelines were analysed. The greatest variability concerned strategies to reduce diagnostic blood loss. In contrast, most other PBM domains showed substantial agreement, particularly regarding restrictive transfusion strategies, most defined by a haemoglobin threshold of 7 g dl-1 (22 guidelines) or lower (nine guidelines). National standardisation was frequently absent, even in countries with advanced hospital-level PBM programmes. Guidance for acute care and intensive care was usually issued by specialty societies rather than national authorities; prehospital recommendations were scarce. Conclusion(s): National guidelines on Patient Blood Management remain fragmented, as comprehensive policy frameworks and multidisciplinary coordination are lacking. Greater harmonisation and structured change management are required to support wider global adoption of PBM. Systematic review protocol: CRD420251032664 (PROSPERO). Copyright © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <61> Accession Number 2046520452 Title A Systematic Review of Modeling Platforms for Atrioventricular Valves in Atrioventricular Septal Defects. Source Journal of Cardiovascular Translational Research. 19(1) (no pagination), 2026. Article Number: 73. Date of Publication: 01 Dec 2026. Author Wang C.C.; Marx M.; Barth E.; D'Amore A.; Luo H.; Coyan G. Institution (Wang, Marx, Coyan) Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, United States (Barth, Luo) Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, United States (D'Amore) Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States (D'Amore) Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Coyan) Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, United States (Coyan) Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, United States Publisher Springer Abstract Given the high rate of re-intervention in patients with atrioventricular septal defects (AVSD), there is a continuing need to accurately model the complex valve anatomy and surgical repair strategies. This systematic review examined the current scientific landscape for modeling platforms designed to study abnormal congenital heart valves that are used or could be used for AVSD investigation. Of 1,050 sources screened, 47 were included (14 in silico; 26 in vitro; 7 in vivo). In silico models studying valve pathologies have advanced in recent years, but few targeted AVSD valves. In vitro platforms allow comparisons of repair techniques, but have yet to be applied for AVSD valve repair. In vivo studies could offer physiologically accurate platforms, but face challenges such as replicating AVSD pathologies. Multidisciplinary approaches to creating high-fidelity, reproducible, physiologically accurate AVSD valve models can transform the understanding of AVSD valve properties and repair strategies. Copyright © The Author(s) 2026. <62> Accession Number 2043706590 Title Development of coronary artery disease in patients with initially normal coronary arteries in the SCOT-HEART trial. Source European Radiology. 36(7) (pp 5533-5542), 2026. Date of Publication: 01 Jul 2026. Author Avigdor L.; Williams S.E.; Guimaraes A.R.; Wood K.; Ramsay J.; Khaing P.H.; Sim K.; Roditi G.; Mills N.L.; Dweck M.R.; Newby D.E.; Williams M.C. Institution (Avigdor, Williams, Guimaraes, Wood, Ramsay, Khaing, Sim, Mills, Dweck, Newby, Williams) British Heart Foundation Centre of Research Excellence, The University of Edinburgh, Edinburgh, United Kingdom (Roditi, Dweck) University of Glasgow, Glasgow, United Kingdom Publisher Springer Science and Business Media Deutschland GmbH Abstract Objectives: Individuals with normal coronary arteries may develop coronary artery disease (CAD). Coronary computed tomography (CT) angiography (CCTA) offers a non-invasive method to assess the development of CAD. Material(s) and Method(s): In a post-hoc observational study of the Scottish Computed Tomography of the HEART (SCOT-HEART) trial, we identified patients with normal coronary arteries on initial CCTA who subsequently underwent clinically indicated CT. Images were visually assessed for the presence, severity, and type of CAD. Result(s): Normal coronary arteries on baseline CCTA were present in 524 patients (mean age 53 +/- 10 years, 38% male). After a median of 9.3 (Interquartile range, IQR: 9.3-10.8) years, 31 (6%) underwent repeat CCTA and 162 (31%) underwent chest CT. There were no differences in baseline clinical characteristics amongst those who did or did not have repeat CCTA, but those with subsequent chest CT were older and had higher cardiovascular risk scores. CAD was identified on 48% (n = 15) of CCTA and 25% (n = 41) of chest CT. Median time to CT scan on which CAD was identified was 8.1 (IQR: 6.9-9.7) years. There was no difference in all-cause mortality or combined CAD death or non-fatal myocardial infarction in patients who had CAD identified on subsequent CT. However, they were more likely to undergo invasive coronary angiography (adjusted hazard ratio [aHR] 4.94, 95% confidence interval [CI]: 1.95, 12.51; p < 0.001) and revascularization (aHR 19.99, 95% CI: 1.69, 237.1; p = 0.018), adjusted for age and sex. Conclusion(s): One third of patients with previously normal CCTA will develop CAD on clinically indicated CT imaging over a 10-year period. Key Points: Question In patients with normal coronary arteries on coronary computed tomography angiography (CCTA), the risk of developing CAD in the future is uncertain. Findings Among 524 patients with normal coronaries, CAD was identified on 48% of CCTA and 25% of chest CT during 10 years of follow-up. Clinical relevance A substantial proportion of patients with initially normal coronary arteries on CCTA later develop CAD, highlighting the need for clinicians to be alert for the development of new CAD in patients with initially normal coronary arteries. Copyright © The Author(s) 2026. <63> Accession Number 2045938905 Title Implementing a national acute rheumatic fever case-finding program and registry in Nepal: protocol for a multi-site implementation study. Source Frontiers in Cardiovascular Medicine. 13 (pp 1-9), 2026. Article Number: 1823957. Date of Publication: 2026. Author Klassen S.; Karki S.; Adler A.; Regmi P.R.; Sherpa K.; Shetty G.; Khadka P.; Shakya U.; Shakya S.; Gupta N.; Sridhar S.; Bukhman G.; Levine R.; Koirala B. Institution (Klassen, Adler, Gupta, Sridhar, Bukhman) Center for Integration Science, Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States (Karki, Shetty, Khadka, Shakya, Koirala) Kathmandu Institute of Child Health, Kathmandu, Nepal (Adler, Bukhman) Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States (Regmi) Nepal Heart Foundation, Kathmandu, Nepal (Sherpa) National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal (Shakya) Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal (Levine) Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA, United States Publisher Frontiers Media SA Abstract Background - Rheumatic heart disease (RHD) is a leading cause of preventable cardiovascular morbidity and mortality among children and young adults in low- and lower-middle-income countries. Acute rheumatic fever (ARF), the immunologic precursor to RHD, is frequently missed in endemic settings, resulting in delayed treatment and progressive valvular disease. Nepal bears a high burden of RHD but lacks a coordinated system for early ARF identification, standardized echocardiographic evaluation, and longitudinal follow-up. Methods - This protocol describes implementation of a standardized ARF case-finding program and integrated clinical and echocardiographic registry across 11 district and referral hospitals in Nepal. The program is delivered through the PRIMA Network in partnership with the Kathmandu Institute of Child Health (KIOCH), embedded within existing PEN-Plus chronic disease infrastructure at district-level facilities. Case-finding is integrated into routine care using the 2015 modified Jones criteria, standardized echocardiography protocols, centralized training, and REDCap registry-based follow-up. Implementation outcomes are evaluated using Proctor's taxonomy, focusing on acceptability, feasibility, and adoption of the program within routine care, rather than on clinical detection rates or RHD outcomes. Contextual determinants are examined using the Consolidated Framework for Implementation Research (CFIR). Care-process indicators including diagnostic patterns and follow-up completion are summarized descriptively over the first 12 months of program delivery. Discussion - This protocol describes a pragmatic approach to embedding ARF case-finding within routine district-level care in Nepal. Findings will inform future evaluations of program performance, scale-up, and sustainability, and may serve as a replicable model for strengthening ARF detection in other RHD-endemic low-resource settings. Copyright © 2026 Klassen, Karki, Adler, Regmi, Sherpa, Shetty, Khadka, Shakya, Shakya, Gupta, Sridhar, Bukhman, Levine and Koirala. <64> Accession Number 651180773 Title Immediate versus staged revascularization in acute coronary syndrome and multivessel disease: a meta-analysis and meta-regression of RCTs. Source Internal and emergency medicine. 21(4) (pp 1469-1480), 2026. Date of Publication: 01 Jun 2026. Author Bergmann F.; Jorda A.; Pecho T.; Stoiber L.; Gelbenegger G.; Pracher L.; Leutzendorff A.; Heitzinger G.; Siller-Matula J.M.; Schorgenhofer C.; Zeitlinger M.; Lang I.; Al Jalali V. Institution (Bergmann, Jorda, Pecho, Stoiber, Gelbenegger, Pracher, Leutzendorff, Schorgenhofer, Zeitlinger, Al Jalali) Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria (Heitzinger, Siller-Matula, Lang) Department of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria (Siller-Matula) Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland Abstract In patients presenting with acute coronary syndrome (ACS) and multivessel disease, it is unclear whether non-culprit lesions should be revascularized immediately or in a staged procedure. We performed a meta-analysis of randomized controlled trials that compared immediate versus staged revascularization strategies. Two authors independently screened records from the online databases PubMed, Embase, Web of Science, and the Cochrane Library to identify eligible trials up to November 2025. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included cardiovascular events at 1 year. Meta-regressions were performed to explore the influence of study-level characteristics. This study was registered in PROSPERO (CRD42023446181). Ten trials with a total of 5651 patients were included in the final analysis. All-cause death at 1 year occurred in 109 (3.9%) of 2809 patients in the immediate revascularization group and 100 (3.5%) of 2842 patients in the staged revascularization group (risk ratio, 1.10; 95% CI 0.79-1.52). Cardiovascular death at 1 year occurred in 76 (2.8%) of 2749 patients in the immediate revascularization group and 66 (2.4%) of 2768 patients in the staged revascularization group. Meta-regression suggested that higher mean patient age was significantly associated with a lower risk ratio favoring the immediate revascularization group (regression coefficient -0.10; 95% CI -0.16 to -0.002; p = 0.047). All-cause mortality and cardiovascular deaths were similar in patients with ACS, predominantly with STEMI, and multivessel coronary disease undergoing immediate or staged revascularization. The available effect estimates do not exclude the possibility of clinically meaningful benefit or harm from immediate revascularization. Copyright © 2026. The Author(s). <65> Accession Number 2046160066 Title The Effects of Pemafibrate on Fibrinogen and Thrombogenicity in Patients with Coronary Artery Disease. Source Journal of Atherosclerosis and Thrombosis. 33(6) (pp 759-774), 2026. Date of Publication: 2026. Author Ishii M.; Fujisue K.; Kaikita K.; Yamanaga K.; Hanatani S.; Matsuzawa Y.; Miura M.; Kudo T.; Shimomura H.; Takae M.; Shirahama Y.; Yamamoto N.; Ito T.; Tsunoda R.; Horio E.; Sakamoto T.; Rokutanda T.; Morihisa K.; Noda K.; Tanaka H.; Matsuura Y.; Yamamoto E.; Izumiya Y.; Tsujita K. Institution (Ishii, Fujisue, Hanatani, Matsuzawa, Shirahama, Yamamoto, Izumiya, Tsujita) Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (Ishii) Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (Kaikita, Tanaka, Matsuura) Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan (Yamanaga, Rokutanda, Morihisa, Noda) Department of Cardiovascular Medicine, Kumamoto Central Hospital, Kumamoto, Japan (Miura, Kudo, Shimomura) Department of Cardiovascular Medicine, Fukuoka Tokushukai Medical Center, Fukuoka, Japan (Takae, Yamamoto) Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan (Ito, Tsunoda) Department of Cardiovascular Medicine, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan (Horio, Sakamoto) Department of Cardiovascular Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan Publisher Japan Atherosclerosis Society Abstract Aims: Pemafibrate effectively reduces the triglyceride levels in patients with coronary artery disease (CAD). However, its effect on the fibrinogen levels in these patients remains unclear. This study aimed to investigate the effects of pemafibrate on thrombogenicity and the plasma fibrinogen levels in patients complicated by hypertriglyceridemia. Method(s): This multicenter, randomized, controlled trial enrolled 101 patients with hypertriglyceridemia (fasting triglycerides >= 150 mg/dL) and CAD who received antiplatelet monotherapy and statin therapy. After exclusion, 98 participants were randomly assigned to receive either pemafibrate 0.1 mg twice daily (intervention group) or standard care without any additional lipid-lowering therapy (control group), and 96 patients were analyzed. The fibrinogen levels were assessed at the baseline and after 12 weeks of treatment. The primary endpoint was the change in the fibrinogen level from baseline to week 12. The secondary endpoints included thrombogenicity measured using the Total Thrombus-formation Analysis System (T-TAS). Result(s): Among the 96 patients, the median baseline fasting triglyceride, HDL cholesterol, LDL cholesterol, and fibrinogen levels were 175 mg/dL, 45 mg/dL, 72 mg/dL, and 299 mg/dL, respectively. The median decrease in triglycerides from baseline to 12 weeks was greater in the pemafibrate group than in the control group (-62 mg/dL vs. -5 mg/dL, p0.001), as was the median decrease in fibrinogen (-58 mg/dL vs. 9 mg/dL, p0.001). Conclusion(s): Pemafibrate significantly reduced fibrinogen levels in patients with CAD and hypertriglyceridemia, thus highlighting its primary benefit in lowering thrombotic risk. Copyright PEMA-TAS Investigators. <66> Accession Number 2046780537 Title Individualised positive end-expiratory pressure to minimise driving pressure and postoperative pulmonary complications in minimally invasive thoracic and abdominal surgery a systematic review and meta-analysis. Source British Journal of Anaesthesia. 137(1) (pp 231-243), 2026. Date of Publication: 01 Jul 2026. Author Abbott M.; Ma R.; Chakera H.; Kishibe T.; Girard M.; Turgeon A.F.; Serpa Neto A.; Sklar M.C.; Sankar A. Institution (Abbott) Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada (Abbott, Sklar, Sankar) Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada (Ma) Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada (Chakera) Schulich School of Medicine and Dentistry, Western University, London, ON, Canada (Kishibe) Library Services, St. Michael's Hospital, Toronto, ON, Canada (Girard) Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada (Girard) Division of Critical Care Medicine, Department of Medicine, Centre Hospitalier de l'Universite de Montreal, Montreal, QC, Canada (Girard) Imaging and engineering, CHUM Research Center, Montreal, QC, Canada (Turgeon) Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Faculty of Medicine, Universite Laval, Quebec City, QC, Canada (Turgeon) CHU de Quebec - Universite Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Universite Laval, Quebec City, QC, Canada (Serpa Neto) Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia (Serpa Neto) Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia (Serpa Neto) Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, Melbourne, VIC, Australia (Serpa Neto) Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil (Sklar) Interdepartmental Division of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada (Sklar, Sankar) Department of Anesthesia, Unity Health Toronto - St. Michael's Hospital and Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada Publisher Elsevier Ltd Abstract Background: Mechanical ventilation during minimally invasive surgery is associated with postoperative pulmonary complications. Limiting driving pressure appears to reduce pulmonary complications with lung-protective ventilation strategies. Whether individualising PEEP minimises driving pressure to reduce pulmonary complications is unknown. In this systematic review, we assessed whether individualised PEEP strategies during minimally invasive surgery reduce postoperative pulmonary outcomes and driving pressures or both. Method(s): We searched Medline, Central, LILACS, Embase, and Scopus for studies comparing individualised PEEP to lung-protective ventilation in minimally invasive thoracic and abdominal surgery (PROSPERO CRD42023495377). The primary outcome was postoperative pulmonary complication. Random-effects models generated risk ratios (RRs) with 95% confidence intervals (95% CIs) for binary outcomes. We conducted prespecified subgroup analyses by surgery type and post hoc subgroup analyses by individualised PEEP strategy and patient factors. We compared driving pressure differences between individualised PEEP and lung-protective strategies. Statistical heterogeneity was assessed using the I2 index and the risk of bias with Cochrane (RoB2) and ROBINS-I. Result(s): Thirty studies were included (n=3295 participants). Individualised PEEP was associated with reduced risk of postoperative pulmonary complications, compared with lung-protective ventilation (RR=0.67, 95% CI=0.56-0.79, I2=0.4%). This association was consistent in abdominal and thoracic surgery, and in subgroup analyses. Individualised PEEP was associated with lower driving pressures (mean difference= -3.17, 95% CI= -3.84 to -2.50); I2=86.6%). The certainty of evidence for PPCs was moderate, with a low risk of bias. Conclusion(s): Individualised PEEP was associated with fewer postoperative pulmonary complications and lower driving pressures during minimally invasive surgery; showing causality requires further research. Copyright © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <67> 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/ <68> 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. <69> Accession Number 2045922032 Title Transversus thoracis muscle plane plus rectus sheath block improve perioperative analgesia for cardiac surgery: a randomized double-blind controlled trial. Source European Journal of Medical Research. 31(1) (no pagination), 2026. Article Number: 810. Date of Publication: 01 Dec 2026. Author Luo J.; Zhou H.; Ou G.; Li W.; Lu C.; Zheng B. Institution (Luo, Zhou, Ou, Li, Lu, Zheng) Department of Anesthesiology, Guangzhou First People's Hospital, Guangzhou Medical University, 1 Panfu Road, Guangdong, Guangzhou, China Publisher BioMed Central Ltd Abstract Background: The transverse thoracic muscle plane block (TTPB) covers the thoracic intercostal nerves T2-T6, while the rectus sheath block (RSB) relieves the cutting pain from drainage tubes placed under the xiphoid. Bilateral TTPB combined with RSB may represent a new analgesic strategy for thoracotomy, though its clinical efficacy remains uncertain. Method(s): In a single-center, randomized, double-blind, controlled clinical trial, patients scheduled for coronary artery bypass grafting or heart valve surgery via median sternotomy were randomized to receive either 0.3% ropivacaine (n = 30) or 0.9% normal saline (n = 29) for TTPB (15 ml) and RSB (10 ml) on each side. The primary outcome was total sufentanil consumption during surgery. Other outcomes included the postoperative visual analogue scale (VAS) score, time to extubation, length of intensive care unit stay, and days of hospitalization. Result(s): Significant improvements were observed in the TTPB + RSB group compared to the control group. Intraoperative sufentanil consumption was significantly lower (25 [19.2-33.1] microg vs 55 [49.6-79.3] microg, p < 0.001). The TTPB + RSB group required fewer analgesic pump activations and less total pump volume. Patients in the TTPB + RSB group had a shorter time to extubation and a reduced length of ICU stay. VAS pain scores were also significantly lower at both 24 h and 48 h postoperatively. The groups did not differ significantly with respect to length of hospital stay or the incidence of adverse events. Conclusion(s): Bilateral TTPB + RSB blockade significantly reduces intraoperative sufentanil consumption, enhances postoperative pain relief, and accelerates recovery. Trial registration number NCT04838132. Copyright © The Author(s) 2026. <70> Accession Number 2046131626 Title Outcomes after tricuspid transcatheter edge-to-edge repair: a systematic review and meta-analysis. Source Annals of Cardiothoracic Surgery. 15(3) (no pagination), 2026. Article Number: 30. Date of Publication: 01 May 2026. Author Bombace S.; Fortuni F.; Zancanaro E.; De Luca V.M.; Schlotter F.; Rommel K.-P.; Di Mauro M.; Squeri A.; Carluccio E.; Condorelli G.; Sannino A.; Kresoja K.-P.; Lurz P. Institution (Bombace, Schlotter, Rommel, Kresoja, Lurz) Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany (Bombace, Condorelli) Department of Biomedical Sciences, Humanitas University, Milan, Italy (Fortuni, Carluccio) S. Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy (Zancanaro) Heart and Vascular Institute, Brigham and Women's Hospital, Mass General Brigham, Harvard Medical School, Boston, MA, United States (Zancanaro) Department of Cardiac Surgery, San Raffaele Hospital, Milan, Italy (De Luca, Squeri) Department of Cardiology, Cardiovascular Imaging Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (Di Mauro) Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy (Condorelli) Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (Sannino) Deutsches Herzzentrum der Charite, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany (Sannino) Friede Springer-Cardiovascular Prevention Center @Charite Universitatsmedizin Berlin, Berlin, Germany (Sannino) Baylor Scott & White Research Institute Cardiac Imaging Core Laboratory, Plano, TX, United States Publisher AME Publishing Company Abstract Background: Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) improves TR severity and symptoms, yet survival benefit remains uncertain. This meta-analysis aims to evaluate 1-year outcomes after T-TEER and explore clinical and echocardiographic correlates of prognosis. Method(s): A systematic search of PubMed/MEDLINE, Web of Science, and Scopus was conducted through June 2025. Studies enrolling >=100 patients undergoing T-TEER and reporting 1-year outcomes were included. Primary endpoints were 1-year all-cause mortality, heart failure (HF) hospitalization, and persistence of New York Heart Association (NYHA) class III-IV. Early residual TR (>=3+), assessed at the earliest post-procedural time point within 30 days, was a secondary endpoint. Result(s): Ten studies, including 4,134 patients, were analyzed. At 1-year, pooled all-cause mortality was 14.0% [95% confidence interval (CI): 9.6-18.5%], HF hospitalization 16.9% (95% CI: 8.7-25.1%), and 30.9% of patients remained in NYHA class III-IV (95% CI: 22.1-39.7%). Early residual TR >=3+ occurred in 19.1%. In meta-regression analysis, more contemporary recruitment periods were associated with lower 1-year mortality, whereas single-center design was associated with higher early residual TR >=3+. Exploratory aggregate-level analyses suggested potential associations between comorbidity burden and mortality, right-sided dysfunction and HF hospitalization, and left-sided disease and persistent functional limitation. Conclusion(s): T-TEER effectively reduces TR and improves functional status; however, 1-year mortality and HF hospitalization remain substantial. More contemporary recruitment periods were associated with lower 1-year all-cause mortality, suggesting improved outcomes over time. Systemic comorbidity burden, right-sided disease, and concomitant left-sided disease may contribute to residual risk after T-TEER; however, these associations should be considered hypothesis-generating and require validation in individual patient-level datasets. Copyright © AME Publishing Company. <71> Accession Number 2045061169 Title Timing of antihypertensive medication (bedtime versus morning) and cardiovascular risk: an updated systematic review and meta-analysis. Source Frontiers in Pharmacology. 17 (pp 1-12), 2026. Article Number: 1758890. Date of Publication: 01 Jan 2026. Author Wang T.; Lai S.; Wang D.; Wang X. Institution (Wang, Wang, Wang) Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China (Lai) Geriatrics Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China (Wang, Wang) Institute of Cardiovascular Diseases, Beijing University of Chinese Medicine, Beijing, China Publisher Frontiers Media SA Abstract Introduction - Previous studies on the optimal timing for antihypertensive medication administration have yielded inconsistent results. While earlier meta-analyses indicated that bedtime dosing significantly reduces myocardial infarction (MI) risk, more recent research has presented conflicting evidence. Therefore, we aimed to evaluate the impact of bedtime versus morning dosing of antihypertensive drugs on cardiovascular outcomes. Methods - We conducted a systematic search across PubMed, EMBASE, and Web of Science databases, covering studies published from inception to 16 July 2025, to identify relevant randomized controlled trials. We calculated risk ratios (RRs) for dichotomous outcomes along with the corresponding 95% confidence intervals (CIs). The study protocol was registered in PROSPERO (ID: CRD420251102968). Results - In total, 8 studies involving 64, 235 patients were included in our analysis. Compared with morning dosing, bedtime dosing exhibited no significant differences in all-cause mortality (RR: 0.78; 95% CI: 0.59-1.04; P = 0.09), major adverse cardiovascular events (RR: 0.80; 95% CI: 0.61-1.05; P = 0.10) or cardiovascular death (RR: 0.59; 95% CI: 0.34-1.04; P = 0.07). However, bedtime dosing significantly decreased heart failure risk (RR: 0.67; 95% CI: 0.46-0.96; P = 0.03), lowered clinical systolic blood pressure (mean difference: -3.27 mmHg; 95% CI: -4.13 to -2.41; P < 0.00001), and improved non-dipper conversion (RR: 0.61; 95% CI: 0.47-0.77; P < 0.0001). Non-significant trends favoring bedtime dosing were noted for MI and coronary revascularization. Conclusion - For critical outcomes, including MACE, all-cause mortality and cardiovascular death, no statistically significant benefits associated with bedtime dosing were observed. The overall findings are inconsistent, and the observed advantages for endpoints such as heart failure are closely linked to a single research group, necessitating cautious interpretation. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420251102968, identifier CRD420251102968. Copyright © 2026 Wang, Lai, Wang and Wang. <72> [Use Link to view the full text] Accession Number 2044543721 Title MR-proADM Predicts Mortality and Heart Failure Events in ATTR Cardiac Amyloidosis. Source Circulation. 153(18) (pp 1350-1361), 2026. Date of Publication: 05 May 2026. Author Peiro-Aventin B.; Revuelta-Lopez E.; Brandao M.; Nunez J.; Fernandez-Rojo M.A.; Carmona R.M.; Montejo B.; Ferrando-Munoz A.; Martin-Garcia A.; Gonzalez-Lopez E.; Dominguez F.; Camblor A.; Ruiz-Cueto M.; Lupon J.; Teruya S.; Bampatsias D.; Jahan I.; Royuela A.; Masri A.; Maurer M.S.; Bayes-Genis A.; Garcia-Pavia P. Institution (Peiro-Aventin, Brandao, Gonzalez-Lopez, Dominguez, Garcia-Pavia) Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA; (B.P.-A., M.B., E.G.-L., F.D., P.G.-P.), Majadahonda, Spain (Peiro-Aventin, Fernandez-Rojo, Carmona, Dominguez, Garcia-Pavia) Centro Nacional de Investigaciones Cardiovasculares (CNIC), (B.P.-A., M.A.F.-R., R.M.C., F.D., P.G.-P.), Madrid, Spain (Revuelta-Lopez, Camblor, Ruiz-Cueto, Lupon, Bayes-Genis) Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Department of Medicine, Autonomous University of Barcelona, (E.R.-L., A.C., M.R.-C., J.L., A.B.-G.), Barcelona, Spain (Revuelta-Lopez, Nunez, Gonzalez-Lopez, Dominguez, Ruiz-Cueto, Lupon, Bayes-Genis, Garcia-Pavia) CIBERCV, Instituto de Salud Carlos III, (E.R.-L., J.N., E.G.-L., F.D., M.R.-C., J.L., A.B.-G., P.G.-P.), Madrid, Spain (Revuelta-Lopez, Montejo, Bayes-Genis) ICREC Research Program, Germans Trias i Pujol Research Institute (IGTP), Barcelona; (E.R.-L., B.M., A.B.-G.), Badalona, Spain (Nunez) Cardiology Department, Hospital Clinico Universitario de Valencia, Universitat de Valencia, INCLIVA; (J.N.), Valencia, Spain (Fernandez-Rojo) The University of Queensland, Frazer Institute, (M.A.F.-R.), Brisbane, Australia (Ferrando-Munoz, Martin-Garcia) Department of Biochemistry, Hospital Universitario Puerta de Hierro Majadahonda, (A.F.-M., A.M.-G., A.J.-M.), Majadahonda, Spain (Teruya, Bampatsias, Maurer) Clinical Cardiovascular Research Laboratory for the Elderly (CCRLE), New York-Presbyterian/Columbia University Irving Medical Center, (S.T., D.B., M.S.M.), New York, NY, United States (Jahan, Masri) Cardiovascular Institute, Oregon Health and Science University, (I.J., A.M.), Portland, OR, United States (Royuela) Clinical Biostatistics, Puerta de Hierro Biomedical Research Institute (IDIPHISA), CIBERESP; (A.R.), Madrid, Spain (Garcia-Pavia) Universidad Francisco de Vitoria (UFV), (P.G.-P.), Pozuelo de Alarcon, Spain Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - With the increasing diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) at earlier stages and new therapies, there is a rising demand for tools to stratify risk and prognosis. We evaluated the prognostic value of multiple circulating biomarkers for predicting outcomes in ATTR-CM. METHOD(S): - We evaluated 12 different circulating biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP], high-sensitivity troponin I [hsTnI], mid-regional pro-adrenomedullin [MR-proADM], carbohydrate antigen 125 [CA125], soluble suppression of tumorigenicity 2 [sST2], cluster of differentiation antigen 146 [CD146], growth/differentiation factor-15 [GDF-15], alpha-klotho, fibroblast growth factor 23 [FGF-23], galectin-3, insulin-like growth factor-binding protein 7 [IGFBP-7], and estimated glomerular filtration rate [eGFR]) in 337 ATTR-CM patients from Spain. Cox models were employed to determine their predictive abilities. Findings were validated in 2 independent external cohorts of 210 patients from the United States and 416 patients from the ATTR-ACT trial, respectively. RESULT(S): - Over a median follow-up of 19.7 months (IQR, 6.5-42.3), 67 patients (19.9%) died/underwent heart transplantation, and 81 (24%) had heart failure events. MR-proADM was the biomarker with the strongest prognostic performance, with a C-index of 0.788 (95% CI, 0.723-0.851) for all-cause mortality and 0.721 (95% CI, 0.669-0.772) for the composite end point of death and heart failure events. MR-proADM was associated with multiple parameters of ATTR-CM severity and was independently associated with mortality, heart failure events, and the composite end point. MR-proADM >=1.1 nmol/L was identified as the optimal prognostic threshold, and it improved prediction of mortality when added to the National Amyloid Center (area under the curve [AUC], 0.682 versus 0.737; P<0.001), Mayo (AUC, 0.659 versus 0.749; P<0.001), and the Columbia staging systems (AUC, 0.699 versus 0.768; P<0.001). In both validation cohorts, patients with MR-proADM >=1.1 nmol/L had worse outcomes (P<0.001). This association was also confirmed in patients receiving tafamidis. CONCLUSION(S): - In patients with ATTR-CM, MR-proADM levels are associated with disease severity and worse prognosis. MR-proADM improves prediction of all-cause mortality and captures heart failure events. Copyright © 2026 The Authors. <73> Accession Number 2045798301 Title A systematic review and meta-analysis of axillary intra-aortic balloon pump as a bridge to advanced heart failure therapy. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1790627. Date of Publication: 2026. Author Allaham H.; Kwiatkowski S.; Alswayed K.; Bennet S.; Cong O.; Magder L.; Ramani G.; Chahal D.; Srivastava M.; Aalaei-Andabili S.-H.; Soares C.; Gupta A. Institution (Allaham, Kwiatkowski, Ramani, Chahal, Srivastava, Aalaei-Andabili, Soares, Gupta) Division of Cardiovascular Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD, United States (Alswayed, Bennet, Cong) Division of Internal Medicine, Department of Medicine, University of Maryland Medical Center, Baltimore, MD, United States (Magder) Department of Epidemiology & Public Health, University of Maryland Medical Center, Baltimore, MD, United States Publisher Frontiers Media SA Abstract Background - The axillary approach for intra-aortic balloon pump (IABP) placement offers an alternative to traditional transfemoral insertion, with the potential advantage of preserving mobility during temporary mechanical circulatory support. Methods - We performed a systematic review and meta-analysis of four retrospective studies evaluating outcomes in patients who received axillary IABP support. Results - Most patients supported with an axillary IABP were able to ambulate, with a pooled probability of 0.928 (95% CI: 0.811-0.999). The incidences of vascular complications (0.059; 95% CI: 0.001-0.137), stroke (0.022; 95% CI: 0.001-0.044), infection (0.037; 95% CI: 0.001-0.106), and bleeding (0.028; 95% CI: 0.005-0.052) were low. The most frequent adverse event was device failure (including kinking, rupture, migration, or malposition), with a pooled incidence of 0.314 (95% CI: 0.224-0.404). Conclusion - Axillary IABP support is a feasible bridge to advanced heart failure therapies, enabling ambulation in most patients and facilitating transition to definitive treatment. While the overall safety profile is favorable, the relatively high rate of device failure represents a key limitation of this approach. Copyright © 2026 Allaham, Kwiatkowski, Alswayed, Bennet, Cong, Magder, Ramani, Chahal, Srivastava, Aalaei-Andabili, Soares and Gupta. <74> Accession Number 2045186340 Title Multi-center Randomized Controlled Trial of Catheter-Directed Mechanical Thrombectomy Versus Systemic Thrombolysis in Patients with Acute Intermediate-to-High-Risk Pulmonary Embolism: Study Protocol. Source CardioVascular and Interventional Radiology. 49(6) (pp 1210-1218), 2026. Date of Publication: 01 Jun 2026. Author Wang C.; Fang P.; Zhou D.; Xu B.; Dai X.; Zhang Z.; Xie M.; Duan Z.; Zhang L.; Li Y.; Zhu Y.; Jiang Y.; Qie L.; Shi H.; Feng J.; Zhang W.; Jin X. Institution (Wang) Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Fang, Xu) Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (Zhou) Department of Pulmonary and Critical Care Medicine, Huashan Hospital Fudan University, Shanghai, China (Dai, Zhang, Xie, Duan, Shi) Department of Cardiology, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China (Zhang, Li, Zhu) Department of Cardiology, Third Affiliated Hospital of Naval Medical University, Shanghai, China (Jiang) Emergency Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China (Qie) Department of Geriatric Medicine and Laboratory of Gerontology and Anti-Aging Research, Qilu Hospital of Shandong University, Shandong, China (Feng) Vascular Surgery Department, Ruijin Hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China (Zhang) Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Henan, Zhengzhou, China (Jin) Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China Publisher Springer Abstract Purpose: This study aims to compare the efficacy and safety of catheter-directed mechanical thrombectomy using the Tendvia system versus systemic thrombolysis in patients with intermediate-to-high-risk acute pulmonary embolism. Material(s) and Method(s): This is a 1:1 block-randomized, controlled, open-label parallel-group, multi-center, superiority trial. Eligible patients aged 18-75 years, diagnosed with intermediate-to-high-risk acute pulmonary embolism and hemodynamic deterioration, will be included. The main exclusion criteria are unsuitable target vessel criteria; sustained systolic hypotension; severe pulmonary hypertension; hematocrit < 28%; chronic pulmonary hypertension; left bundle branch block; chronic left heart failure; renal dysfunction; coagulopathy; recent cardiothoracic surgery; intracardiac thrombus. The intervention group will undergo catheter-directed thrombectomy using the Tendvia system under fluoroscopic guidance within 4 h of computed tomography pulmonary angiography. The control group will receive standard alteplase infusion. The primary efficacy endpoint is absolute reduction in the right ventricular/left ventricular diameter ratio from baseline to 48 h post-intervention, measured by blinded core-lab computed tomography pulmonary angiography analysis. The primary safety endpoint is the rate of composite major adverse events within 48 h. Secondary endpoints include the proportion of patients achieving a >= 50% reduction from baseline in NT-proBNP level at 48 h post-intervention, dyspnea scores, change in pulmonary arterial pressure, 48-h post-procedure clinical deterioration, symptomatic recurrence within 30 days, major access site complications, device-related serious adverse events, length of post-procedure hospital and intensive care unit stay, and change in cardiac biomarkers. Expected Gain of Knowledge: This trial will provide evidence regarding the use of catheter-directed thrombectomy in intermediate-to-high-risk pulmonary embolism. Trial Registration: This study was registered in Clinicaltrials.gov on 2025-06-22 (Registration number NCT07032025) Copyright © Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2026. <75> Accession Number 2045458370 Title Natural history and outcomes of early aortic valve replacement versus conservative management in asymptomatic severe aortic stenosis: A meta-analysis. Source American Journal of Medicine. 139(8) (pp 1052-1064.e8), 2026. Date of Publication: 01 Aug 2026. Author Huang J.; Ellis J.; Wang D.; Joseph E.; Connolly J.; Hasan R.; Rahman F. Institution (Huang, Ellis, Wang, Joseph, Connolly, Hasan, Rahman) Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States Publisher Elsevier Inc. Abstract Background: For patients with asymptomatic severe aortic stenosis, optimal timing of aortic valve replacement remains unclear. We investigated the natural history of asymptomatic severe aortic stenosis and analyzed the impact of early aortic valve replacement versus conservative management using a meta-analysis. Method(s): PubMed, Embase, Cochrane, and Web Of Science were searched through June 24, 2025 for randomized controlled trials (RCTs) and observational studies comparing patients with asymptomatic severe aortic stenosis receiving early aortic valve replacement versus conservative management. A random-effects meta-analysis estimated risks of all-cause mortality, cardiovascular mortality, heart failure hospitalization, stroke, myocardial infarction, atrial fibrillation, and thromboembolic events. Result(s): Thirteen studies were included (4 RCTs, 9 observational studies; 3960 patients: 1868 early aortic valve replacement, 2092 conservative management). Seven of these studies (1620 patients) were aggregated to investigate the natural history of asymptomatic severe aortic stenosis. Over a mean follow-up of 5.6 years [5 studies]/median follow-up of 4.1 years [2 studies], 710 (44%) patients developed symptoms while 910 patients remained asymptomatic (319 undergoing aortic valve replacement, 591 managed conservatively). Of the 591 asymptomatic patients managed conservatively, 194 (33%) died. Across all 13 studies, aortic valve replacement was associated with lower all-cause mortality (RR 0.51 [95% CI 0.35-0.75], P < 0.001), cardiovascular mortality (RR 0.45 [0.37-0.67], P < 0.001), and heart failure hospitalization (RR 0.40 [0.20-0.82], P = 0.012). Conclusion(s): Approximately half of all patients with asymptomatic severe aortic stenosis developed symptoms within five years, and one-third of asymptomatic patients managed conservatively died. Aortic valve replacement was associated with lower all-cause mortality, cardiovascular mortality, and heart failure hospitalization, suggesting pre-symptom aortic valve replacement is reasonable in selected patients with asymptomatic severe aortic stenosis. Copyright © 2026 Elsevier Inc. <76> Accession Number 2046223061 Title Superficial parasternal intercostal plane block with ropivacaine versus placebo for opioid exposure after cardiac surgery (EPOCH CardioLink-10): a multicentre, double-blind, randomised trial. Source The Lancet Regional Health - Americas. 60 (no pagination), 2026. Article Number: 101508. Date of Publication: 01 Aug 2026. Author Alli A.; Mazer C.D.; Dennis F.; Teoh H.; Chin K.; Quan A.; Hassan S.M.A.; Szarek M.; Tran J.D.; Dhingra N.K.; Ghiringhelli J.P.; de Vasconcelos Papa F.; Lee Y.; Ricci M.J.; Verma R.; Derry K.L.; George T.; Krishnaraj A.; Hess D.A.; Rotstein O.D.; Cook R.C.; Hassan A.; Yau T.M.; Spence J.D.; Martinka P.M.; Sutherland K.; Gregory A.J.; Noss C.D.; de Jager P.; Dougherty J.L.; Arora R.C.; Verma S. Institution (Alli, Mazer, Chin, Tran, Ghiringhelli, de Vasconcelos Papa, Lee, Ricci, Derry, George) Department of Anesthesia, St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada (Alli, Mazer, Dennis, Teoh, Chin, Quan, Hassan, Krishnaraj, Hess, Rotstein, Verma) Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada (Alli, Mazer, Ghiringhelli, de Vasconcelos Papa, Lee, Ricci, Derry, George) Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada (Alli, Mazer, Hassan, Dhingra, Ghiringhelli, de Vasconcelos Papa, Lee, Ricci, Derry, George, Rotstein, Yau, Verma) Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada (Mazer, Tran) Department of Physiology, University of Toronto, Toronto, ON, Canada (Mazer, Dennis, Hassan, Hess, Verma) Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada (Dennis, Teoh, Quan, Hassan, Krishnaraj, Verma) Division of Cardiac Surgery, St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada (Teoh) Division of Endocrinology and Metabolism, St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada (Hassan, Dhingra, Rotstein, Yau, Verma) Department of Surgery, University of Toronto, Toronto, ON, Canada (Szarek) University of Colorado Anschutz Medical Campus and CPC Clinical Research, Aurora, CO, United States (Szarek) Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States (Szarek) State University of New York Downstate School of Public Health, Brooklyn, NY, United States (Dhingra, Yau) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (Verma) School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland (Hess) Robarts Research Institute, Schulich School of Medicine and Dentistry, London, ON, Canada (Rotstein) Division of General Surgery, St Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada (Cook) Division of Cardiac Surgery, Vancouver General Hospital, Vancouver, BC, Canada (Cook) Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada (Hassan) MaineHealth Maine Medical Center, Portland, ME, United States (Spence) Departments of Anesthesia, Critical Care, and Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, ON, Canada (Martinka) Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada (Martinka, Sutherland) Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, New Westminster, BC, Canada (Gregory, Noss) Department of Anesthesiology, Perioperative and Pain Medicine, & Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (de Jager, Dougherty) Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada (Arora) Departments of Surgery and Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States Publisher Elsevier Ltd Abstract Background: Cardiac surgery performed through a midline chest incision (median sternotomy) is associated with substantial postoperative pain and opioid use, the latter of which remains the dominant modality of analgesia. Contemporary international guidelines prioritise opioid-sparing, multimodal strategies; however, robust randomised evidence to support specific opioid-sparing analgesic approaches in cardiac surgery is lacking. Method(s): EPOCH CardioLink-10 was a pan-Canadian, multicentre, randomised, double-blind, placebo-controlled trial in adults undergoing cardiac surgery via median sternotomy. Participants were assigned to receive bilateral superficial parasternal intercostal plane (SPIP) blocks with either 0.2% ropivacaine or placebo (0.9% sodium chloride), delivered via indwelling catheters. Study interventions were delivered at a basal infusion rate (0.1-1 mL/h) after a 20 mL bolus post-insertion. Bolus dosing of 5 mL every 3-4 h was continued for 48 h. In the ropivacaine arm, this resulted in a maximum total ropivacaine dose of 592 mg over the infusion period. The primary outcome was cumulative opioid consumption over 72 h following catheter insertion, expressed in morphine milligram equivalents (MMEs). Secondary outcomes included subjective pain scores, cumulative use of opioid to discharge, rates of delirium, and participant-reported Quality of Recovery-15 score (ClinicalTrials.gov NCT06028126). Finding(s): Between Aug 16, 2023, and Dec 22, 2025, 650 patients were screened, and 318 included in the modified intention-to-treat population (164 in the ropivacaine group, 154 in the placebo group). Median age was 67 years (IQR 61-72), 72 (23%) participants were female, 178 (56%) were White, and 69 (22%) were South Asian. Over 72 h, ropivacaine reduced opioid consumption compared with placebo (least-squares mean difference -20.7 MMEs [95% CI -39.0 to -2.3]; p = 0.027). Pain scores and other secondary outcomes were similar between groups. There were no serious block-related complications and there was no pre-specified analysis of adverse events. Interpretation(s): The findings of this multicentre, randomised trial suggest that bilateral SPIP blockade with ropivacaine may be a pragmatic option to manage sternotomy pain with lower opioid consumption post-cardiac surgery. Funding(s): Grants from the Canadian Institutes of Health Research (CIHR) [Principal Applicant: C D Mazer], the Dr. Timothy & Mrs. Linda Tang Anesthesia Research Fund at the University of Calgary, Calgary, AB [A J Gregory and C D Noss], and the CardioLink Research Trial Platform at St. Michael's Hospital, Toronto, ON. In-kind support from the Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS [P de Jager and J L Dougherty]. 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/ <77> Accession Number 2045919925 Title Comparison of Ultrasound-Guided Erector Spinae Plane Block, Thoracic Paravertebral Block, and Control for Postoperative Recovery in Video-Assisted Thoracic Surgery Patients: A Randomized Controlled Trial. Source Journal of Pain Research. 19 (no pagination), 2026. Article Number: 572950. Date of Publication: 2026. Author You Y.; Zhang X.; Zheng X. Institution (You, Zhang) Department of Anesthesiology, Fuzhou University Affiliated Provincial Hospital, 134 Dong Jie, Gulou DistrictFujian Province, Fuzhou City, China (Zheng) Department of Otolaryngology, Fujian Medical University Union Hospital, Fuzhou, China (Zheng) Department of Anesthesiology, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China Publisher Dove Medical Press Ltd Abstract Background: The objective of this study was to examine the effect of ultrasound-guided Erector Spinae Plane Block (ESPB) and Thoracic Paravertebral Block (TPVB) on the quality of recovery (QoR) in video-assisted thoracic surgery (VATS). Method(s): A total of 129 patients were randomly assigned to three groups: ESPB group and TPVB group received ultrasound-guided nerve blocks, and Control group received multimodal analgesia protocol only. The primary outcome measure was QoR-15 scale at 24 hours postoperatively. Secondary outcome measures included visual analog scale (VAS) scores at rest and cough, intraoperative remifentanil dosage, number of postoperative patient-controlled intravenous (PCI) self-controlled compressions, and the incidence of adverse effects. Result(s): The QoR-15 scores at 24 hours postoperatively were significantly higher in ESPB and TPVB group as compared to Control group. The static (at rest) and dynamic (at cough) VAS scores within 7 h of surgery, intraoperative remifentanil dosage, and number of postoperative PCI self-controlled compressions were significantly lower in ESPB and TPVB groups as compared to Control group (all P<0.001). The occurrence of nausea, vomiting, and dizziness in ESPB and TPVB group was lower than that in Control group (P<0.05), whereas other adverse effects were not statistically different between the three groups. Conclusion(s): The ultrasound-guided ESPB may be a promising form of regional anesthesia to aid recovery after VATS surgery, which is similar to TPVB. Trial Registration: This study has been registered at the Chinese Clinical Trial Registry (ChiCTR2500105099). Copyright © 2026 You et al. <78> [Use Link to view the full text] Accession Number 2045887702 Title Vagus Nerve Stimulation in Cardiac Disease: A Systematic Review of Randomized Clinical Trials. Source Cardiology in Review. Publish Ahead of Print (no pagination), 2026. Article Number: 10.1097/CRD.0000000000001315. Date of Publication: 11 May 2026. Author Alrabadi B.; Bandak N.; Badwan A.; Abu-Irsheid L.; Refai Y.; Marouf M.; Alomari O. Institution (Alrabadi, Bandak, Abu-Irsheid, Refai, Marouf) Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Badwan) Faculty of Medicine, University of Jordan, Amman, Jordan (Alomari) Hamidiye International Faculty of Medicine, University of Health Sciences, Uskudar, Istanbul, Turkey Publisher Lippincott Williams and Wilkins Abstract Cardiac arrhythmias remain a major cause of morbidity and mortality, and current therapies have notable limitations. Vagus nerve stimulation (VNS), which modulates autonomic tone, has emerged as a potential adjunctive treatment. This systematic review evaluated the efficacy of invasive and noninvasive VNS in patients with atrial fibrillation, heart failure, myocardial infarction, and other rhythm disorders. A search of PubMed, Scopus, and Web of Science identified 21 randomized controlled trials, including 11, 368 patients. Overall, VNS was associated with reduced atrial fibrillation incidence and burden, improved autonomic function and left ventricular ejection fraction in heart failure, and reduced arrhythmic events and infarct biomarkers after myocardial infarction. Additional benefits were observed in conditions such as vagally mediated atrioventricular block and postural orthostatic tachycardia syndrome. Across studies, VNS demonstrated a favorable safety profile. These findings suggest that VNS may be a promising multimodal strategy for reducing arrhythmia burden and improving cardiac autonomic regulation, although larger confirmatory trials are needed. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <79> Accession Number 2046637037 Title Long-term risks of major adverse cardiovascular events after acute kidney injury: a systematic review and meta-analysis. Source Clinical Kidney Journal. 19(6) (no pagination), 2026. Article Number: sfag145. Date of Publication: 01 Jun 2026. Author Veltkamp D.M.J.; Zwank F.; Groenestege W.M.T.; Verhaar M.C.; vanSolinge W.W.; Haitjema S.; Vernooij R.W.M.; Janse R.J. Institution (Veltkamp, Verhaar, Vernooij, Janse) Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands (Veltkamp, Zwank, Groenestege, van Solinge, Haitjema, Vernooij, Janse) Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands (Vernooij) Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands Publisher Oxford University Press Abstract Background and aims: Acute kidney injury (AKI) is increasingly recognized as a long-term risk factor for chronic kidney disease and cardiovascular disease (CVD). However, it remains uncertain which patients with AKI are at greatest CVD risk. We performed a systematic review and meta-analysis to quantify CVD risks post-AKI and to determine whether these risks differ by AKI severity, duration, and clinical setting. Method(s): PubMed and Embase were systematically searched for studies comparing individuals with and without AKI and reporting major adverse cardiovascular events (MACE) or individual outcomes such as myocardial infarction (MI), stroke, heart failure (HF), or cardiovascular mortality. Follow-up was at least 1 year. Relative risks (RRs) were pooled in meta-analyses using random-effect models. Subgroup and metaregression analyses were used to explore heterogeneity across patient and AKI characteristics, and clinical settings. Result(s): We included 54 studies comprising 1261 090 individuals, of whom 290 648 experienced AKI. Meta-analyses showed that AKI was associated with an RR of 1.97 [95% confidence interval (CI) 1.67-2.27] for MACE (13.9% overall incidence), 1.64 [95% CI 1.38-1.89] for MI (3.5% overall incidence), 1.36 [95% CI 1.13-1.59] for stroke (1.7% overall incidence), 1.92 [95% CI 1.67-2.16] for HF (3.5% overall incidence), and 1.86 [95% CI 1.59-2.13] for cardiovascular mortality (9.4% overall incidence), compared to patients without AKI. Elevated risks were observed across all AKI stages and durations and in patients across all studied clinical settings, including noncardiac care. The highest RRs were shown for more severe AKI stages and longer AKI durations. Older age and lower baseline estimated glomerular filtration rate were associated with even higher risk of MACE compared to patients without AKI. Conclusion(s): AKI is followed by an increase in CVD risk, even after AKI with low severity. These findings highlight AKI as a clinically relevant CVD risk marker and support the need for targeted post-AKI care management to prevent future cardiovascular events. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the ERA. 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. <80> Accession Number 2040952184 Title Revisiting Heparin-Induced Thrombocytopenia among Patients Undergoing Free Tissue Transfer: A Systematic Review. Source Journal of Reconstructive Microsurgery. 42(6) (pp 473-481), 2026. Date of Publication: 01 Jul 2026. Author Yamin M.; Tobin M.; Raquepo T.; Park J.B.; Lee D.; Escobar-Domingo M.J.; Foppiani J.; Fanning J.E.; Zhu E.; Posso A.N.; Ma H.; Lin S.J.; Lee B.T.; Cauley R.P. Institution (Yamin, Tobin, Raquepo, Park, Lee, Escobar-Domingo, Foppiani, Fanning, Posso, Lin, Lee, Cauley) Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Zhu) Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, United States (Ma) Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts, United States Publisher Thieme Medical Publishers, Inc. Abstract Background Heparin is frequently used to mitigate the risk of thrombosis in microsurgical free tissue transfer. Although rare, heparin-induced thrombocytopenia (HIT) is a severe, life-threatening complication that can arise in patients exposed to heparin products. This systematic review aims to examine patterns in demographics, flap characteristics, diagnostic approaches, and treatment protocols for HIT following free flap reconstruction. Methods A systematic search was conducted across PubMed, MEDLINE, and Web of Science, following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Search terms included "heparin-induced thrombocytopenia," "HIT syndrome," "free flaps," "microsurgery," "plastic surgery," and "reconstructive surgery." Case reports or series written in English that presented patients developing HIT following free flap procedures were included. Eligibility criteria are accessible on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42025650125). Results A total of 15 articles were included, encompassing a total of 23 free flap reconstruction cases. The median patient age was 52 years, with male predominance (69.6). Lower extremity reconstruction was most common (47.8%), primarily using anterolateral thigh flaps (39.1%). Median 4T score was 6, median time to HIT diagnosis was 6 days, and median nadir platelet count was 72 x 103/muL. Thrombotic complications were common, with venous thrombosis (34.8%) predominating. Argatroban (26.1%) was the most frequently used alternative anticoagulant, while warfarin (30.4%) was the most common discharge medication. Overall flap survival was 43.5%. Meta-analysis revealed no significant difference in flap survival between anticoagulation strategies (95% CI: 0.38-2.63, p 1/4 1.000). Conclusion HIT represents a rare but devastating complication in free flap reconstruction, with approximately half of the affected flaps failing despite intervention. Although no single anticoagulation strategy demonstrated superior outcomes, expeditious diagnosis and treatment may improve flap salvage rates. This review provides a foundation for developing standardized protocols for HIT management in microsurgical patients. Copyright © 2025. Thieme. All rights reserved. <81> Accession Number 2044730617 Title Colchicine for the Prevention of Major Adverse Cardiovascular Events After Acute Coronary Syndromes: A Systematic Review and Meta-Analysis of Large, Long-Term, Placebo-Controlled Randomized Trials. Source Journal of Clinical Medicine. 15(7) (no pagination), 2026. Article Number: 2695. Date of Publication: 01 Apr 2026. Author Popescu R.M.; Dragoi Galrinho R.; Pareek M.; Karthikesan D.; Dumitrescu G.; Balanescu S.M.; Vinereanu D. Institution (Popescu, Dumitrescu, Balanescu) University of Medicine and Pharmacy "Carol Davila", Department of Cardiology, Elias Emergency University Hospital, Bucharest, Romania (Dragoi Galrinho) Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, Bucharest, Romania (Pareek) Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark (Karthikesan) Hospital Sultanah Bahiyah, Alor Setar, Malaysia (Vinereanu) University of Medicine and Pharmacy "Carol Davila", Department of Cardiology and Cardiovascular Surgery, University and Emergency Hospital, Bucharest, Romania Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Despite major advancements in the treatment of post-acute coronary syndrome (ACS), the prevalence of early and late major adverse cardiovascular events (MACEs) remains high. Inflammation, a key feature of atherosclerosis, plays an important role in the healing process following ACS. This suggests that anti-inflammatory agents might improve both atherosclerotic progression and cardiovascular outcomes. Colchicine has potent anti-inflammatory effects and may, therefore, be a suitable agent for mitigating this response. Method(s): We conducted a systematic search up to September 2025 across Embase, MEDLINE, the Cochrane databases, and the Clinical Trials.gov registry to assess whether colchicine administration after ACS reduces the risk of a MACE (a composite of cardiovascular death, ACS, stroke, and urgent revascularization). We selected placebo-controlled randomized trials enrolling more than 500 participants, in which colchicine was administered as a long-term intervention, defined as treatment and/or follow-up of at least 12 months, and in which MACEs were assessed as the primary endpoint. Result(s): We included three large, long-term, placebo-controlled randomized trials (n = 12,602 participants). Primary events occurred in 485 participants in the colchicine group and 551 in the control group, with a calculated odds ratio (OR) of 0.87 (95% CI 0.77-0.99, p = 0.03), with high heterogeneity between studies (I2 = 71%): p for heterogeneity = 0.03. Subgroup analysis of diabetic patients (OR 0.81, 95% CI 0.63-1.04), as well as of individual components of the primary outcome, showed non-significant effects: OR= 0.92 (95% CI 0.76-1.11, p = 0.38) for myocardial infarction, OR = 0.88 (95% CI 0.72-1.07, p = 0.15) for revascularization, OR = 1.09 (95% CI 0.86-1.38, p = 0.29) for cardiovascular death, and OR = 0.89 (95% CI 0.63-1.27, p = 0.47) for stroke. Conclusion(s): In this meta-analysis of large, long-term, placebo-controlled randomized trials, colchicine administration after ACS was associated with a modest reduction in MACEs. However, the proximity of the confidence interval to unity reflects a statistical equilibrium between opposing trial-level effects rather than a robust treatment signal. Further investigation is warranted, given the small number of existing large trials and their heterogeneity. Copyright © 2026 by the authors. <82> Accession Number 2046212992 Title Chlorhexidine gluconate vs povidone-iodine for surgical site infection prevention: a systematic review and meta-analysis stratified by surgery type, wound classification, antiseptic formulation, and country income, with meta-regression. Source Journal of Hospital Infection. 173 (pp 140-153), 2026. Date of Publication: 01 Jul 2026. Author Benhammou M.; Elraggal D.; Saleh S.; Nobuhara C.K.; van Ramshorst G.H.; Mimoz O.; Nounou M.V.; Shawesh Q.; Tuuli M.G.; Wexner S.D.; Catena F.; Forrester J.D.; Elhadi M. Institution (Benhammou) Faculty of Medicine, University of Oran 1, Ahmed Ben Bella, Oran, Algeria (Elraggal) Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt (Saleh) The Hashemite University, Zarqa, Jordan (Nobuhara, Forrester) Department of Surgery, Stanford University, Stanford, CA, United States (van Ramshorst) Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium (van Ramshorst) Department of Human Structure and Repair, Ghent University, Ghent, Belgium (Mimoz) CHU de Poitiers, Service des Urgences Adultes-SAS 86-Centre 15, Poitiers, France (Mimoz) INSERM, Pharmacologie des Agents Anti-Infectieux, Poitiers, France (Mimoz) Alliance for Vascular Access Teaching and Research, Griffith University, Nathan, QLD, Australia (Nounou) University of Nouakchott Al Aasrya, Faculty of Medicine, Nouakchott, Mauritania (Shawesh) Department of Internal Medicine, HCA Mountain View Hospital, Las Vegas, NV, United States (Tuuli) Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, RI, United States (Wexner) Division of Colorectal Surgery, MedStar Georgetown University Hospital, Washington, DC, United States (Catena) Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy (Catena) Department of General and Emergency Surgery Bufalini Hospital AUSL Romagna Cesena ITALY, Italy (Elhadi) College of Medicine, Korea University, Seoul, South Korea Publisher W.B. Saunders Ltd Abstract Background: The comparative effectiveness of chlorhexidine gluconate (CHG) vs povidone-iodine (PVI) for preventing surgical site infections (SSIs) remains unclear across surgical types and resource settings. This study compared CHG and PVI overall and within key clinical subgroups. Method(s): Five databases were searched through February 2025 for randomized controlled trials comparing CHG with PVI and reporting SSI outcomes. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals (CIs). Result(s): Twenty-nine randomized clinical trials involving 35,317 patients were included. CHG significantly reduced superficial incisional SSIs (OR = 0.80; 95% CI: 0.67-0.95; P = 0.01; I2 = 18.4%), but not overall, deep, or organ/space infections; meta-regression indicated that patient age was a significant effect modifier. In caesarean sections, CHG lowered overall SSIs (OR = 0.64; 95% CI: 0.48-0.85), superficial incisional SSIs (OR = 0.65; 95% CI: 0.48-0.87), and deep incisional SSIs (OR = 0.41; 95% CI: 0.22-0.75). In abdominal surgery, CHG reduced only superficial incisional SSIs (OR = 0.68; 95% CI: 0.52-0.91). No significant differences were observed in gynaecologic, cardiothoracic, or orthopaedic procedures. By wound classification, CHG had no effect in clean surgery but reduced superficial incisional SSIs in clean-contaminated cases (OR = 0.65; 95% CI: 0.48-0.89). By income level, no differences were seen in high-income countries (HICs), whereas in low- and middle-income countries, CHG decreased overall SSIs (OR = 0.58; 95% CI: 0.46-0.74), superficial incisional SSIs (OR = 0.54; 95% CI: 0.38-0.76), and deep incisional SSIs (OR = 0.48; 95% CI: 0.25-0.92). Conclusion(s): Alcohol-based CHG and alcohol-based PVI are comparably effective in most surgical settings. However, CHG demonstrates superior prevention of SSIs in caesarean, abdominal, and clean-contaminated surgeries, with the most substantial benefit in low- and middle-income settings. Broader use may be justified pending cost-effectiveness evaluation. Copyright © 2026 The Healthcare Infection Society <83> Accession Number 2046749120 Title Clinical Features of Adult Patients with Isolated Pulmonary Valve Endocarditis: A Systematic Review. Source Microorganisms. 14(6) (no pagination), 2026. Article Number: 1208. Date of Publication: 01 Jun 2026. Author Cuervo G.; Chesdachai S.; Hindy J.-R.; Gerberi D.; DeSimone C.V.; Deshmukh A.J.; Miro J.M.; El Sabbagh A.; DeSimone D.C.; Baddour L.M. Institution (Cuervo, Miro) Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain (Cuervo, Miro) CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain (Cuervo, Chesdachai, Hindy, DeSimone, Baddour) Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, United States (Chesdachai, DeSimone, Deshmukh, DeSimone, Baddour) Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States (Gerberi) Department of Library Services, Mayo Clinic, Rochester, MN, United States (Miro) Reial Academia de Medicina de Catalunya, Barcelona, Spain (El Sabbagh) Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Isolated pulmonary valve endocarditis (PV-IE) is a rare condition. Its epidemiology, clinical profile, and management remain poorly characterized. A systematic review was conducted to provide a contemporary characterization (2020-2025) of adult cases with isolated PV-IE. Individuals with previous cardiac surgeries, cardiac implantable electronic devices (CIEDs), or long-term venous catheters were excluded. Of 1902 citations identified, 72 studies were selected with 79 eligible cases, mostly case reports. Patients were predominantly male (78.5%) with a median age of 43 years. Congenital heart disease (CHD) and injection drug use (IDU) were risk factors in 30.4% and 27.8% of cases, respectively, while 41.8% had neither (No-CHD/IDU group). Staphylococcus aureus was the leading pathogen (39%), followed by streptococci (16.5%) and Enterococcus faecalis (8.9%). Vegetations were large (median, 19.5 mm), and pulmonary septic emboli highly prevalent (~93% of cases). More than half (54.4%) of patients underwent surgery. Hospital mortality was low (7.6%). Differences across risk factor subgroups were observed, with higher median age in No-CHD/IDU patients and more staphylococcal etiology in patients with IDU, although treatment approaches and mortality did not differ. This review highlights distinct characteristics and the overall favorable short-term prognosis of isolated PV-IE, underscoring the need for larger, systematically collected datasets. Copyright © 2026 by the authors. <84> Accession Number 2046705485 Title Psychological Experiences of Pregnancy Following Transplantation: A Systematic Qualitative Review. Source Medicina (Lithuania). 62(6) (no pagination), 2026. Article Number: 1072. Date of Publication: 01 Jun 2026. Author Papalois K.-B.; Tsarna E.; Vakas P.; Stavros S.; Matsas A.; Christopoulos P. Institution (Papalois) Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Old Rd, Headington, Oxford, United Kingdom (Tsarna, Vakas, Matsas, Christopoulos) Second Department of Obstetrics and Gynecology, Aretaieion Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece (Stavros) Third Department of Obstetrics and Gynecology, General University Hospital Attikon, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: To examine the psychological parameters among pregnant organ transplant recipients that are understudied compared to the physical health of women during post-transplantation pregnancy. Material(s) and Method(s): Systematic review based on PubMed, EMBASE, CINAHL, and PsycInfo that were searched until 15 January 2025. Quality Assessment and meta-aggregation were applied to qualitative studies. Result(s): Out of 4361 screened unique studies, six are included. Most studies were retrospective and focused on liver, kidney, and heart transplants. Meta-aggregation identified four synthesized findings: "Perception of Pregnancy after Transplantation", "Concerns about Maternal Physical Health", "Concerns about Fetal Health", and "Emotional Burden by Expectant Mothers and Coping Strategies". The review was constrained by the potential exclusion of relevant studies due to language restrictions and uncontrolled bias in the included studies. Conclusion(s): Several psychological themes were identified, not all exclusive to transplant recipients. Developing a targeted questionnaire to gather primary data could enhance clinical practice and improve counseling services for this patient population. Copyright © 2026 by the authors. <85> Accession Number 651541061 Title Use of Argatroban as a Heparin Alternative in Cardiac Surgery - A Rapid Review of Case Reports and Series. Source Journal of thrombosis and haemostasis : JTH. (no pagination), 2026. Date of Publication: 16 Jun 2026. Author Bouvette S.; Butt A.L.; Clifton S.C.; Stewart K.E.; Boylan P.M.; Mazzeffi M.A.; Tanaka K. Institution (Bouvette, Butt, Clifton, Stewart, Boylan, Tanaka) University of Oklahoma Health (Mazzeffi) Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States Abstract BACKGROUND: Argatroban has been used as an alternative anticoagulant for cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia (HIT) or heparin allergy. Its mechanism of action differs from heparin, and concerns regarding dosing, monitoring, and circuit thrombosis risk remain insufficiently characterized. OBJECTIVE(S): To systematically review published cases of argatroban anticoagulation during CPB for dosing patterns, activated clotting time (ACT) responses, thrombotic and bleeding events as well as transfusions. METHOD(S): A rapid review was performed following PRISMA and Cochrane Rapid Reviews guidance. Searches of MEDLINE, Embase, and other index databases identified clinical reports involving argatroban use during CPB. Two investigators independently screened studies, extracted data, and assessed risk of bias. RESULT(S): Twenty-nine publications describing 30 patients (24 adult, 6 pediatric) met inclusion criteria. The initial argatroban bolus was median 0.1 mg/kg, but it was doubled to achieve ACTs >400 seconds. Median infusion rate (25th-75th percentile) was 6.8 (4.6-9.7) mug/kg/min. ACT responses were nonlinear, with fluctuations >100 seconds occurring in 70% of cases. Despite ACTs >400 seconds, circuit thrombosis occurred in 40% of cases, most commonly in the reservoir or oxygenator. Recovery to ACT <200 seconds required a median of 7 hours after discontinuing drug infusion. Perioperative transfusion occurred in 80% of cases. CONCLUSION(S): Published experience demonstrates major limitations of argatroban as a heparin substitute for CPB, including unpredictable ACT responses and frequently documented circuit thromboses. The reported complication rates should be interpreted as an upper bound given the descriptive nature of case-level evidence and the likelihood of publication bias. Copyright © 2026. Published by Elsevier Inc. <86> Accession Number 2046747344 Title Safety of Invasive Procedures During Adult Extracorporeal Membrane Oxygenation: A Systematic Review. Source Journal of Clinical Medicine. 15(12) (no pagination), 2026. Article Number: 4792. Date of Publication: 01 Jun 2026. Author Neri G.; Mazza G.; Mastrangelo H.; Ielapi J.; Longhini F.; Bosco V.; Russo A.; Serapide F.; Aquila I.; Sacco M.A.; Caroleo Z.; Bruni A.; Garofalo E. Institution (Neri, Mazza, Ielapi, Longhini, Bosco, Russo, Serapide, Aquila, Sacco, Garofalo) Department of Medical and Surgical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy (Mastrangelo) ASP Catanzaro, Catanzaro, Italy (Caroleo, Bruni) Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, Cosenza, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Adult patients supported with extracorporeal membrane oxygenation (ECMO) frequently require invasive diagnostic, therapeutic, surgical, or bedside procedures during ongoing extracorporeal support. These procedures are clinically challenging because ECMO-related anticoagulation, platelet dysfunction, acquired coagulopathy, and circuit-related coagulation activation may increase both bleeding and thrombotic risks. This systematic review evaluated the safety of invasive procedures performed during adult ECMO support, excluding tracheostomy/tracheotomy because this procedure has recently been addressed in a dedicated systematic review. Method(s): A systematic search of PubMed/MEDLINE and Scopus was performed. The final bibliographic data collection was completed in April 2026. Studies were eligible if they included adult ECMO or extracorporeal life support patients undergoing invasive procedures during ongoing ECMO support, or with ECMO used as procedural support, and reported at least one procedure-specific safety outcome. Primary outcomes were procedure-related complications, bleeding, major bleeding, and transfusion requirements. Secondary outcomes included thrombotic and circuit-related complications, oxygenator exchange, reintervention, reoperation, procedural failure, ECMO duration, intensive care unit and hospital length of stay, and mortality. Result(s): The final qualitative synthesis included 46 studies, comprising 26 studies from PubMed/MEDLINE and 20 additional unique studies from Scopus. Included procedures were grouped into six domains: airway, bronchoscopic, and tracheobronchial procedures; thoracic surgery and lung resections; abdominal surgery, gastrointestinal endoscopy, and decompressive laparotomy; lung transplantation and perioperative extracorporeal life support; cardiovascular, vascular, pulmonary embolism-related, and mechanical circulatory support-related procedures; and mixed non-cardiac surgery. Airway and bronchoscopic procedures generally showed high procedural success in selected cohorts, although registry-level tracheal procedure data reported hemorrhagic complications in 26.0% and surgical-site bleeding in 13.0%. Emergency thoracic and abdominal procedures carried the highest bleeding, transfusion, reintervention, and mortality burden. Lung transplantation studies showed that ECMO can be integrated into perioperative pathways, but hemothorax, transfusion, thromboembolism, and anticoagulation strategy remained central safety issues. Conclusion(s): Invasive procedures during adult ECMO are feasible in selected patients and experienced centers, but procedural safety varies markedly by procedure type, urgency, baseline disease severity, and anticoagulation strategy. A procedure-centered, multidisciplinary approach with individualized anticoagulation management and careful planning is essential. Copyright © 2026 by the authors. <87> Accession Number 2046716837 Title Non-ST-Elevation Myocardial Infarction: A Heterogeneous Syndrome with Evolving Management-A Narrative Review. Source Biomedicines. 14(6) (no pagination), 2026. Article Number: 1379. Date of Publication: 01 Jun 2026. Author Muste S.R.; Babes E.E.; Bustea C.; Dobjanschi L.; Muste F.A.; Zaha D.C. Institution (Muste, Babes, Bustea, Dobjanschi, Muste, Zaha) Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania (Babes) Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania (Bustea, Dobjanschi, Zaha) Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Non-ST-segment elevation myocardial infarction (NSTEMI) has become the predominant form of acute coronary syndrome (ACS) and is frequently associated with multivessel coronary artery disease (MVD). Patients presenting with NSTEMI and MVD represent a particularly high-risk population characterized by advanced age, comorbidities, and an increased atherosclerotic burden. Although advances in pharmacological therapy and early invasive management have improved prognosis, the optimal revascularization strategy in this setting remains uncertain. In contrast to ST-segment elevation myocardial infarction (STEMI), where randomized controlled trials consistently support complete revascularization, evidence in NSTEMI with MVD is limited and is largely derived from observational studies and registry data. This has generated ongoing debate regarding whether complete revascularization offers superior outcomes compared with culprit-only percutaneous coronary intervention (PCI), and whether non-culprit lesions should be treated during the index procedure (immediate strategy) or in a staged manner. Current data suggest that complete PCI is generally associated with reduced recurrent ischemia, reinfarction, and repeat revascularization, with potential long-term survival benefits. However, patient comorbidities, lesion complexity, and procedural risk continue to influence outcomes, highlighting the importance of individualized decision-making. This narrative review synthesizes contemporary evidence on PCI-based revascularization strategies in NSTEMI with MVD, focusing on two central aspects: the extent of revascularization (complete versus incomplete) and the timing of intervention (single-stage versus staged). By integrating findings from registries, randomized trials and guideline recommendations, the review identifies areas of consensus, persisting uncertainties, and key evidence gaps. Ultimately, it underscores the need for large, dedicated trials to guide practice and optimize outcomes for NSTEMI patients with multivessel coronary disease. Copyright © 2026 by the authors. <88> Accession Number 2047124911 Title "Comparison Of Hemodynamic Changes In Cardiac Surgery During Induction With Etomidate And Thiopentone". Source International Journal of Drug Delivery Technology. 16(64 Supplement) (pp 440-459), 2026. Date of Publication: 2026. Author Kumar D.; Verma M.K.; Barma D. Institution (Kumar) Department of Allied Health Care Sciences, Vivekananda Global University, Jaipur, India (Verma) Department of Allied Health Care Sciences, Radiology, Vivekananda Global University, Jaipur, India (Barma) Department of Allied Health Care Sciences Operation Theatre Technology, Vivekananda Global University, Jaipur, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Hemodynamic stability during induction of anesthesia is a critical determinant of perioperative outcomes in cardiac surgery. Induction agents can significantly influence cardiovascular parameters such as heart rate, blood pressure, and systemic vascular resistance. Among commonly used intravenous anesthetic agents, Etomidate is known for its cardiovascular stability, whereas Thiopentone (thiopental sodium) has been associated with myocardial depression and hypotension. Given the high-risk profile of cardiac surgery patients, the choice of induction agent plays a crucial role in minimizing perioperative morbidity and mortality. Aim(s): This study aims to compare the hemodynamic changes during induction of anesthesia using etomidate and thiopentone in patients undergoing cardiac surgery. Material(s) and Method(s): This prospective, randomized comparative study was conducted in a tertiary care hospital on 60 adult patients (ASA III-IV) scheduled for elective cardiac surgery. Patients were randomly divided into two groups: Group E (n=30) received etomidate (0.2-0.3 mg/kg), and Group T (n=30) received thiopentone (3-5 mg/kg) for induction. Standard monitoring was applied, including electrocardiography, non-invasive blood pressure, pulse oximetry, and invasive arterial pressure monitoring. Hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded at baseline, after induction, immediately after intubation, and at 1, 3, and 5 minutes post-intubation. Statistical analysis was performed using appropriate tests (Student's t-test and repeated measures ANOVA), with p < 0.05 considered statistically significant. Result(s): Both groups were comparable in demographic characteristics and baseline hemodynamic parameters. Following induction, Group T (thiopentone) showed a significant reduction in SBP, DBP, and MAP compared to Group E (etomidate) (p < 0.05). The decrease in MAP was more pronounced in the thiopentone group, indicating greater cardiovascular depression. In contrast, Group E demonstrated minimal changes in blood pressure, maintaining better hemodynamic stability. Heart rate increased in both groups following intubation; however, the rise was more significant in the thiopentone group. Etomidate provided superior stability during the critical phases of induction and intubation. No significant adverse effects were observed in either group, although mild myoclonus was noted in a few patients receiving etomidate. Conclusion(s): Etomidate is superior to thiopentone in maintaining hemodynamic stability during induction of anesthesia in cardiac surgery patients. It produces minimal changes in blood pressure and heart rate, making it a safer and more reliable induction agent in high-risk cardiac patients. Thiopentone, although effective, is associated with significant hypotension and cardiovascular depression, which may be detrimental in compromised patients. Therefore, etomidate should be preferred as an induction agent in cardiac surgical procedures where maintaining stable hemodynamics is essential. Copyright © 2026, Dr. Yashwant Research Labs Pvt Ltd. All rights reserved. <89> Accession Number 2046746938 Title The Effectiveness of Methylene Blue in Adult Shock: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Source Journal of Clinical Medicine. 15(12) (no pagination), 2026. Article Number: 4481. Date of Publication: 01 Jun 2026. Author Rodriguez-Lima D.R.; Rodriguez-Villegas A.; Toro Egas J.D.; Bautista E.M.C. Institution (Rodriguez-Lima) Critical and Intensive Care Medicine, Hospital Universitario Mayor-Mederi, Bogota, Colombia (Rodriguez-Lima) Clinical Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia (Rodriguez-Villegas, Toro Egas) School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia (Bautista) Cardiology Department, La Cardio, Bogota, Colombia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Methylene blue (MB) has re-emerged as an adjunctive vasopressor-sparing therapy in vasoplegic shock states, with emerging evidence supporting its hemodynamic benefits; however, its effect on mortality remains uncertain. We systematically evaluated the effectiveness of MB versus standard therapy in adults with circulatory shock. Method(s): We performed a systematic review and meta-analysis of randomized controlled trials registered in PROSPERO (CRD420261326534) and reported according to PRISMA. MEDLINE, Embase, and the Cochrane Library were searched through February 2026. An additional AI-assisted supplementary search was conducted to minimize the risk of missing eligible studies. Eligible studies enrolled adults with shock and compared MB with standard therapy or placebo. The primary outcome was 28-30-day all-cause mortality. Secondary outcomes were renal replacement therapy (RRT), hospital length of stay, and intensive care unit (ICU) length of stay. Risk of bias was assessed with RoB 2. Result(s): Nine randomized trials involving 535 participants met the eligibility criteria; most evaluated septic shock, while one trial included post-cardiac surgery vasoplegic shock. Eight trials contributed to the quantitative synthesis of mortality. MB was not associated with a statistically significant reduction in short-term mortality. Secondary analyses also did not demonstrate significant pooled effects for RRT, hospital length of stay, or ICU length of stay, although several individual trials reported faster hemodynamic improvement and reduced vasopressor exposure with MB. Overall confidence in the pooled estimates was limited by small sample sizes, clinical heterogeneity, imprecision, and risk-of-bias concerns in some studies. Conclusion(s): Current randomized evidence does not demonstrate a clear mortality or resource use benefit of MB in adult shock, despite signals of hemodynamic improvement. MB appears promising as an adjunctive therapy, but adequately powered, methodologically rigorous trials are required before its routine early use can be recommended. Copyright © 2026 by the authors. <90> Accession Number 2046729900 Title Vein Graft Preservation During Coronary Artery Bypass Graft Surgery: Operative Techniques, Biomaterials and Advances from Tissue Engineering. Source Journal of Functional Biomaterials. 17(6) (no pagination), 2026. Article Number: 305. Date of Publication: 01 Jun 2026. Author Ferraresi B.; Nenna A.; Jawabra M.; Corrado D.; Barberi F.; Dominici C.; Casali G.; Barbieri L.; Tumminello G.; Carugo S.; Chello M.; Lusini M. Institution (Ferraresi, Jawabra, Corrado, Barberi, Chello, Lusini) Cardiac Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, Italy (Nenna, Dominici, Barbieri, Tumminello, Carugo) Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, Milan, Italy (Casali) Cardiac Surgery, Azienda Ospedaliero Universitaria Maggiore della Carita di Novara, Corso Mazzini 18, Novara, Italy (Carugo) Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract The failure of saphenous vein grafts following coronary artery bypass grafting (CABG) remains a significant issue, as it limits the durability of vein-based surgical revascularisation compared to arterial conduits. Venous graft disease is a dynamic process that begins early in the perioperative period as a consequence of harvesting trauma, ex vivo preservation, and the sudden exposure of the conduit to the arterial haemodynamic environment. This narrative review summarises the available evidence on local graft protection strategies, focusing on intraoperative and perioperative approaches aimed at preserving endothelial integrity, attenuating initial inflammation, and limiting maladaptive remodelling. Specifically, the review analyses the role of endothelium-protective preservation solutions, external support devices, biodegradable drug-eluting biomaterials, and locally targeted RNA therapies. Preclinical and early clinical evidence suggests that local graft protection is biologically plausible and may reduce intimal hyperplasia, luminal irregularity and adverse graft remodelling. However, its impact on long-term clinical outcomes remains uncertain. An integrated approach combining harvest optimisation, conduit preservation, mechanical support, and local delivery of drugs or regulatory molecules may represent a promising framework for improving vein graft biology; however, its ability to translate into durable patency gains and improved clinical outcomes after CABG requires further clinical validation. Copyright © 2026 by the authors. <91> Accession Number 651539341 Title Impact of liposomal bupivacaine parasternal block combined with rectus sheath block on postoperative pain in patients undergoing sternotomy for cardiac surgery: a randomized controlled trial. Source BMC anesthesiology. (no pagination), 2026. Date of Publication: 17 Jun 2026. Author Huang Y.; Hong M.; Mao Q.; Liang D.; Liu G.; Huang M.; Zhong H.; Yang N.; Zhong Y.; Chen Y. Institution (Huang, Hong, Mao, Liang, Liu, Huang, Zhong) Department of Anesthesiology and Operating Center, First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China (Yang) Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China (Zhong) Department of Anesthesiology and Operating Center, First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China (Chen) Department of Anesthesiology and Operating Center, First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning, China Abstract OBJECTIVE: To compare the effects of liposomal bupivacaine and ropivacaine for ultrasound-guided parasternal block combined with rectus sheath block (PSB + RSB) on acute and chronic postoperative pain in patients undergoing cardiac sternotomy, so as to provide an evidence-based basis for optimizing the multimodal analgesia regimen for such surgeries. METHOD(S): A total of 90 patients scheduled for elective median sternotomy cardiac and great vessel surgery at the Institute of Cardiovascular Diseases, The First Affiliated Hospital of Guangxi Medical University from April 2024 to February 2025 were enrolled. They were divided into the liposomal bupivacaine group (group LB, n=45) and the ropivacaine group (group ROP, n=45) using the random number table method. After endotracheal intubation under general anesthesia, group LB was given 40 mL of 266 mg liposomal bupivacaine injection for bilateral PSB+RSB, while group ROP was administered 40 mL of 0.375% ropivacaine injection for the same block regimen.The following outcomes were recorded at different postoperative time points: cumulative consumption of analgesic drugs (calculated as morphine milligram equivalents, MMEs), scores of Numeric Rating Scale (NRS, 0-10 points) for pain assessment, scores of Quality of Recovery-15 (QoR-15) scale, and the incidence of adverse events. RESULT(S): A total of 88 patients completed the study (2 patients in group LB were excluded due to surgical duration exceeding 8 hours). At 24 h and 48 h after the first postoperative awakening, the cumulative MMEs consumption in group LB was significantly lower than that in group ROP [55.30(47.80,62.10) vs 68.00(48.40,80.00) mg, 76.30(68.80.83.10) mg vs 86.00(63.40,119.60), all P < 0.05]. At 4 h and 12 h post-extubation, the activity-related NRS scores in group LB were significantly lower than those in group ROP [2.00(2.00.2.00) points vs 2.00(2.00,3.00) points, 2.00(2.00,3.00) points vs 3.00(2.00,4.00) points, all P < 0.05]. At 24 h, 48 h and 72 h post-extubation, the QoR-15 scores in group LB were significantly higher than those in group ROP [(85.4+/-11.78) points vs (74.7+/-9.89) points, (91.6+/-10.4) points vs (86.8+/-8.6) points, (107.1+/-9.87) points vs (100.0+/-9.15) points, all P < 0.05]. The incidence of postoperative nausea and vomiting in group LB (16.3%, 7/43) was significantly higher than that in group ROP (2.2%, 1/45) (P < 0.05). There were no significant differences between the two groups in postoperative endotracheal extubation time, ICU stay time, hospital stay, and the incidence of chronic postsurgical pain (CPSP) at 3 months after surgery . CONCLUSION(S): The use of liposomal bupivacaine for PSB+RSB block in patients undergoing cardiac sternotomy can significantly reduce postoperative analgesic consumption, optimize early analgesic effect, and improve postoperative recovery quality. However, attention should be paid to the risk of nausea and vomiting, and individualized selection should be made after balancing the benefits and risks in clinical application. TRIAL REGISTRATION: Trial registration:This trial was registered in the Chinese Clinical Trial Registry (ChiCTR2400084078) on May 10, 2024 (https://www.chictr.org.cn/). Copyright © 2026. The Author(s). <92> Accession Number 651540286 Title Effects of discharge education program on recovery and quality of life after cardiac surgery: a 12 week follow-up single-blind randomized controlled trial. Source BMC surgery. (no pagination), 2026. Date of Publication: 16 Jun 2026. Author Kajti E.; Selcuk I.; Selcuk UN.; Tokoz H.; Ozbas A. Institution (Kajti) Istanbul Atlas University, Istanbul, Turkey (Selcuk, Tokoz) Atasehir Acibadem Private Hospital, Istanbul, Turkey (Selcuk) Istanbul Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey (Ozbas) Demiroglu Bilim University Florence Nightingale School of Nursing, Istanbul, Turkey Abstract AIMS: In the contemporary era of rapid societal and technological advancement, factors such as sedentary lifestyles, environmental pollution, unhealthy dietary habits, consumption of sugar-sweetened beverages, tobacco and alcohol use, and the growing prevalence of comorbid conditions associated with these risk factors have contributed to cardiovascular diseases becoming one of the leading causes of mortality worldwide. Among the therapeutic interventions for cardiovascular diseases, open-heart surgery remains one of the principal treatment modalities, as it is associated with superior symptom control, enhanced quality of life, and improved long-term survival outcomes compared with medical management alone. Beside the surgical intervention one of the main components determining the outcomes of the surgery is the patient education therefore this study was conducted to determine the effect of discharge education provided after cardiac surgery on recovery and quality of life. METHODS AND RESULTS: This research was conducted as a randomized pretest-posttest controlled study to determine the effects of discharge education after cardiac surgery on recovery and quality of life. The study was conducted between March 2022 and July 2023, in two Training and Research Hospitals with 70 inpatients. The data of the study were collected face to face and via telephone calls using the 'Patient's Personal Information Form', 'Multidimensional Index of Life Quality-MILQ-TR', 'Quality of Recovery - 40 Questionnaire-QOR-40' and 'Telephone Follow-Up Form'. According to this study's results, the recovery quality level and the quality of life of the patients in the intervention group was significantly higher than the patients in the control group. CONCLUSION(S): According to the results of the study, which was evaluated at a 95% confidence interval and a significance level below p < 0.05; the quality of recovery and quality of life of the intervention group patients were statistically higher, the complications were fewer, and the level of knowledge was higher. TRIAL REGISTRATION: Trial Registry The Effects of Discharge Education Program on Recovery and Quality of Life After Cardiac Surgery. Unique Identifying Number NCT05631340. Date of Registration 21/11/2022. ( https://clinicaltrials.gov/study/NCT05631340 ). Copyright © 2026. The Author(s). <93> Accession Number 651528235 Title Critical Appraisal of "Continued versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Replacement in Patients with Atrial Fibrillation: A Meta-Analysis". Source American journal of therapeutics. (no pagination), 2026. Date of Publication: 17 Jun 2026. Author Tahir M.; Akhtar I.; Javaid M.H. Institution (Tahir, Akhtar) Department of Medicine, Ayub Medical College, Abbottabad, Pakistan; and (Javaid) Department of Medicine, Shifa College of Medicine, Islamabad, Pakistan <94> Accession Number 651541127 Title Impact of opioid free anesthesia on postoperative nausea and vomiting, chronic pain, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials. Source BMC anesthesiology. (no pagination), 2026. Date of Publication: 16 Jun 2026. Author Yang J.; Liao T.; Luo J.; Ma A.; He J.; Li H.; Liu R.; Yu Y.; Peng J. Institution (Yang, Liao, Ma, He, Li) College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, China (Yang, Liao, Ma, He, Li, Liu, Yu) Department of Thoracic Surgery, First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China (Luo) Department of Anaesthesiology, First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China (Peng) Department of Thoracic Surgery, First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China Abstract BACKGROUND: Opioids are frequently used in general anesthesia but may delay recovery owing to adverse effects, which include respiratory depression, postoperative nausea and vomiting (PONV), and opioid-induced hyperalgesia. Opioid-free anesthesia (OFA), based on multimodal analgesia, offers an alternative to mitigate these issues and enhance recovery in thoracic surgery. However, high-quality evidence confirming its effectiveness and safety is needed. METHOD(S): The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this study. PubMed, Web of Science, Embase, and Cochrane Library were systematically searched from inception to March 01, 2025, for randomized controlled trials (RCTs) that compared OFA and opioid-based anesthesia (OBA) in patients undergoing video-assisted thoracoscopic surgery (VATS). Study titles, abstracts, and full texts were separately evaluated for eligibility by two researchers; disagreements were resolved by discussion or a third researcher. The Cochrane Risk of Bias tool was used to evaluate the risk of bias in included studies. Primary outcomes included PONV incidence and 24-h postoperative pain scores. Secondary outcomes included chronic pain, intraoperative hemodynamic events, length of stay in the recovery room, length of hospitalization, and quality of recovery (as measured by QoR-40/QoR-15). RESULT(S): This systematic review and meta-analysis consisted of 10 RCTs involving 1,106 patients. OFA reduced the risk of PONV (risk ratio (RR) = 0.41, 95% confidence interval (CI): 0.380-0.665) and the incidence of postoperative chronic pain at 3 months (RR = 0.566, 95% CI: 0.347-0.925), compared with OBA. However, the 24-h postoperative pain scores did not differ (MD = 0.082, p = 0.305). Bradycardia incidence was lower in the OFA group, but hypotension rates did not differ. The length of stay in recovery rooms and the length of hospitalization did not differ significantly. Although 24-h QoR-40 scores favored OFA (mean difference = 2.914, 95% CI: 1.017-4.811), this improvement did not reach the clinically established threshold of 6.3 points. CONCLUSION(S): Without worsening intraoperative hemodynamic instability or extending postoperative recovery, OFA significantly reduced the incidence of PONV and chronic pain in patients undergoing VATS. These results validate OFA as a potentially safe and effective anesthetic strategy for improving postoperative recovery after thoracic surgery. Further large-scale RCTs are warranted to standardize OFA protocols and validate its long-term advantages. TRIAL REGISTRATION: Registration of systematic reviews: CRD42025636410. Copyright © 2026. The Author(s). <95> Accession Number 651529965 Title Early versus delayed evolocumab treatment and complex coronary artery revascularization. Source European journal of preventive cardiology. (no pagination), 2026. Date of Publication: 16 Jun 2026. Author Haller P.M.; Gaba P.; Thomas C.; Fagundes A.; Oyama K.; Furtado R.H.M.; Zelniker T.A.; Kuder J.; Murphy S.; Verma S.; Wang H.; da Silva Lima G.P.; Ohman E.M.; Braunwald E.; Giugliano R.P.; O'Donoghue M.L.; Sabatine M.S.; Bergmark B.A. Institution (Haller, Zelniker) Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria (Haller, Thomas, Murphy, Braunwald, Giugliano, O'Donoghue, Sabatine, Bergmark) TIMI Study Group, Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States (Gaba, Kuder) Division of Cardiovascular Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States (Fagundes) IDOR - the D'Or Institute for Research and Education and DFStar Hospital, Brasilia, Brazil (Oyama) Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (Furtado) Brazilian Clinical Research Institute, Brazil and Sirio Libanes Hospital, Sao Paulo, Brazil (Verma) Department of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Canada (Wang, da Silva Lima, Ohman) Amgen, Thousand Oaks, CA, United States Abstract BACKGROUND: In FOURIER, the PCSK9 inhibitor evolocumab (Evo) significantly reduced the rate of major adverse cardiovascular events and coronary revascularization. AIMS: To investigate the effect of evolocumab on the incidence of complex coronary revascularization during long-term follow-up. METHOD(S): In FOURIER, patients with atherosclerotic cardiovascular disease with LDL-C >=70mg/dL despite optimized statin therapy were randomized to evolocumab or placebo. At the end of the trial, patients had the option to be treated with evolocumab in the open label extension (OLE) at participating sites. All cases of coronary revascularization were centrally reviewed, and complex revascularization was defined as coronary artery bypass graft surgery (CABG) or complex percutaneous coronary intervention (PCI) using the GLOBAL LEADERS definition. Event rates through 8 years were compared between patients randomized in the parent trial to evolocumab or placebo. RESULT(S): Of 27,564 patients in FOURIER, 6,635 patients (median achieved LDL-C 30 mg/dL) continued in OLE (total median follow-up 7.2 years). Patients initially randomized to evolocumab were treated on average 2.2 years earlier than patients starting treatment during OLE. In patients receiving evolocumab earlier, the rate for complex coronary revascularization through 8 years was reduced by 24% (HR 0.76 [0.67, 0.87], p<0.001). This effect was consistent for both CABG (HR 0.77 [0.66, 0.94], p=0.01) and complex PCI (HR 0.78 [0.65, 0.93], p=0.006) individually. Early versus delayed evolocumab therapy resulted in lower total stent length implanted (22,521 mm vs 28,946 mm, p<0.001). CONCLUSION(S): Compared with delayed treatment initiation, early and sustained treatment with evolocumab significantly reduced the likelihood of complex revascularization during long-term follow-up. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. 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 <96> Accession Number 651530026 Title Simulation-based training in cardiovascular intervention and cardiac surgery: bridging skill, safety, and innovation. Source European heart journal. (no pagination), 2026. Date of Publication: 16 Jun 2026. Author Reed G.W.; Bansal A.; Yun J.; Kapadia S. Institution (Reed, Bansal, Kapadia) Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Ave, Cleveland, United States (Yun) Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, OH, United States Abstract The increasing complexity of cardiovascular procedures, regulatory constraints, and heightened patient safety requirements have necessitated a fundamental transformation in medical education of interventional cardiology and cardiac surgery beyond traditional apprenticeship models. A comprehensive review of simulation-based training (SBT) in cardiovascular medicine and surgery was conducted, analysing evidence from 2020 to 2025 across multiple databases and incorporating data from systematic reviews, randomized controlled trials, and international surveys. SBT demonstrates significant educational benefits with moderate to large effect sizes across all training domains. Meta-analyses of over 6000 participants show technical skill improvements of 20%-40%, medical error reduction of 51%, and large effect sizes for skill acquisition (Cohen's d = 0.85-2.2). Contemporary platforms, including virtual reality, haptic feedback systems, and artificial intelligence-powered adaptive, learning achieve high simulation accuracy for complex procedures. Despite proven efficacy, implementation of SBT faces barriers including cost ($50 000-$200 000 per high-fidelity system) and limited access, with 71% of practitioners reporting insufficient simulation exposure. SBT represents a paradigm shift in cardiovascular education, offering standardized, patient risk-free environments for technical skill development. While evidence demonstrates improved procedural competency and knowledge acquisition with SBT, the critical gap remains in demonstrating direct patient outcome improvements. Future integration of artificial intelligence, digital twins, and personalized learning platforms promises to further transform training in interventional cardiology and cardiothoracic surgery. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. 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 <97> Accession Number 2046665784 Title Clopidogrel vs. Aspirin in Double Antithrombotic Therapy for Patients on Oral Anticoagulation Undergoing Coronary Stenting. Source Journal of Cardiovascular Development and Disease. 13(6) (no pagination), 2026. Article Number: 249. Date of Publication: 01 Jun 2026. Author Pompei G.; Arioti M.; Moretti C.; Bendandi F.; Panevino R.; Sanna S.; Casu G.; Rubboli A. Institution (Pompei, Arioti, Moretti, Bendandi, Panevino, Rubboli) Division of Cardiology, Department of Emergency, Internal Medicine and Cardiology, Santa Maria delle Croci Hospital, Viale Vincenzo Randi 5, Ravenna, Italy (Pompei) Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, Italy (Bendandi) Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy (Sanna, Casu) Clinical and Interventional Cardiology, Department of Medicine, Surgery and Pharmacy, University Hospital, Viale San Pietro 10, Sassari, Italy (Rubboli) Faculty of Medicine, University of Bologna, Campus of Ravenna, Ravenna, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Over the past two decades, the combined use of long-term anticoagulation and antiplatelet therapy following percutaneous coronary intervention has been extensively investigated. Efforts to define an optimal antithrombotic strategy-balancing protection against thrombotic and thromboembolic events with minimization of bleeding risk-have led to the design and conduct of randomized clinical trials. This narrative review synthesizes the main evidence comparing different antithrombotic approaches in this setting, with particular focus on regimens stratified by oral anticoagulant type and on the direct comparison between aspirin- and clopidogrel-based double antithrombotic therapy, as evaluated in a limited number of recent studies. Further large-scale randomized data comparing these two regimens are needed to strengthen the current evidence and clarify this issue, as well as to evaluate the role of platelet function and/or genetic testing in guiding the selection of the optimal antiplatelet agent. Copyright © 2026 by the authors. <98> Accession Number 651506722 Title Great debate: surgical aortic valve replacement is first choice for aortic stenosis in patients with a life expectancy beyond 5 years. Source European heart journal. (no pagination), 2026. Date of Publication: 15 Jun 2026. Author Doenst T.; Prendergast B.; Allen C.J.; Barili F.; Falk V.; Kirov H.; Patterson T.; Redwood S.; Baumgartner H. Institution (Doenst, Kirov) Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany (Prendergast, Redwood) Cardiology Department, London, United Kingdom (Prendergast, Allen, Patterson, Redwood) Cardiology Department, St Thomas' Hospital, London, United Kingdom (Allen) Cedars-Sinai Medical Center, Los Angeles, CA, United States (Barili) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States (Barili) University Cardiac Surgery Unit, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy (Falk) Department of Cardiothoracic and Vascular Surgery, Berlin, Germany (Baumgartner) Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1 ,Building A1, Muenster, Germany Abstract Transcatheter aortic valve implantation (TAVI) is increasingly used for the treatment of aortic stenosis. Recently published guidelines favour now TAVI in all patients 70 years or older who have tricuspid valves and suitable anatomy. However, while a number of randomized controlled trials confirm that TAVI and surgical aortic valve replacement (SAVR) provide equivalent outcomes up to 5 years, data beyond 5 years are still scarce and real-world registry data report indeed conflicting results. Higher rates of complications after TAVI such as pacemaker requirement and paravalvular regurgitation, which have been shown to be associated with worse outcome may become more relevant after 5 years and still favour surgery on long-term. In addition, long-term durability data for TAVI are still insufficient. Thus, the question whether SAVR should still be the first choice for patients with a life expectance beyond 5 years is therefore justified. This debate summarizes the pros and cons for this claim. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Society of Cardiology. 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 <99> Accession Number 2046626562 Title Inequalities in Access to and Outcomes of Cardiac Surgery Among Patients with Mental Health Disorders. Source Medical sciences. 14(2) (no pagination), 2026. Article Number: 277. Date of Publication: 01 Jun 2026. Author Leivaditis V.; Mitsos S.; Mulita F.; Maniatopoulos A.; Baikoussis N.G.; Shaska E.; Andrikopoulou C.; Liolis E.; Skoura T.; Antzoulas A.; Boucharas I.; Sepetis A.; Tomos P.; Dahm M. Institution (Leivaditis, Dahm) Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany (Mitsos, Tomos) Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Mulita, Andrikopoulou, Boucharas) Department of General Surgery, General Hospital of Eastern Achaia-Unit of Aigio, Aigio, Greece (Maniatopoulos) Department of Electrical and Computer Engineering, Democritus University of Thrace, Xanthi, Greece (Baikoussis) Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece (Shaska) Department of Psychiatry, "Ali Mihali" Psychiatric Hospital, Vlora, Albania (Liolis) Department of Oncology, General University Hospital of Patras, Patras, Greece (Skoura) Medical School, National and Kapodistrian University of Athens, NKUA, Aretaeion Hospital, Athens, Greece (Antzoulas) Department of Surgery, General University Hospital of Patras, Patras, Greece (Sepetis) Postgraduate Health and Social Care Management Program, Department of Business Administration, University of West Attica, Athens, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Cardiovascular disease remains the leading global cause of morbidity and mortality. Mental health disorders are common comorbidities that significantly influence how patients access and navigate specialist care. Increasingly, mental illness is recognized not merely as a comorbidity but as a potential driver of inequities in cardiovascular care, affecting diagnosis, referral, procedural management, and long-term secondary prevention. These concerns are particularly relevant in cardiac surgery, where care pathways are complex and resource-intensive. Aims and Objectives: This narrative review examines recent evidence on inequalities in access to cardiac surgery and postoperative outcomes among patients with mental health disorders. Particular emphasis is placed on severe mental illness, mood disorders, anxiety-related conditions, and mixed psychiatric cohorts. Material(s) and Method(s): A structured narrative review approach was employed. PubMed and ScienceDirect were systematically searched for peer-reviewed studies published between 2020 and 2025, including cohort studies, registry analyses, systematic reviews, and meta-analyses. The evidence was synthesized thematically, focusing on access to care, perioperative management, clinical outcomes, underlying mechanisms, ethical considerations, policy implications, and future research directions. Result(s): Evidence suggests that patients with mental health disorders are more likely to undergo cardiac surgery via emergency pathways, experience longer hospital stays, and have higher rates of readmission. Individuals with severe mental illness are less likely to receive invasive coronary procedures compared to the general population and exhibit higher short- and long-term mortality following acute coronary syndromes. Among psychiatric subgroups, psychosis-spectrum disorders appear to be associated with the greatest excess risk of morbidity, mortality, and adverse long-term surgical outcomes. Conclusion(s): Patients with mental health disorders face inequities across the entire surgical pathway, including preoperative, perioperative, and postoperative phases. Key contributing factors include stigma, diagnostic overshadowing, fragmented healthcare systems, socioeconomic disadvantage, and insufficiently developed models of integrated care. Addressing these disparities requires redesigned referral pathways, strengthened multidisciplinary collaboration (including cardiology, cardiac surgery, psychiatry, and primary care), and a shift toward interventional research aimed at reducing inequities rather than solely documenting them. Copyright © 2026 by the authors. <100> Accession Number 2046598163 Title Inhaled nitric oxide for reducing major adverse events requiring intensive life support in adults undergoing cardiac surgery with cardiopulmonary bypass: protocol for a phase III, double-blind, multicenter randomized controlled trial (NORISC Trial). Source Nitric Oxide - Biology and Chemistry. 164 (pp 19-28), 2026. Date of Publication: 01 Oct 2026. Author Wang L.; Kamenshchikov N.O.; Zhang H.; Huang M.; Tyo M.A.; Koyanidi A.Y.; Shi J.; Evgeny G.; Sergey P.; Zhang Z.; Yang X.; Gao B.; Boboshko V.; Moroz G.; Vasilev M.; Zhai W.; Min J.; Liu Z.; Wang J.; Miao Z.H.; Wu Q.; Song Z.; Berra L.; Lei C. Institution (Wang, Zhang, Huang, Zhang, Yang, Gao, Lei) Department of Anesthesiology and Perioperative Medicine, Key Laboratory of Anesthesiology (The Fourth Military Medical University), Ministry of Education of China, Anesthesia Clinical Research Center, Xijing Hospital, The Fourth Military Medical University, Xi'an, China (Kamenshchikov, Tyo, Koyanidi) Laboratory of Critical Care Medicine, Department of Anesthesiology and Intensive Care Medicine, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 111a Kievskaya St., Tomsk, Russian Federation (Shi) Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China (Evgeny, Sergey) Scientific Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation (Boboshko, Moroz, Vasilev) Department of Anesthesiology and Intensive Care, Meshalkin National Medical Research Center, Federal State Budgetary Institution National Medical Research Center Named After Academician E.N. Meshalkin of the Ministry of Health of the Russian Federation, Novosibirsk, Russian Federation (Zhai) Tianjin University Chest Hospital, Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin, China (Min, Liu) Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, China (Wang, Miao) Anesthesia & Operation Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China (Wu) Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Song) Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China (Berra) Department of Anesthesia, Mass General Brigham, Anesthesia Center for Critical Care Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Publisher Academic Press Inc. Abstract Introduction Cardiac surgery remains a high-risk intervention, with postoperative complications, including ischemic events (myocardial infarction and stroke), acute kidney injury, respiratory failure, and neurocognitive dysfunction, affecting up to 30% of patients and resulting in increased mortality. While inhaled nitric oxide (NO) is traditionally used for pulmonary hypertension and right ventricular dysfunction, recent experimental and clinical studies suggest its organ-protective potential may mitigate ischemia-reperfusion injury and hemolysis induced toxicity. However, whether these physiological and mechanistic effects translate into improved patient-centered outcomes remains unproven in a large-scale setting. The NORISC trial aims to determine whether perioperative NO administration reduces major complications requiring intensive life support following cardiac surgery. Method and analysis This is an international, multicenter, double-blind, randomized (1:1), parallel-arm superiority trial. We will enroll 3650 patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). The intervention group will receive NO at 80 parts per million (ppm) via the oxygenator sweep gas during CPB, followed by inhaled NO at 40-80 ppm via mechanical ventilation for up to 6 h postoperatively or until extubation, whichever occurs first. The control group will receive standard care with placebo gas. The primary outcome is a 30-d composite of all-cause mortality and major adverse events (MAEs) necessitating intensive life support (e.g., stage 3 AKI, mechanical circulatory support, or prolonged ventilation, etc). Based on a hypothesized 20% relative risk reduction (from 20% to 16%), a sample size of 3650 provides 80% power at a one-sided alpha of 0.025. Conclusion/Expected Impact: The NORISC trial will provide high-quality, definitive evidence on the clinical efficacy of NO in cardiac surgery. By targeting hemolysis-mediated organ injury through a standardized delivery strategy, this study has the potential to redefine perioperative management and reduce the global burden of postoperative morbidity. Ethics and dissemination The protocol has received Institutional Review Board approval at all participating centers. Recruitment commenced in May 2025. Results will be disseminated through peer-reviewed publications and international scientific congresses. Trial registration number ClinicalTrials.gov NCT06702553 . Copyright © 2026 Elsevier Inc. <101> Accession Number 651527097 Title Effect of remote ischaemic preconditioning on acute kidney injury after heart transplantation (RIPCAT): A randomised controlled feasibility trial. Source European journal of anaesthesiology. (no pagination), 2026. Date of Publication: 16 Jun 2026. Author M'Pembele R.; Jagdfeld J.D.; Henning L.S.; Huhn R.; Lurati Buse G.; Boeken U.; Roth S. Institution (M'Pembele) From the Department of Anaesthesiology, Germany (RMP, Department of Anaesthesiology, Kerckhoff Heart and Lung Centre, Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Bad Nauheim, Germany <102> Accession Number 651508072 Title Effects of FiO2 adjustment on hyperoxia biomarkers and postoperative complications using oxygen reserve index during one-lung ventilation. Source BMC anesthesiology. (no pagination), 2026. Date of Publication: 15 Jun 2026. Author Aykenar B.; Ayhan A.; Issi S.; Kilic M.D.; Zeyneloglu P. Institution (Aykenar) Department of Intensive Care, Faculty of Medicine, Gazi University, Mevlana street, Ankara, Turkey (Ayhan, Zeyneloglu) Department of Anesthesia and Reanimation, Faculty of Medicine, Baskent University, Ankara, Turkey (Issi, Kilic) Department of Thoracic Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey Abstract BACKGROUND: One-lung ventilation (OLV) is commonly used in thoracic surgery but increases the risk of intraoperative hypoxemia. To prevent hypoxia, high fractions of inspired oxygen (FiO2) are frequently administered; however, excessive oxygen exposure may lead to hyperoxia and oxidative tissue injury. The Oxygen Reserve Index (ORi) is a non-invasive monitoring parameter that provides real-time information on moderate hyperoxia. This study aimed to evaluate whether ORi-guided oxygen titration reduces intraoperative FiO2 exposure and influences oxidative stress biomarkers and postoperative outcomes in patients undergoing OLV. METHOD(S): In this prospective, randomized controlled trial, 60 patients undergoing elective thoracic surgery requiring OLV were allocated to either an ORi-guided group or a conventional oxygen management group. In the ORi group, FiO2 was adjusted according to predefined ORi thresholds, whereas in the control group oxygen management was guided solely by pulse oximetry. The primary outcome was the mean intraoperative FiO2 administered during OLV and throughout the entire surgery. Secondary outcomes included serum and tracheal aspirate levels of interleukin-6 (IL-6), superoxide dismutase (SOD), and malondialdehyde (MDA), postoperative pulmonary complications, and surgical site infections. RESULT(S): Mean intraoperative FiO2 was significantly lower in the ORi group compared with the control group during OLV and across total surgery duration (p < 0.001). Oxygen saturation and ventilatory parameters were comparable between groups. Biomarker levels showed significant time-dependent changes; however, no significant differences were observed between groups, and no significant group x time interaction was detected. The incidence of postoperative pulmonary complications and surgical site infections did not differ between groups. CONCLUSION(S): ORi-guided oxygen titration during OLV enables safe reduction of intraoperative FiO2 while maintaining adequate oxygenation. Although this strategy did not translate into measurable differences in oxidative stress biomarkers or postoperative complications, these findings provide important clinical evidence regarding the physiological impact of moderate hyperoxia in thoracic surgery. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT07359833. First submission date: 17.01.2026 Retrospectively registered on 21.1.2026. Copyright © 2026. The Author(s). <103> Accession Number 2046895961 Title Robotic versus traditional coronary artery bypass grafting (CABG): A dual-phase meta-analysis comparing human and AI-derived evidence. Source American Journal of Surgery. 260 (no pagination), 2026. Article Number: 117072. Date of Publication: 01 Oct 2026. Author Georginian N.; Wijeewera C.; Tran H.T.; Wilson H.; Carney T.; Wilson M.K.; Preda V.A. Institution (Georginian, Wilson, Preda) Macquarie University Hospital, 2 Technology Place Macquarie Park, Sydney, Australia (Wilson, Carney, Wilson) SurgicalXR, Suite 203, 2 Technology Place Macquarie Park, Sydney, NSW, Australia (Wijeewera) Bairnsdale Regional Health Service, East Gippsland, Victoria, NSW, Australia (Tran) Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia (Preda) Faculty of Medicine Health and Human Sciences, Macquarie University, Suite 407, 2 Technology Place, Sydney, NSW, Australia Publisher Elsevier Inc. Abstract Background: Robotic-assisted coronary artery bypass grafting (CABG) is gaining attention as a viable alternative to traditional CABG with reported benefits secondary to reduced invasiveness of procedure. Despite this, advantages, the impact of robotic-assisted CABG on critical outcomes such as graft patency, mortality, and need for reintervention remains incompletely defined. The emergence of artificial intelligence (AI) based large language models (LLMs) promise the ability to rapidly deliver robust secondarily derived data, like that obtained from gold standard human meta-analyses. However, there is a lack of direct comparison between these modalities, preventing adoption of these tools in clinical practice. Method(s): We conduct a dual-phase study, by first performing a rigorous, traditional human-led systematic review and meta-analysis comparing robotic-assisted CABG with traditional CABG with respect to graft patency, mortality, reintervention rates, and operative time. In the second phase, we compare outputs of flagship multimodal LLMs from five major vendors-OpenAI (GPT-4o), Anthropic (Claude Sonnet 4), xAI (Grok 3), Google (Gemini 2.5 Pro), and High-Flyer (DeepSeek-R1)-to the same clinical question, called via public, and domain specific API. Sensitivity analyses were performed excluding studies comparing robotic-assisted CABG with conventional minimally invasive direct CABG (MIDCAB) to address procedural heterogeneity. Result(s): Meta-analysis of 27 studies found no significant differences between robotic and conventional CABG in reintervention (OR 0.92, 95% CI 0.61-1.38), mortality (OR 0.65, 95% CI 0.38-1.13), or graft patency (P = 0.29). Sensitivity analysis excluding MIDCAB comparator studies did not materially alter these findings. Operative time analyses showed heterogeneous results: pooled estimates suggested shorter times with robotic CABG, but subgroup analyses revealed longer durations for multi-vessel procedures and shorter harvest times for single ITA grafts. Overall, robotic CABG demonstrated comparable outcomes to conventional surgery. Conclusion(s): Operative time findings were heterogeneous, with shorter durations observed in single-vessel procedures and longer operative times in multivessel robotic CABG. Domain-specific orchestration-such as that employed by CardioCanon-can substantially improve the clinical fidelity and interpretive quality of AI-generated evidence synthesis in cardiovascular surgery. Human oversight remains essential for robust use of AI and LLM in clinical research. Copyright © 2026 The Author(s) <104> Accession Number 2046866323 Title Surgical Repair of the Aortic Valve in Children: A State-of-the-Art Systematic Review. Source Journal of Cardiac Surgery. 2026(1) (no pagination), 2026. Article Number: 6691434. Date of Publication: 2026. Author Semyashkin A.; Sandica A.; Gherta L.; Ben Mime L. Institution (Semyashkin) Department of Pediatric Cardiac Surgery and Congenital Heart Defects, Klinikum Stuttgart, Stuttgart, Germany (Sandica, Gherta, Ben Mime) Ruhr University Bochum, University Hospital Herz- und Diabeteszentrum NRW, Center for Congenital Heart Defects and Pediatric Heart Center, Pediatric Heart Surgery, Bad Oeynhausen, Germany (Sandica, Gherta, Ben Mime) Bielefeld University, Medical School OWL, Bad Oeynhausen, Germany Publisher John Wiley and Sons Inc Abstract Aortic valve repair in children remains an important strategy to preserve native valve tissue, avoid prosthetic valve replacement, and accommodate somatic growth. However, outcomes vary substantially across repair techniques, valve morphologies, and patient subgroups. We performed a systematic review with quantitative synthesis of outcomes to provide a contemporary overview of surgical strategies and long-term results of pediatric aortic valve repair. PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were searched for studies published between January 2000 and January 2026 reporting outcomes of surgical aortic valve repair in patients aged <= 18 years. Thirty-four studies, including 2684 children, were analyzed. Repair strategies included commissurotomy, leaflet plication, cusp extension or tricuspidization, annuloplasty-based techniques, pericardial leaflet reconstruction, and aortic valve neocuspidization. Early mortality after pediatric aortic valve repair was low overall (1.3%; 95% confidence interval [CI]: 0.7%-2.1%) but higher in neonates and infants. Long-term durability differed by technique and underlying pathology. Autologous pericardial cusp extension and tricuspidization demonstrated favorable long-term durability in selected patients, with freedom from reoperation approaching 75% at 15 years in some series. Valve neocuspidization was associated with excellent early hemodynamics and no early mortality in the included studies, but currently available pediatric data suggest less certain mid-term durability, with estimated freedom from reintervention of 44% at 10 years; however, interpretation is limited by small sample sizes and relatively short follow-up. Younger age at repair and the use of treated xenograft material were associated with increased risk of reintervention. Pediatric aortic valve repair provides low operative mortality and favorable valve preservation in carefully selected patients, but outcomes depend strongly on patient age, valve morphology, surgical technique, and institutional experience. Pooled estimates should be interpreted cautiously in view of substantial clinical heterogeneity. Surgical decision-making should remain individualized and lesion-specific, with a strong emphasis on valve preservation whenever feasible. Copyright © 2026 Andrey Semyashkin et al. Journal of Cardiac Surgery published by John Wiley & Sons Ltd. <105> Accession Number 2046979960 Title Relationship between anatomical variations in the aortic arch and risk of aneurysm formation - a systematic review. Source European Journal of Clinical and Experimental Medicine. 24(2) (pp 406-416), 2026. Date of Publication: 2026. Author Jain S.K.; Sharma S. Institution (Jain, Sharma) Department of Anatomy, Teerthanker Mahaveer Medical College and Research Center, Teerthanker Mahaveer University, Uttar Pradesh, Moradabad, India Publisher Rzeszow University Press Abstract Introduction and aim. Anatomical variation in the aortic arch has been proposed as an aneurysm risk factor based on changed hemodynamic forces and structural stress in arterial walls. Knowledge of these variations will be valuable in optimizing surgical planning and management of risks for patients to undergo cardiovascular and thoracic procedures. This systematic review summarized existing literature to assess the relation of different variations in the aortic arch with the risk of aneurysm formation by consolidating evidence of clinical relevance and predictive markers of risk. Material and methods. We conducted our searches in seven databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, CINAHL, and ProQuest, using Boolean operators and MeSH terms. The ROBINS-I tool was used to assess the risk of bias in studies, including confounding, participant selection, and outcome reporting. GRADE was used to evaluate global certainty of evidence, which also considered consistency, directness, and precision of evidence. Studies were eligible based on strict eligibility criteria and reported findings on specific aortic arch and their potential association with aneurysm formation. Results. The review included 12 studies that varied in terms of sample size and used a mostly retrospective design. According to the findings evaluated, certain forms of the aortic arch, for example, the bovine arch and aberrant right subclavian artery, posed an increased risk of developing proximal versus distal aneurysms. Advanced imaging studies, such as 4D flow MRI and enhanced CT, aided in the selection of at-risk patients, as they described the flow pressure dynamics with detailed assessments. While several authors reported consistent associations of anatomical variation with risk, other authors found no significant correlation and thus suggested variability in clinical relevance. The general review showed both converging and divergent findings of the review about the predictive value of certain types of arch for aneurysm risk. Conclusion. This systematic review highlights the incorporation of knowledge on aortic arch variation as part of the detailed risk assessment required in aneurysmal formation among patients. Although some forms, such as the bovine arch and the aberrant right subclavian artery, did indeed demonstrate the potential to be predictive of complications, study inconsistencies provide reason for continuing research on the topic. Advanced imaging may improve medical decision-making, as patient risk stratification would be feasible with greater information on anatomical variation. Copyright © 2026 Rzeszow University Press. All rights reserved. <106> Accession Number 2046979141 Title Patient selection for complex, high-risk indicated percutaneous coronary intervention procedures: an overview. Source European Heart Journal, Supplement. 28 (pp vii3-vii13), 2026. Date of Publication: 01 Jun 2026. Author Panoulas V.; De Filippo O.; Bossard M.; Leick J.; Sacha J.; Iannaccone M.; Lux A.; Tavazzi G.; Pareek N.; Lorusso R.; Werner N. Institution (Panoulas) Harefield Hospital, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, Hill End Road, London, Harefield, United Kingdom (Panoulas) Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, Guy Scadding Building, Cale Street, London, United Kingdom (De Filippo) Division of Cardiology, Cardiovascular and Thoracic Department, Citta della Salute e della Scienza (AOU), Corso Bramante 88/90, Turin, Italy (De Filippo, Lorusso) Cardio-Thoracic Surgery Department, Maastricht University Medical Centre+, Maastricht, Netherlands (Bossard) Heart Centre, Luzerner Kantonsspital, University Research and Teaching Hospital, Spitalstrasse 16, Luzern, Switzerland (Bossard) Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, Luzern, Switzerland (Leick, Werner) Heart Centre Trier, Hospital of the Brothers of Mercy, Nordallee 1, Trier, Germany (Sacha) Department of Cardiology, University Clinical Hospital in Opole, Al. Witosa 26, Opole, Poland (Sacha) Faculty of Physical Education and Physiotherapy, Opole University of Technology, Proszkowska 76, Opole, Poland (Iannaccone) Department of Cardiology, Turin Nord Emergency Hospital, Piazza Donatori di Sangue 3, TO, Torino, Italy (Lux) Department of Cardiology, Maastricht University Medical Centre+, Maastricht, Netherlands (Lux, Lorusso) Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (Tavazzi) Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Golgi 19, Pavia, Italy (Tavazzi) Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, Pavia, Italy (Pareek) King's College Hospital NHS Foundation Trust, London, United Kingdom (Pareek) British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, United Kingdom Publisher Oxford University Press Abstract Percutaneous coronary intervention (PCI) has evolved substantially over recent decades, enabling treatment of increasingly complex coronary anatomy through major technological advances, including enhanced stent platforms, intracoronary imaging, plaque modification devices, and mechanical circulatory support (MCS). Despite these developments, coronary artery bypass grafting often remains the guideline-preferred strategy for patients with complex and prognostically significant coronary artery disease. However, patients with complex and advanced coronary artery disease are often older and burdened by greater comorbidity than those enrolled in randomized clinical trials, rendering many patients poor surgical candidates, and prompting preference for less invasive therapies to preserve quality of life. This shift has driven the emergence of complex, high-risk indicated PCI (CHIP) and protected PCI as alternative treatment strategies. CHIP encompasses both anatomical complexity and heightened procedural risk related to haemodynamic compromise and patient comorbidities. As randomized trials capture only a small subset of real-world patients and are often subject to selection bias, current practice relies heavily on observational data-derived largely from registries, expert consensus, and institutional experience-to guide selection of patients most likely to benefit from MCS support. This review synthesizes available contemporary evidence and consensus frameworks to delineate the multifactorial nature of CHIP risk, organizing key determinants into four categories: complex coronary anatomy, impaired haemodynamics, cardiac comorbidities, and non-cardiac comorbidities. Understanding how these factors influence procedural risk, patient selection, and therapeutic benefit is essential to decision-making and optimization of outcomes in this vulnerable population. 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. <107> Accession Number 2046937589 Title Effects of propofol versus sevoflurane induction on echocardiographic parameters in patients with mitral stenosis: a randomized clinical trial. Source Brazilian Journal of Anesthesiology (English Edition). 76(4) (no pagination), 2026. Article Number: 844772. Date of Publication: 01 Jul 2026. Author Sherif M.J.; BabuMS S.; Dash P.K.; Panidappu N.; Sukesan S.; Koshy T. Institution (Sherif, Dash, Sukesan, Koshy) Sree Chitra Tirunal Institute for Medical Sciences and Technology, Division of Cardiothoracic and Vascular Anesthesia, Trivandrum, India (BabuMS) All India Institute of Medical Sciences, Department of Anesthesiology, Madurai, India (Panidappu) Amrita Institute of Medical Sciences, Department of Cardiothoracic and Vascular Anesthesia, Kochi, India Publisher Elsevier Editora Ltda Abstract Background: The main aim of this study was to compare the effects of propofol and sevoflurane induction on the echocardiographic parameters of Mitral Stenosis (MS) patients. Method(s): Prospective, randomized, outcome-assessor-blinded clinical trial in 80 adults with MS undergoing mitral valve replacement. Patients were randomized to receive General Anesthesia (GA) induction with either propofol (Group P) or sevoflurane (Group S). The primary objective was to assess the changes in mean gradient after 3 minutes of GA induction. Secondary objectives were to assess the changes in echocardiographic Doppler parameters and hemodynamic variables. Result(s): Compared to pre-induction values, there was significant reduction in the peak and mean gradients as well as peak velocity, in both the groups after GA induction. The Mitral Valve Area calculated by continuity equation (MVA-c) and by pressure half time (MVA-p) were increased in Group S after GA induction. On comparison between the two groups, Group S showed lower pressure half time and greater MVA-p (p = 0.0099) and MVA-c (p = 0.0316) than Group P after GA induction. Mean arterial pressure decreased at the 1st and 3rd minute following GA induction in both groups. The Heart Rate (HR) increased at the 1st and 3rd minute in Group P whereas it reduced at both the time points in group S. Conclusion(s): Even though both anesthetic agents reduced transvalvular gradients in MS patients, sevoflurane was associated with a greater increase in estimated valve area and a reduction in heart rate compared with propofol. These findings suggest more favorable short-term hemodynamic and echocardiographic changes with sevoflurane at the studied time points. Copyright © 2026 Sociedade Brasileira de Anestesiologia <108> Accession Number 2046807889 Title Comment on "Machine learning and regression-based models for prediction of postoperative atrial fibrillation following coronary artery bypass grafting: A systematic review and meta-analysis". Source International Journal of Cardiology: Cardiovascular Risk and Prevention. 30 (no pagination), 2026. Article Number: 200667. Date of Publication: 01 Sep 2026. Author Sharma P.; Kumar A.; Verma H. Institution (Sharma) Tata Communications Limited, India (Kumar, Verma) Department of CSE, Career Point University, Kota, Rajasthan, India Publisher Elsevier B.V. <109> Accession Number 2046987101 Title Robot-Assisted Coronary Artery Bypass Versus Percutaneous Coronary Intervention in Patients With Coronary Artery Disease: A Meta-Analysis. Source Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. (no pagination), 2026. Date of Publication: 2026. Author Doma M.; Bertoli E.D.; Rovari G.; Ramadan A.; Seferasi L.; Kritya M.; Sanadgol G.; Kamel I.; Lingamsetty S.S.P.; Karara Y.; Bendaham L.C.A.R.; Hosseini M.; Geirsson A.; Brown C.R.; Goldsweig A.M. Institution (Doma, Ramadan, Sanadgol) Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Bertoli) Department of Internal Medicine, Marieta Konder Bornhausen Hospital and Maternity, Itajai, Brazil (Rovari) Hospital Universitario Antonio Pedro/Federal Fluminense University, Niteroi, Brazil (Ramadan, Kamel) Department of Internal Medicine, Boston Medical Center, MA, United States (Seferasi) Faculty of Medicine, University of Tirana, Albania (Kritya) DeBakey Heart and Vascular Institute, Houston Methodist, TX, United States (Sanadgol) General Surgery Department, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States (Lingamsetty) Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Karara) Division of Cardiovascular Medicine, Alexandria Faculty of Medicine, Egypt (Bendaham) Faculty of Medicine, Federal University of Roraima, Boa Vista, Brazil (Hosseini) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Geirsson) Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, NY, United States (Brown) Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States (Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, MA, United States Publisher SAGE Publications Ltd Abstract Objective: As alternatives to conventional coronary artery bypass grafting (CABG), robot-assisted CABG (R-CABG) and percutaneous coronary intervention (PCI) offer less invasive treatments for coronary artery disease (CAD). However, data comparing outcomes of R-CABG versus PCI are limited. Method(s): Databases were systematically searched for studies comparing R-CABG versus PCI. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs), both overall and stratified by left main or multivessel (LM+MV) or isolated left anterior descending artery (LAD) disease. Kaplan-Meier curves were digitally extracted to reconstruct individual participant data (IPD), from which hazard ratios (HRs) were estimated for survival analyses. Result(s): Six retrospective studies, including 1,896 patients (R-CABG: 894, 47.1%), were analyzed. The mean age was 63.8 +/- 11.3 years, and 78.7% were male patients. Follow-up ranged from 2 to 8 years. Overall, R-CABG was associated with a lower odds of target vessel revascularization (TVR; OR = 0.50, 95% CI: 0.27 to 0.93, P = 0.03) and myocardial infarction (MI; OR = 0.44, 95% CI: 0.26 to 0.76, P < 0.01), with no significant difference in all-cause mortality. Among patients with LM+MV disease, R-CABG reduced TVR and MI. In LAD lesions, R-CABG significantly lowered the likelihood of MI (OR = 0.18, 95% CI: 0.04 to 0.71) as well as major adverse cardiovascular events (MACE; OR = 0.51, 95% CI: 0.28 to 0.93). Time-to-event analysis from reconstructed IPD demonstrated significantly improved freedom from reintervention (HR = 0.31, 95% CI: 0.16 to 0.60) and MACE (HR = 0.24, 95% CI: 0.15 to 0.60) with R-CABG, whereas no significant difference was found for all-cause mortality. Conclusion(s): R-CABG was associated with less TVR and MI compared with PCI in CAD patients, with no difference in all-cause mortality. Copyright © The Author(s) 2026 <110> Accession Number 2046785117 Title A Trends Analysis and Scoping Review: Minimal Invasive Extracorporeal Circulation. Source Cardiovascular Engineering and Technology. (no pagination), 2026. Date of Publication: 2026. Author Hemsinli D.; Karakisi S.O.; Kilic H. Institution (Hemsinli, Karakisi) Faculty of Medicine, Department of Cardiovascular Surgery, Recep Tayyip Erdogan University, Rize, Turkey (Kilic) Faculty of Medicine, Department of Medical Biochemistry, Recep Tayyip Erdogan University, Rize, Turkey Publisher Springer Abstract Purpose: The minimal invasive extracorporeal circulation (MiECC) was developed as abiocompatible alternative to conventional cardiopulmonary bypass (cCPB), intending to mitigate haemodilution, lessen the systemic inflammatory response, and enhance organ protection. AQ2 Although the evidence base has grown over the past 30 years, there has been no systematic mappingof the evolution of research activity and its results. Method(s): The objectives are to perform a detailed analysis of the temporal, geographical, methodological, and clinical trends within MiECC research published between 1990 and 2025. Studies involving original human clinical data (randomized controlled trials, cohort studies, observational reports, methodological or protocol papers) that reported perioperative or clinical outcomes of MiECC were included. Exclusion criteria comprised reviews, meta-analyses, editorials, letters, guidelines, animal studies, and conference abstracts lacking full text. A comprehensive search of PubMed/MEDLINE, Web of Science, Scopus, and Cochrane databases was conducted up to September 2025 to gather evidence. Reference lists of included articles and relevant reviews were also screened. Data were extracted on publication year, country, sample size, study design, surgical procedure, and reported outcomes. Two reviewers independently charted the data, and discrepancies were resolved by a third reviewer. Result(s): A total of 151 studies were identified, of which 128 met eligibility criteria. Publication activity increased substantially after 2002 and peaked in 2021, with major contributions from European centres (Germany, Italy, Switzerland, Greece, and the Netherlands). Methodological/protocol papers and Randomize Controlled Trials (RCT) predominated (respectively, n = 37, n = 36). Most studies focused on coronary artery bypass grafting (CABG), while valve surgery and paediatric populations were underrepresented. Reported outcomes shifted over time: early studies emphasised transfusion and inflammatory markers, whereas more recent investigations increasingly examined renal function, neurological complications, and survival. Subgroup analyses suggested notable benefits in elderly patients, those with renal dysfunction, and individuals with low ejection fraction (EF). Conclusion(s): MiECC research has progressed from feasibility series to large multicentre trials, generating evidence for reduced transfusion requirements, attenuated inflammatory response, and better organ protection, though no clear mortality benefit has been demonstrated. Copyright © The Author(s) 2026. <111> Accession Number 2047031859 Title HLA selected red cell transfusions to prevent HLA sensitisation: a prospective, double-blinded, randomised controlled trial. Source Transplant Immunology. 97 (no pagination), 2026. Article Number: 102412. Date of Publication: 01 Aug 2026. Author McComish J.S.; Brewster J.; Brizard C.P.; Carreiro E.; Hogan C.; Hu R.; Ng I.; Paul S.; Williams D.; Zantomio D.; Daly J. Institution (McComish, Brewster, Carreiro, Daly) Australian Red Cross Lifeblood, Melbourne, Australia (Brizard) Cardiac Surgery Unit, Royal Children's Hospital, Melbourne, Australia (Hogan, Zantomio) Austin Health, Melbourne, Australia (Hu, Ng) Department of Critical Care, The University of Melbourne, Melbourne, Australia (Hu) Department of Anaesthesia, Austin Health, Melbourne, Australia (Ng, Williams) Department of Anaesthesia & Pain Management, Royal Melbourne Hospital, Melbourne, Australia (Paul) College of Life Sciences, University of Leicester, Leicester, United Kingdom (Williams) Department of Medicine, University of Melbourne, Melbourne, Australia Publisher Elsevier B.V. Abstract Human Leucocyte Antigen (HLA) sensitisation following red cell transfusion can disrupt planned transplantation and impair outcomes. We conducted a prospective, randomised controlled, double blinded, parallel arm study to evaluate the efficacy of HLA selected red cell transfusions in preventing blood donor specific HLA antibodies (bDSA). Participants were recruited to two groups: adults requiring transfusion or surgery, and paediatric cardiac surgery patients; and randomised to receive red cells selected for HLA compatibility from HLA-typed blood donors, or unselected red cells. Exclusion criteria included recent transfusions, immunoglobulin or B cell depleting treatments, and requirement for additional blood products. The primary outcome was cumulative incidence of de novo bDSA, by HLA antibody testing pre- and post-transfusion. 73 adult participants and 68 paediatric participants were randomised, with 26 and 52 respectively completing the study. Many randomised participants (40% and 59% in adult and paediatric groups respectively) received non-trial products, and there was no significant difference between treatment groups in the intention-to-treat analyses. No de novo bDSA were detected in participants who had received trial products only, while de novo bDSA were detected in participants who received unselected red cell products. Larger studies could confirm the potential to avoid HLA sensitisation by blood donor selection. Copyright © 2026 Published by Elsevier B.V. <112> Accession Number 2046632822 Title Robotic-Assisted Thoracic Surgery in the Immunotherapy Era: Navigating Altered Anatomy, Oncologic Precision, and the Future of Integrated Platforms. Source Journal of Clinical Medicine. 15(12) (no pagination), 2026. Article Number: 4485. Date of Publication: 01 Jun 2026. Author Magouliotis D.E.; Androutsopoulou V.; Cioffi U.; Brecher V.; Xanthopoulos A.; Minervini F.; Scarci M. Institution (Magouliotis, Brecher) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States (Androutsopoulou) Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, Larissa, Greece (Cioffi) Department of Surgery, University of Milan, Milan, Italy (Xanthopoulos) Department of Cardiology, University of Thessaly, Biopolis, Larissa, Greece (Minervini) Department of Thoracic Surgery, Luzern Kanton Hospital, Luzern, Switzerland (Scarci) Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare, National Health Service (NHS) Trust, London, United Kingdom Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, robotic-assisted thoracic surgery (RATS) has consolidated its position as the dominant minimally invasive platform for pulmonary resection, accounting for the majority of lobectomies and segmentectomies performed at high-volume centers in 2023. Whether RATS confers specific technical advantages in this increasingly complex operative context remains incompletely characterized. We conducted a structured narrative review of published evidence, synthesizing data from randomized controlled trials, prospective cohorts, national registry analyses, and emerging technology reports addressing RATS in the setting of neoadjuvant ICI-based therapy for NSCLC. A systematic literature search was conducted across PubMed and EMBASE using predefined search terms. Available evidence, though largely retrospective and limited by small sample sizes, consistently demonstrates that RATS after neoadjuvant chemoimmunotherapy is technically feasible and oncologically sound, with R0 resection achievable in virtually all cases. The enhanced three-dimensional visualization, tremor filtration, and instrument degrees of freedom afforded by robotic platforms appear particularly advantageous in the setting of dense hilar adhesions and fragile pulmonary vasculature. Lymph node yield, a recognized robotic advantage, is preserved or enhanced despite post-ICI fibrosis. Pooled conversion rates to thoracotomy, derived from post hoc surgical analyses of ICI trial populations rather than trials designed to measure conversion, are higher than for upfront resection; available retrospective single-center data, including one direct RATS-versus-VATS comparison, suggest lower conversion rates with RATS in experienced hands, though this conclusion requires prospective validation. Emerging platform integrations, including combined robotic bronchoscopy and thoracoscopic surgery, single-port systems, and artificial intelligence-assisted anatomical navigation, are poised to further extend the reach of minimally invasive surgery in this challenging clinical scenario. In experienced centers, RATS appears to offer a technically favorable minimally invasive platform for pulmonary resection after neoadjuvant ICI-based therapy, with potential advantages over VATS in managing immunotherapy-altered anatomy; however, this conclusion is derived from retrospective series and should be interpreted cautiously pending prospective comparative data. Prospective multicenter trials with standardized surgical endpoints are urgently needed. Copyright © 2026 by the authors. <113> Accession Number 2046664578 Title Prehabilitation in Patients Undergoing Cardiac Surgery: An Umbrella Review of Systematic Reviews and Meta-Analysis. Source Surgeries (Switzerland). 7(2) (no pagination), 2026. Article Number: 49. Date of Publication: 01 Jun 2026. Author Sidik A.I.; Khavandeev M.L.; Al-Ariki M.K.; Dontsov V.V.; Karpenko I.G.; Djumanov A.K.; Ogurchikova A.V.; Kurnosov S.A.; Shirin D. Institution (Sidik, Al-Ariki, Ogurchikova) Medical Insitute, Peoples' Friendship University of Russia, Moscow, Russian Federation (Khavandeev) Department of Cardiac Surgery, Gusak Institute of Emergency and Reconstructive Surgery, Donetsk, Russian Federation (Dontsov, Kurnosov) Moscow Regional Research and Clinical Institute Named After M.F. Vladimirsky, Moscow, Russian Federation (Karpenko) Department of Cardiac Surgery, A.A. Vishnevskiy Hospital, Kranogorsk, Russian Federation (Djumanov, Shirin) Department of Surgical Diseases No. 2, Tashkent State Medical University, Tashkent, Uzbekistan Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Method(s): We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (>=18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Result(s): Eighteen systematic reviews (published 2012-2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42-0.53), pneumonia (RR ~0.44-0.45), and atelectasis (RR ~0.49-0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5-3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH<inf>2</inf>O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50-75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusion(s): Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence. Copyright © 2026 by the authors. <114> Accession Number 2046626695 Title Depression and Suicidality in Patients with Left Ventricular Assist Devices and Advanced Cardiac Therapies: Mechanisms, Risk Factors, and Clinical Management. Source Medical sciences. 14(2) (no pagination), 2026. Article Number: 244. Date of Publication: 01 Jun 2026. Author Leivaditis V.; Mulita F.; Andrikopoulou C.; Shaska E.; Liolis E.; Mitsos S.; Grapatsas K.; Tomos P.; Baikoussis N.G. Institution (Leivaditis) Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany (Mulita, Andrikopoulou) Department of General Surgery, General Hospital of Eastern Achaia-Unit of Aigio, Aigio, Greece (Shaska) Department of Psychiatry, "Ali Mihali" Psychiatric Hospital, Vlora, Albania (Liolis) Department of Oncology, General University Hospital of Patras, Patras, Greece (Mitsos, Tomos) Department of Thoracic Surgery, Attikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Grapatsas) Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany (Baikoussis) Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: The increasing use of advanced cardiac surgical therapies, particularly left ventricular assist devices (LVADs), has improved survival in patients with end-stage heart failure. However, the psychological burden associated with these therapies-especially depression and suicidality-remains underrecognized. Objective(s): This narrative review synthesizes current evidence on the prevalence, underlying mechanisms, risk factors, screening strategies, and management of depression and suicidality in patients undergoing LVAD implantation and other advanced cardiac surgical interventions. Method(s): A structured literature search of PubMed, Embase, and Scopus was conducted for studies published between 2020 and 2025 addressing depression, suicidal ideation, suicide attempts, and psychological distress in LVAD and advanced cardiac therapy populations. Result(s): Depression affects approximately 20-42% of patients with advanced heart failure, including those supported with LVADs, while suicidal ideation is reported in up to 12% of LVAD recipients, with higher rates of suicide attempts compared to other chronic disease populations. Risk factors are multifactorial and can be categorized into patient-related, disease-related, device-related, and psychosocial domains. Proposed mechanisms include neurohormonal dysregulation, systemic inflammation, and psychological processes such as loss of autonomy and existential distress. Although validated screening tools and multidisciplinary management strategies are available, their implementation in routine clinical practice remains inconsistent. Conclusion(s): Depression and suicidality represent significant and complex challenges in patients undergoing advanced cardiac therapies, particularly LVAD support. Systematic mental health screening and integrated, multidisciplinary care models are essential to improve patient outcomes. Future research should focus on longitudinal assessment, standardized suicide risk monitoring, and the development of targeted, evidence-based interventions for this vulnerable population. Copyright © 2026 by the authors. <115> Accession Number 651506857 Title Certainty of Evidence and Procedural Durability of Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: An Umbrella Review of Meta-Analyses. Source Cardiology. (pp 1-16), 2026. Date of Publication: 13 Jun 2026. Author Simao A.C.; de Oliveira M.B.G.; Menezes Junior A.D.S. Abstract INTRODUCTION: This umbrella review aims to evaluate the certainty and consistency of the available evidence rather than to provide a new procedural comparison. We combined systematic reviews that looked at surgical septal myectomy (SM) and alcohol septal ablation (ASA) for treating symptoms of obstructive hypertrophic cardiomyopathy (oHCM) Methods: An umbrella review of meta-analyses was conducted following Cochrane and PRISMA guidelines. A systematic search of four databases was performed. Methodological quality, risk of bias, and study overlap were assessed. Quantitative synthesis was performed using a random-effects model, and the certainty of evidence was classified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULT(S): Six meta-analyses encompassing 33 distinct primary studies and 12,860 patients were incorporated, indicating substantial study overlap. ASA was associated with a significantly higher risk of reintervention compared to SM, supported by high-certainty evidence. On the other hand, for all other results, like death rates and the need for permanent pacemakers, the evidence was often considered very weak because it was inconsistent and unclear. CONCLUSION(S): Strong evidence shows that SM is a longer-lasting treatment for oHCM, as it leads to fewer reinterventions. The evidence for mortality outcomes is of very low certainty, making it impossible to draw firm conclusions about which technique is better. This review identifies current knowledge gaps regarding survival benefits to inform clinical practice and future research. Copyright S. Karger AG, Basel. <116> Accession Number 2046655540 Title Transcatheter Aortic Valve Implantation in Cancer Patients: A Contemporary Review of the Specific Challenges, the Outcomes, Risk Stratification, and Decision-Making. Source Medicina (Lithuania). 62(6) (no pagination), 2026. Article Number: 1139. Date of Publication: 01 Jun 2026. Author Keramida K.; Mavraganis G.; Masoura C.; Aznaouridis K.; Androutsopoulou V.; Tsioufis K. Institution (Keramida) Cardiology Department, General Anticancer Oncological Hospital, Agios Savvas, Athens, Greece (Mavraganis) Department of Clinical Therapeutics, Alexandra Hospital, School of Medical, National and Kapodistrian University of Athens, 80 Vas. Sofias Str., Athens, Greece (Masoura) Department of Cardiology, General Hospital of Athens "Laiko", Athens, Greece (Aznaouridis, Tsioufis) Department of Cardiology, "Hippokration" General Hospital of Athens, Athens, Greece (Androutsopoulou) Department of Cardiothoracic Surgery, University Hospital of Larissa, Larissa, Greece Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract The coexistence of cancer and severe aortic stenosis (AS) is increasing as a result of population aging and substantial improvements in cancer survival. Transcatheter aortic valve implantation (TAVI) has transformed the management of AS; however, patients with active malignancy or a history of cancer remain markedly under-represented in pivotal randomized trials. This under-representation has resulted in persistent uncertainty regarding patient selection, risk stratification, and the expected benefit of TAVI in this growing and clinically heterogeneous population. This review provides a comprehensive and contemporary synthesis of the evidence on TAVI in patients with cancer, integrating cardiovascular (CV), oncologic, and geriatric perspectives. Available data on epidemiological overlap, cancer-specific procedural challenges, and short- and long-term outcomes following TAVI are critically examined, with particular emphasis on distinctions between active cancer and cancer survivorship. Key modifiers of risk and benefit-including prior thoracic radiotherapy, competing thrombotic and bleeding risk, immunosuppression, frailty, sarcopenia, and nutritional status-are discussed in detail. Limitations of conventional surgical risk scores in oncology populations are highlighted, underscoring the need for individualized assessment beyond traditional CV metrics. Across registries and meta-analyses, TAVI is associated with high procedural success and comparable short-term outcomes in patients with and without cancer. Excess mortality observed during mid- and long-term follow-up is driven predominantly by non-CV causes related to malignancy rather than valve-related complications. Importantly, patients with cancer in remission demonstrate outcomes similar to those of non-cancer populations, whereas prognosis in active cancer is strongly influenced by disease stage, biology, and competing risks. Overall, cancer diagnosis alone should not preclude consideration of TAVI. Optimal management requires multidisciplinary, goal-oriented decision-making that integrates oncologic prognosis, functional status, and patients' priorities. As cancer survivorship continues to expand, prospective studies, integrated risk stratification tools, and closer alignment between cardio-oncology and structural heart programs are essential to guide evidence-based and equitable care. Copyright © 2026 by the authors. <117> Accession Number 2046634856 Title Cardiac Rehabilitation in the WHO Eastern Mediterranean Region: A Scoping Review with a Saudi Arabia-Focused Synthesis. Source Journal of Clinical Medicine. 15(12) (no pagination), 2026. Article Number: 4413. Date of Publication: 01 Jun 2026. Author Alghamdi W. Institution (Alghamdi) Nursing Faculty, Al-Baha University, Al-Baha 65779, Saudi Arabia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Cardiac rehabilitation (CR) is underused globally, and evidence on its availability and delivery in the World Health Organization Eastern Mediterranean Region (WHO EMR) remains fragmented. This scoping review mapped evidence on cardiac rehabilitation (CR) across countries of the World Health Organization Eastern Mediterranean Region (WHO EMR), including service availability, delivery models, participation pathways, and barriers and enablers, with focused consideration of Saudi Arabia. Studies published from 1 January 2000 to 14 January 2026 were searched in MEDLINE, Scopus, Web of Science Core Collection, CINAHL, Embase, and the WHO Index Medicus for the Eastern Mediterranean Region. Data were synthesised descriptively and narratively in accordance with scoping review methodology. Twenty-five studies met the inclusion criteria, covering eight WHO EMR countries and one regional audit. Evidence was unevenly distributed, centre-based outpatient CR predominated, and losses were most evident at referral and enrolment stages. CR evidence across the WHO EMR remains fragmented and uneven. Stronger referral pathways, greater service capacity, and flexible delivery models are needed, including in Saudi Arabia. Copyright © 2026 by the author. <118> Accession Number 2046634840 Title Atrial Fibrillation Risk Management and Emerging Therapies. Source Journal of Clinical Medicine. 15(12) (no pagination), 2026. Article Number: 4612. Date of Publication: 01 Jun 2026. Author Vaughan M.; Kaur B.; Mehta N.K. Institution (Vaughan) Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV, United States (Kaur) Department of Cardiovascular Medicine, West Virginia University School of Medicine, 1 Medical Center Dr, Box 8500, Morgantown, WV, United States (Mehta) Department of Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Atrial fibrillation (AF) is the most common tachyarrhythmia worldwide. Accompanying the increasing age of the general population, as well as an increase in underlying cardiovascular disease in the United States, is an explosive rise in the incidence and prevalence of this condition. We reviewed observational cohort studies, systematic reviews, meta-analyses, and randomized controlled trials (RCTs) to determine both underlying risk factors and treatment of AF, with particular focus on comorbid conditions influencing treatment success. Numerous studies have demonstrated a reciprocal relationship between maladaptive cardiac remodeling and AF, with the suggestion that aggressive management of both AF itself and resultant cardiovascular disease can lead to reversal of both conditions. Ultimately, many modifiable risk factors for AF exist, with treatment delays associated with a shift towards these conditions becoming unmodifiable. While a large area of focus for AF research has been on determining the optimal pharmacological strategy (i.e., rate versus rhythm control), results have been mixed, with emerging guidelines now pointing towards a flexible treatment strategy that allows for consideration of patient comorbid conditions, medication ease and affordability, and patient preference. Treatment of AF also includes prevention of thromboembolic events. In recent years, novel strategies for surgical or physical occlusion of the left atrial appendage (LAA) with devices such as the Watchman have arisen. Multiple large RCTs have demonstrated the safety and efficacy of these devices, but consideration must be given towards the patient's bleeding risk, as short-term courses of blood thinners are still considered the standard of care. Finally, emerging therapies for AF include novel drug combinations, neuromodulation devices, and potentially glucagon-like peptide receptor-1 (GLP-1) agonist medications for reduction in overall metabolic disease. Copyright © 2026 by the authors. <119> Accession Number 2046662225 Title A Review of Risk Assessment in the Evolving Heart Transplant Landscape. Source Transplantology. 7(2) (no pagination), 2026. Article Number: 14. Date of Publication: 01 Jun 2026. Author Labrada L.; Shah M.; Saiganesh P.; Inam M.; Hamad E. Institution (Labrada, Shah, Saiganesh, Hamad) Department of Medicine, Lewis Katz School of Medicine at Temple University, Temple University Hospital, Philadelphia, PA, United States (Inam) Department of Medicine, Yale School of Medicine, New Haven, CT, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Heart transplantation remains a vital therapy for patients with end-stage heart failure, yet organ scarcity and evolving allocation policies necessitate robust risk prediction models to optimize outcomes and equity. This narrative review explores the current landscape of risk assessment in heart transplantation, contextualized within the broader framework of solid organ allocation and the emerging continuous distribution (CD) model. While kidney, liver, and lung transplantation have integrated validated risk scores into allocation systems, heart transplantation continues to rely on therapy-based criteria without a unified, benefit-based approach. We examine existing pre- and post-transplant predictive models and highlight their strengths and limitations. Additionally, we discuss the multidimensional factors influencing transplant success, ranging from donor and recipient characteristics to psychosocial and system-level variables. As CD expands across organ types, the development and integration of validated heart-specific risk scores will be essential to ensure equitable and effective organ allocation. Copyright © 2026 by the authors. <120> Accession Number 2046626352 Title The Role of the Cardiothoracic Surgeon in the Age of AI-Are the Robots Going to Take Our Jobs?. Source Medical sciences. 14(2) (no pagination), 2026. Article Number: 164. Date of Publication: 01 Jun 2026. Author Streian C.-G.; Meche V.-A.; Feier H.B.; Cozma D.; Dima C.N.; Luca C.T.; Matei S.-C. Institution (Streian, Feier, Dima) Clinic of Cardiovascular Surgery, Institute of Cardiovascular Diseases of Timisoara, Gheorghe Adam Street, No. 13A, Timisoara, Romania (Streian, Feier, Dima) Department VI Cardiology-Cardiovascular Surgery Clinic, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, Timisoara, Romania (Meche) Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania (Feier, Cozma, Luca) Advanced Research Center of the Institute for Cardiovascular Diseases, Timisoara, Romania (Cozma, Luca) Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania (Cozma, Luca) Institute of Cardiovascular Diseases Timisoara, Timisoara, Romania (Matei) Abdominal Surgery and Phlebology Research Center, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania (Matei) 1st Surgical Department, Pius Brinzeu Emergency County Hospital, Timisoara, Romania Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Introduction: Artificial intelligence (AI) and robot-assisted platforms are increasingly influencing cardiothoracic surgery. AI enhances risk prediction, imaging interpretation, and early complication detection, while robotics improves visualization, dexterity, and minimally invasive access. This systematic review evaluates the current evidence supporting these technologies and their implications for clinical practice. Method(s): A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Google Scholar (January 2000-May 2025) following PRISMA 2020 guidelines. After screening and eligibility assessment, 67 studies met predefined inclusion criteria and were incorporated into the qualitative synthesis. Additional high-impact reviews and consensus documents were consulted for contextual interpretation. Result(s): Machine learning models demonstrated modest but consistent improvements in predictive performance compared with EuroSCORE II and STS scores, particularly in high-risk cohorts. Robot-assisted mitral and coronary procedures showed reduced postoperative pain, blood loss, ICU stay, and recovery time in experienced centers, though early learning phases were associated with longer operative, cross-clamp, and bypass times. AI-enabled intraoperative tools, such as video analysis, workflow recognition, and real-time anatomical segmentation, emerged as promising adjuncts for surgical precision. Structured robotic training programs, especially simulation-based and dual-console pathways, accelerated proficiency acquisition. Conclusion(s): AI and robotic systems act as augmentative technologies that enhance rather than replace the surgeon's role. Their safe and effective adoption requires standardized training, transparent AI decision pathways, and clear ethical and medico-legal governance. Copyright © 2026 by the authors. <121> Accession Number 651508463 Title Comparable survival over an extended follow-up after on-pump versus off-pump coronary artery bypass grafting: a propensity score-matched cohort. Source BMC cardiovascular disorders. (no pagination), 2026. Date of Publication: 13 Jun 2026. Author Pikkujamsa A.; Rinne P.; Wistbacka J.-O.; Hilska M. Institution (Pikkujamsa) Department of Cardiothoracic Surgery, Oulu University Hospital, Oulu, Finland (Pikkujamsa) Medical Research Center, Research Unit of Translational Medicine, University of Oulu, Oulu, Finland (Rinne) Department of Surgery, Vaasa Central Hospital, Vaasa, Finland (Wistbacka, Hilska) Department of Anaesthesiology and Intensive Care, Vaasa Central Hospital, Vaasa, Finland (Hilska) Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Faculty of Medicine, University of Turku, Turku, Finland Abstract BACKGROUND: Long-term survival following off-pump coronary artery bypass grafting (OPCAB) compared with conventional on-pump coronary artery bypass grafting (ONCAB) remains uncertain. Randomised trials and meta-analyses up to 5-10 years after procedures have demonstrated either no significant differences or modest disadvantages of OPCAB, particularly regarding completeness of revascularisation and late mortality. However, comparative data extending up to 20 years after procedure are scarce. Thus, very-long-term outcomes after ONCAB versus OPCAB in a propensity score-matched cohort were evaluated. METHOD(S): Consecutive adults undergoing isolated primary coronary artery bypass grafting between 1999 and 2016 at a single cardiac surgery centre were retrospectively identified. Patients undergoing isolated OPCAB or ONCAB procedures were included and matched in a 1:2 ratio using clinically relevant preoperative variables. The primary outcome was overall survival in the matched cohort analysed using Cox proportional hazards regression. RESULT(S): During the study period, 2,935 patients underwent isolated primary coronary artery bypass grafting (CABG), of whom 2,496 (85.0%) underwent ONCAB and 439 (15.0%) OPCAB procedures. Median survival time was 13.7 years (95% CI 13.2-14.2) and median follow-up was 12.3 years (interquartile range 8.0-17.1, maximum 23.9 years). The matched cohort consisted of 402 OPCAB patients matched to 804 ONCAB patients. Median survival time was 12.4 years (95% CI 11.9-13.2) in ONCAB and 12.6 years (95% CI 11.5-13.8) in OPCAB patients. Overall survival did not differ significantly between the groups (HR 0.95, 95% CI 0.82-1.11; ONCAB as reference). No significant differences were observed in the cumulative incidence of cardiovascular mortality. CONCLUSION(S): In this propensity score-matched cohort with follow-up extending up to 20 years, ONCAB and OPCAB were associated with comparable long-term survival and cardiovascular mortality. These findings support an individualised approach to operative technique selection based on patient characteristics and surgical expertise. Copyright © 2026. The Author(s). <122> Accession Number 2046665792 Title Carcinoid Heart Disease: Surgical Timing, Right Ventricular Risk Stratification and Operative Strategy. Source Journal of Cardiovascular Development and Disease. 13(6) (no pagination), 2026. Article Number: 254. Date of Publication: 01 Jun 2026. Author Ali-Ghosh H.; Kho J.; Leventis F.; Asopa S.; Tsang G.; Ohri S.K. Institution (Ali-Ghosh, Kho, Leventis, Asopa, Tsang, Ohri) Department of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Carcinoid heart disease is a progressive right-sided valvulopathy caused by serotonin and other vasoactive mediators released by metastatic neuroendocrine tumours. As oncological therapies have extended survival, cardiac disease has become a leading determinant of mortality. Operative mortality has decreased to 5-6% in contemporary high-volume centres, and long-term survival appears increasingly determined by tumour biology rather than cardiac disease when surgery is appropriately timed. The principal determinant of operative outcome is preoperative right ventricular function; symptom-based referral alone is insufficient because many patients remain compensated until ventricular dysfunction is advanced. This review synthesises the evidence on surgical timing, operative strategy, prosthesis selection, perioperative endocrine management, and emerging transcatheter options. Tricuspid valve replacement is required in the majority of patients, with concomitant pulmonary valve replacement advocated where concurrent disease is present. Bioprosthetic valves are preferred. Continuous perioperative octreotide infusion has substantially reduced the incidence of carcinoid crisis. Structured multidisciplinary decision-making integrating echocardiographic surveillance, biomarker monitoring, and oncological status assessment is essential. Copyright © 2026 by the authors. <123> Accession Number 2047027471 Title Safety and efficacy of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in patients with bicuspid aortic stenosis: A Systematic review and meta-analysis. Source Perfusion (United Kingdom). (no pagination), 2026. Date of Publication: 2026. Author Gadelmawla A.F.; Mansour A.; Elbataa A.; Asiri O.H.; Alharbi A.A.; Alquraish F.A.; Al-Ibrahim F.S.; AlHasani A.F.; Alharbi T.N.; Al Murayyi R.M.; Alotaibi A.G.; Abdul-Hafez H.A.; Suliman I. Institution (Gadelmawla) Faculty of Medicine, Menoufia University, Menoufia, Egypt (Mansour, Elbataa) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Asiri, Al Murayyi) College of Medicine, King Khalid University, Abha, Saudi Arabia (Alharbi) College of Medicine and Surgery, Taibah University, Medina, Saudi Arabia (Alquraish, Al-Ibrahim) College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (AlHasani) College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Alharbi) College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (Alotaibi) Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Abdul-Hafez) Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine (Suliman) King Abdulaziz Medical City, King Abdulaziz Cardiac Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia Publisher SAGE Publications Ltd Abstract Background: Bicuspid aortic valve (BAV) disease is a leading cause of aortic stenosis (AS). Surgical aortic valve replacement (SAVR) has traditionally been regarded as the best therapeutic option for bicuspid AS. However, the distinctive anatomical characteristics of BAV make the treatment with transcatheter aortic valve replacement (TAVR) challenging, so this population was often excluded from the trials. We aimed to compare TAVR and SAVR in terms of safety and efficacy in the population with bicuspid AS. Method(s): We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, searched from PubMed, Cochrane, Scopus, and Web of Science (from inception until September 2025). Dichotomous outcomes were pooled as risk ratios (RRs), and continuous outcomes as mean differences (MDs), each with 95% confidence intervals (CIs). Result(s): A total of 78,677 patients were included in one RCT, 12 retrospective cohort studies, and one prospective cohort study. TAVR, compared to SAVR, was associated with significantly higher rates of permanent pacemaker implantation (PPI) (O.R. = 2.29, 95% C.I. [1.51, 3.47], P < 0.01) and shorter length of hospital stay (M.D. = -2.24, 95% C.I. [-3.96, -0.52], P = 0.01) and lower bleeding rates (O.R. = 0.31, 95% C.I. [0.14, 0.69], P < 0.01). However, there were no significant differences in all-cause mortality (ACM) (P = 0.948), acute kidney injury (AKI) (P = 0.28), stroke incidence (P = 0.475), and vascular complications (P = 0.31). The PPI and stroke rate results were consistent during in-hospital and short-term follow-ups. However, subgroup analysis by follow-up duration revealed that long-term stroke incidence was significantly higher in the TAVI group. Conclusion(s): TAVR offers benefit by minimizing significant bleeding and hospital length of stay. However, the benefits should be balanced against the considerably increased risk of PPI and PVL. Further RCTs are needed to confirm these findings. Copyright © The Author(s) 2026 <124> Accession Number 2046873729 Title Spindle Cell Cardiac Lipoma in an Adolescent: A Case Report and Systematic Review of Cases. Source JACC: Case Reports. (no pagination), 2026. Article Number: 108811. Date of Publication: 2026. Author Soh S.L.; Wee I.J.Y.; Murray Binti Jeffery Murray R.L.; Sivalingam S.; Roslan A. Institution (Soh, Murray Binti Jeffery Murray, Sivalingam) Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia (Wee) Health Services Research Unit, Singapore General Hospital, Singapore, Singapore (Roslan) Department of Cardiology, Sunway Medical Centre, Kuala Lumpur, Malaysia Publisher Elsevier Inc. Abstract Background: Spindle cell lipoma is a benign adipocytic neoplasm that typically arises in subcutaneous soft tissues and is exceptionally rare in the heart. Case Summary: A 13-year-old male patient was referred for evaluation of a cardiac murmur. Transthoracic echocardiography demonstrated multiple intracardiac masses involving the aortic valve, interventricular septum, and posterior left ventricular wall, resulting in severe aortic regurgitation and moderate aortic stenosis. Cardiac magnetic resonance imaging revealed a large lobulated mass arising from the left coronary cusp of the aortic valve with extension into the left ventricular outflow tract. Given diagnostic uncertainty, surgical resection with mechanical aortic valve replacement was performed. Histopathology confirmed a spindle cell lipoma. Recovery was uncomplicated, with no residual mass on follow-up imaging. Discussion(s): A systematic review identified only 2 previously reported adult cases, both involving cardiac valves. Imaging was nonspecific, and definitive diagnosis relied on histopathology. Take-Home Message: Spindle cell cardiac lipoma is a rare but clinically significant cause of valvular cardiac masses; histopathological confirmation is essential, and surgical excision appears curative. Copyright © 2026 The Authors <125> Accession Number 2046979176 Title Protected complex high-risk indicated percutaneous coronary intervention in severe left ventricular dysfunction: an illustrative case highlighting patient selection, procedural planning, execution, and device management. Source European Heart Journal, Supplement. 28 (pp vii14-vii19), 2026. Date of Publication: 01 Jun 2026. Author Ezad S.M.; Alkhalil M.; Monteagudo-Vela M.; Vandenbriele C.; Panoulas V.; Mangner N. Institution (Ezad) British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, Rayne Institute, St Thomas' Hospital, London, United Kingdom (Ezad) Dorset Heart Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, United Kingdom (Alkhalil) Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom (Alkhalil) Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (Monteagudo-Vela, Panoulas) Harefield Hospital, Royal Brompton and Harefield Hospitals, part of Guy's and St Thomas' NHS Foundation Trust, Hill End Road, Harefield, London, United Kingdom (Vandenbriele) Heart Center AZORG, Campus Moorselbaan, Moorselbaan 164, Aalst, Belgium (Vandenbriele) Cardiac Intensive Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Vandenbriele) Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Exhibition Road, London, United Kingdom (Panoulas) Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, Royal Brompton Campus, Guy Scadding Building, Cale Street, London, United Kingdom (Mangner) Department of Internal Medicine and Cardiology, Heart Centre Dresden, University Hospital, Technische Universitat Dresden, Fetscherstrase 76, Dresden, Germany Publisher Oxford University Press Abstract Ischaemic left ventricular dysfunction (ILVD) is the leading cause of heart failure and is commonly encountered in cardiac catheterization laboratories. Patients presenting with ILVD are typically older and often have complex coronary anatomy, making revascularization challenging. Although coronary artery bypass grafting improves long-term survival in patients with ILVD compared with medical therapy, the benefit emerges only after a decade and appears limited to younger patients, leaving many older, frail, or comorbid individuals at untenable risk. Such patients are frequently considered for complex high-risk indicated percutaneous coronary intervention (CHIP), where the primary determinant of procedural risk is intra-procedural haemodynamic instability due to limited ventricular reserve and anticipated prolonged ischaemia. Registry data underscore the heightened risk in patients with multiple CHIP features, including ejection fraction <=30%, left main or multivessel percutaneous coronary intervention, and extensive calcification. Here, temporary mechanical circulatory support has emerged as a strategy to mitigate haemodynamic compromise during CHIP procedures. Although trial data have demonstrated no early benefit with the intra-aortic balloon pump, long-term follow-up suggests improved survival. Alternatively, microaxial flow pumps, such as ImpellaTM, can offer robust haemodynamic support and a reduction in late major adverse events. Although results from the ongoing randomized clinical trials with Impella are pending, careful Heart Team evaluation and procedural planning remain essential to ensure the best possible patient outcomes. Here, we illustrate a structured approach to Impella-supported CHIP in an elderly patient with the presence of ILVD, severely impaired ventricular reserve, and heavily calcified multivessel disease. 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. <126> Accession Number 2046665722 Title Lipoprotein(a) Levels, Risk of Cardiovascular Events, and Benefit of Evolocumab: Findings From the VESALIUS-CV Trial. Source Circulation. 153(25) (no pagination), 2026. Date of Publication: 23 Jun 2026. Author Monguillon V.; Marston N.A.; Bohula E.A.; Park J.-G.; Kuder J.F.; Murphy S.A.; De Ferrari G.M.; Leiter L.A.; Nicolau J.C.; Ebenbichler C.; Sinnaeve P.; Goudev A.; Budaj A.; Averkov O.; Tokgozoglu L.; Blankstein R.; Vinereanu D.; Giugliano R.P.; Sabatine M.S.; O'Donoghue M.L. Institution (Monguillon, Marston, Bohula, Park, Kuder, Murphy, Giugliano, Sabatine, O'Donoghue) TIMI (Thrombolysis in Myocardial Infarction Study) Group, Boston, MA, United States (Monguillon, Marston, Bohula, Park, Kuder, Murphy, Blankstein, Giugliano, Sabatine, O'Donoghue) Heart Vascular Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States (Blankstein) Department of Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States (De Ferrari) Cardiology Division, Department of Medical Sciences, University of Turin and Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza, Italy (Leiter) Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Canada (Nicolau) Instituto do Coracao (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil (Ebenbichler) Department of Internal Medicine I, Medical University Innsbruck, Australia (Sinnaeve) Department of Cardiology, Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Belgium (Goudev) Division of Cardiology, Medical University of Sofia, Bulgaria (Budaj) Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland (Averkov) Pirogov Russian National Research Medical University and Hadassah Medical Ltd, Moscow, Russian Federation (Tokgozoglu) Department of Cardiology, Hacettepe University, Ankara, Turkey (Vinereanu) Cardiology and Cardiovascular Surgery Department, University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Lp(a) (lipoprotein[a]) is a risk factor for coronary heart disease. Whether baseline Lp(a) identifies higher-risk patients who derive more benefit from evolocumab is not established in a population without previous myocardial infarction (MI) or stroke. METHOD(S): - From June 2019 to November 2021, the VESALIUS-CV trial (Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarctions or Stroke) enrolled patients with qualifying atherosclerosis or high-risk diabetes without previous MI or stroke and randomized them to evolocumab or placebo (median follow-up 4.6 years). In a prespecified analysis, Lp(a) was assessed at baseline in 7557 patients. Cox models were used to assess the adjusted risk of cardiovascular events by baseline Lp(a) in the placebo arm, and the efficacy of evolocumab by baseline Lp(a). The primary outcome of interest was the composite of major coronary events (coronary heart disease death, MI, or urgent coronary revascularization). RESULT(S): - Median age was 66 [interquartile range, 60-71] years, and 42.8% were women; median Lp(a) was 28 [interquartile range, 9-132] nmol/L. Higher baseline Lp(a) was associated with an increased risk of major coronary events (adjusted hazard ratio [HR<inf>adjusted</inf>] per 100 nmol/L increase in Lp(a), 1.15 [95% CI, 1.05-1.26]; P=0.004), particularly for MI (HR<inf>adjusted</inf>, 1.23 [95% CI, 1.10-1.38]; P<0.001). There was no association between Lp(a) and ischemic stroke (HR<inf>adjusted</inf>, 1.00 [95% CI, 0.84-1.19]; P=0.99). After 48 weeks, evolocumab reduced LDL-C (low-density lipoprotein cholesterol) by 66.8 mg/dL and Lp(a) by 38.0 nmol/L in patients with baseline Lp(a) >105 nmol/L versus 61.1 mg/dL and 6.0 nmol/L in those with baseline Lp(a) <=105 nmol/L. The relative reductions in the rate of major coronary events were 41% (HR, 0.59 [95% CI, 0.41-0.83]) in those with Lp(a) >105 nmol/L compared with 35% (HR, 0.65 [95% CI, 0.51-0.82]) in those below (P-interaction=0.45 for Lp[a] modeled as continuous variable). The corresponding absolute reductions were 3.7% versus 2.5% (P-interaction=0.09), corresponding to a number needed to treat of 28 versus 40 to prevent 1 major coronary event at 5 years. CONCLUSION(S): - In patients with atherosclerosis or high-risk diabetes but without previous MI or stroke, Lp(a) was independently associated with an increased risk of major coronary events but not ischemic stroke. Evolocumab reduced the relative risk of major coronary events to a similar degree irrespective of baseline Lp(a), with a numerically greater absolute risk reduction in patients with elevated Lp(a). REGISTRATION: - URL: https://www.clinicaltrials.gov; Unique identifier: NCT03872401. Copyright © 2026 American Heart Association, Inc. <127> Accession Number 2046600966 Title Letter to the editor: comments on 'Intercostal nerve cryoablation for postoperative analgesia in open thoracic surgical procedures: a GRADE-assessed systematic review and meta-analysis'. Source Cardiothoracic Surgeon. 34(1) (no pagination), 2026. Article Number: 28. Date of Publication: 01 Dec 2026. Author Zainulabedin F.; Mehmood Q.U.A.; Naeem M.; Shahid M. Institution (Zainulabedin, Mehmood, Naeem, Shahid) Jinnah Sindh Medical University, Rafiqui H.J. Shaheed Road, Karachi, Pakistan Publisher Springer Science and Business Media Deutschland GmbH <128> Accession Number 2046905452 Title Efficacy of Adding Ultrasound-guided Bilateral Erector Spinae Block to Standard Anaesthesia Care Versus General Anaesthesia in Patients Undergoing Single-level Transforaminal Lumbar Interbody Fusion Surgery: A Double-blinded Randomised Controlled Study. Source Apollo Medicine. 23(4) (pp 318-325), 2026. Date of Publication: 01 Jul 2026. Author Vineetha S.; Roopan V. Institution (Vineetha, Roopan) Department of Anaesthesiology, Apollo Hospitals, Tamil Nadu, Chennai, India Publisher SAGE Publications Ltd Abstract Introduction: The erector spinae plane (ESP) block, introduced in 2016, is a fascial plane block gaining popularity for its analgesic efficacy in multiple cardiac, thoracic and abdominal surgeries. It involves injecting local anaesthetic deep into the erector spinae muscles. Multiple large retrospective and prospective studies have shown the efficacy of ESP blocks in various surgeries, and we determined to evaluate them in Spinal surgeries. Method(s): This study evaluated the efficacy of erector spinae block in single-level lumbar fusion surgery. Pain scores, surgical field, opioid use and adverse effects were compared in a double-blind randomised controlled trial (RCT). The block group received 20 mL of 0.375% ropivacaine on each side and the control group received 20 mL of 0.9% normal saline. Result(s): The ESP block group showed lower pain scores in the post anaesthesia care unit (PACU) and up to eight hours postoperatively, with 82.4% requiring no additional analgesia, unlike the control group, where all patients needed supplements like tramadol or buprenorphine. Surgical field conditions, assessed using Boezaart's grading scale, were significantly better up to 30 minutes after incision. Although blood loss differences were statistically significant (P = .048), correlation was weak. Adverse effects, including constipation, nausea and drowsiness, were higher in the control group due to greater opioid use. Conclusion(s): The ultrasound-guided ESP block is a practical, feasible analgesic modality for lumbar spine surgeries, suitable for multimodal and opioid-sparing analgesia. Copyright © 2025 The Author(s). This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). <129> [Use Link to view the full text] Accession Number 2046661680 Title Direct Oral Anticoagulant Monotherapy Versus Dual Antiplatelet Therapy After Left Atrial Appendage Closure: A Meta-Analysis of Randomized Trials. Source Circulation: Cardiovascular Interventions. 19(6) (no pagination), 2026. Date of Publication: 01 Jun 2026. Author Ammirabile N.; Giacoppo D.; Mazzone P.M.; Landolina D.; Capodanno D. Institution (Ammirabile, Giacoppo, Mazzone, Capodanno) Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico G. Rodolico-San Marco, University of Catania, Italy (Landolina) Cardiology Unit, Umberto I Hospital, Siracusa, Italy Publisher Lippincott Williams and Wilkins <130> [Use Link to view the full text] Accession Number 2046665710 Title Pulsed Field Ablation Versus Sham to Treat Atrial Fibrillation: The PFA-SHAM Randomized Clinical Trial. Source Circulation. 153(25) (pp 1984-1998), 2026. Date of Publication: 23 Jun 2026. Author Osmancik P.; Neuzil P.; Hozmanova J.; Petru J.; Herman D.; Kralovec S.; Hozman M.; Tichy M.; Waldauf P.; Karel T.; Sediva L.; Fischer J.; Stepanek L.; Mala I.; Lekesova V.; Hala P.; Funasako M.; Vesela J.; Filipcova V.; Karch J.; Whang W.; Reddy V.Y. Institution (Osmancik, Hozmanova, Herman, Hozman, Vesela, Filipcova, Karch) Cardiocenter, Third Faculty of Medicine (P.O., J.H., D.H., M.H., J.V., V.F., J.K.), Charles University Prague and University Hospital Kralovske Vinohrady, Czechia (Waldauf) Department of Anesthesiology (P.W.), Charles University Prague and University Hospital Kralovske Vinohrady, Czechia (Neuzil, Petru, Kralovec, Tichy, Sediva, Lekesova, Hala, Funasako, Reddy) Department of Cardiology, 1st Faculty of Medicine, harles University and Faculty Hospitals Motol and Homolka, Prague, Czechia (Karel, Fischer, Stepanek, Mala) Department of Statistical Analyses, Prague University of Economics and Business, Czechia (Whang) Helmsley Electrophysiology Center, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Catheter ablation for atrial fibrillation (AF) is one of the most common cardiovascular procedures being performed worldwide. Despite the large body of evidence of its effectiveness, with a single exception, prior ablation studies were largely unblinded trials. Accordingly, residual concerns remained about placebo effects, both for AF recurrence and, in particular, on subjective outcomes such as quality of life or anxiety. Here, we compared pulsed field ablation (PFA) with a sham procedure to treat patients with symptomatic AF. METHOD(S): - This prospective, sham-controlled, single-blind, randomized clinical trial with blinded end-point assessment enrolled patients with AF that was highly symptomatic (Atrial Fibrillation Effect on Quality-of-Life score <50). Patients were assigned 1:1 to PFA or a sham procedure. All participants received implantable cardiac monitors for continuous rhythm monitoring during follow-up. The 6-month co-primary outcomes were (1) time to first recurrence of atrial tachyarrhythmia and (2) changes from baseline in Atrial Fibrillation Effect on Quality-of-Life scores compared between groups. Secondary outcomes were AF burden and psychological distress (assessed by the Hospital Anxiety and Depression Scale [HADS]). RESULT(S): - Patients (n=60) were randomized to PFA or sham. At 6 months, the first co-primary end point of AF recurrence was met in 2 patients (6.7%) who underwent PFA and 25 patients (83.3%) who underwent sham (posterior hazard ratio, 19.6 [95% bayesian credible intervals, 6.7-76.9]; posterior probability of superiority >0.99). For the second co-primary end point, Atrial Fibrillation Effect on Quality-of-Life scores showed greater improvement from baseline with PFA than sham (improved by 43.9+18.1 points versus 11.3+27.9 points; posterior median difference, 32.6 [95% bayesian credible interval, 20.2-44.9]; posterior probability of superiority >0.99). AF burden at 6 months was significantly lower in the PFA than the sham group (0 [0-0] versus 0.43 [0.04-3.47]; between group median difference, -0.39 [95% credible interval, -2.5 to -0.1], posterior probability of superiority >0.99). The Hospital Anxiety and Depression Scale score changed by -4 points (-7.8 to -2.0) with PFA and by -0.5 (-4.5 to 1.0) with sham (group median difference, -3.5 [95% credible interval, -6.0 to -1.0]; posterior probability of superiority >0.99). CONCLUSION(S): - In patients with AF, PFA was superior to sham in reducing arrhythmia recurrences and burden and improving quality of life and AF-associated psychological distress. REGISTRATION: - URL: https://www.clinicaltrials.gov; Unique identifier: NCT05717725. Copyright © 2026 American Heart Association, Inc. <131> Accession Number 2038287491 Title Pharmacist-integrated early screening for postoperative complications in pediatric cardiac surgery: Evidence synthesis and derivation of the pediatric early complication score. Source Pharmacy Practice. 24(2) (no pagination), 2026. Article Number: 3598. Date of Publication: 01 Apr 2026. Author Chidnok W.; Wienghirun J.; Lin C.; Poowaruttanawiwit P. Institution (Chidnok) Department of Physical Therapy, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand (Chidnok) Exercise and Rehabilitation Sciences Research Unit, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, Thailand (Wienghirun, Lin, Poowaruttanawiwit) Medical and Pharmaceutical Innovation Research and Development Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand (Poowaruttanawiwit) Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand Publisher Grupo de Investigacion en Atencion Farmaceutica Abstract Background: Early postoperative complications remain a major determinant of morbidity and mortality in pediatric cardiac surgery despite improved survival. Conventional risk systems such as Risk Adjustment for Congenital Heart Surgery (RACHS) and Risk Adjusted Surgical Complexity Hierarchy (RASCH) focus on procedural complexity and mortality rather than real-time complication prediction. Objective(s): This systematic review and meta-analysis aimed to quantify the pooled incidence and predictors of early postoperative complications and to derive a concise, evidence-based Pediatric Early Complication Score (PECS) to support early screening and pharmacist-integrated care. Method(s): Eligible studies enrolled patients <18 years undergoing congenital heart surgery and reported extractable complication incidences or predictor-adjusted effects. Data were pooled using random-effects meta-analysis with prespecified thresholds (e.g., cardiopulmonary bypass [CPB] >=120 minutes, C-reactive protein [CRP] >118 mg/L). Internal validity was reinforced by preregistration, standardized definitions, duplicate assessment, adjusted-effect preference, and ROBINS-I/RoB2 risk-of-bias tools. Result(s): Across 13 observational studies (n=25,000) and two randomized trials, higher operative complexity (RACHS 3-6 or RASCH-2 >=4), prolonged CPB exposure, neonatal age (<=60 days), and elevated CRP/D-dimer were consistently associated with approximately threefold higher early-complication risk (pooled adjusted effect =2.8, 95% CI 2.03-3.88, I2=23%). These reproducible predictors were transformed into integer points (4, 2, 2, 2, 1 respectively) to form the PECS, which stratifies patients into low (0-3), moderate (4-6), and high (>=7) risk tiers via a logistic probability link. Conclusion(s): The PECS offers a transparent, internally valid, and clinically tractable bedside tool integrating surgical complexity, CPB duration, age, and inflammatory response to predict early postoperative complications. Its pragmatic design supports pharmacist-led, prevention-focused care and warrants multicenter calibration and external validation. Copyright © the Authors. <132> Accession Number 2038281813 Title Perioperative albumin versus other fluids to prevent cardiac surgery-associated kidney injury: a systematic review and meta-analysis of randomized trials. Source Critical Care Science. 38 (no pagination), 2026. Article Number: e20260353. Date of Publication: 2026. Author Darlison P.R.; Shehabi Y.; Walker H.G.M.; Neto A.S.; Motorniak D.C.; Pakavakis A.; Balachandran M.; Wigmore G.J.; Bellomo R.; Brown A.J.W. Institution (Darlison) Department of Anaesthesia, Perioperative Medicine, and Pain Medicine, Peter MacCallum Cancer Centre-Melbourne, VIC, Australia (Darlison, Walker, Motorniak, Brown) Department of Critical Care Medicine, St Vincent's Hospital Melbourne-Fitzroy, VIC, Australia (Darlison) Sir Peter MacCallum, Department of Oncology, The University of Melbourne-Melbourne, VIC, Australia (Shehabi, Pakavakis) School of Clinical Sciences at Monash Health, Monash University-Clayton, VIC, Australia (Shehabi, Pakavakis, Balachandran) Department of Intensive Care, Monash Medical Centre-Clayton, VIC, Australia (Shehabi, Pakavakis, Balachandran) Department of Intensive Care, The Victorian Heart Hospital-Clayton, VIC, Australia (Shehabi) Prince of Wales Clinical School of Medicine, University of New South Wales-Randwick, NSW, Australia (Walker, Neto, Wigmore, Bellomo, Brown) Department of Critical Care, University of Melbourne-Melbourne, VIC, Australia (Neto, Bellomo, Brown) Australia and New Zealand Intensive Care Research Centre, Monash University-Clayton, VIC, Australia (Neto, Bellomo, Brown) Intensive Care Unit, Austin Health-Heidelberg, VIC, Australia (Neto) Department of Critical Care Medicine, Hospital Israelita Albert Einstein, SP, Sao Paulo, Brazil (Motorniak, Wigmore) Faculty of Medicine, Nursing and Health Sciences, Monash University-Clayton, VIC, Australia Publisher Associacao de Medicina Intensiva Brasileira - AMIB Abstract Objective: Cardiac surgery-associated acute kidney injury is a common and serious complication of cardiac surgery. Albumin solution is a commonly administered fluid in cardiac surgery patients; the role of albumin in preventing cardiac surgery-associated acute kidney injury is unclear. The objective of this systematic review and meta-analysis was to evaluate the impact of perioperative albumin compared with other fluid regimens on the risk of acute kidney injury in cardiac surgical patients undergoing cardiopulmonary bypass. Method(s): A systematic search was performed of MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases, and the Australian New Zealand Clinical Trials Registry, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and ISRCTN registries. Randomized trials of adult patients undergoing on-bypass cardiac surgery comparing albumin-containing solutions with any other fluid regimen given perioperatively were included. Trials comparing fluids used only for bypass priming were excluded. Data extraction, risk of bias, and certainty of evidence were assessed in duplicate by independent reviewers. A Bayesian framework was the primary statistical approach, with a secondary frequentist approach. The primary outcome was perioperative acute kidney injury, defined as the period from surgery until hospital discharge. Secondary outcomes were all-cause mortality at longest follow-up, intensive care unit length of stay, hospital length of stay, proportion of patients requiring renal replacement therapy postoperatively, duration of mechanical ventilation postoperatively, and duration of vasopressor support postoperatively. Result(s): Fourteen randomized trials, including 3,304 adults, were included in the analysis. Seven trials contributed data to the primary outcome. Four trials had an overall low risk of bias across all domains and outcomes. The pooled estimated risk ratio for acute kidney injury with albumin solutions was 1.09 (95% credible interval 0.86-1.34, tau = 0.12; I2 = 31.5%), with a 18.3% posterior probability of reduced acute kidney injury. There were no significant subgroup effects or differences in secondary outcomes. Conclusion(s): Among patients undergoing on-bypass cardiac surgery, the use of albumin solutions is unlikely to reduce the risk of acute kidney injury. Other interventions need to be considered for this condition. Copyright © 2026, Associacao de Medicina Intensiva Brasileira - AMIB. All rights reserved. <133> Accession Number 2046873894 Title Coagulopathy in Cardiac Surgery: A Scoping Review of Prothrombin Complex Concentrate. Source Heart Lung and Circulation. (no pagination), 2026. Date of Publication: 2026. Author Vander Zwaag S.; Kukel I.; Fassl J. Institution (Vander Zwaag, Kukel, Fassl) Institute of Cardiac Anaesthesiology, Heart Centre and Medical Faculty, TUD Dresden University of Technology, Dresden, Germany Publisher Elsevier Ltd Abstract Background: Coagulopathy after cardiopulmonary bypass substantially contributes to postoperative bleeding, transfusion requirements, morbidity, and mortality. The traditional treatment option is fresh frozen plasma (FFP), but prothrombin complex concentrate (PCC) has become an alternative in the past years. Aim(s): This study aimed to systematically map the current evidence and identify critical knowledge gaps regarding the efficacy, optimal timing, dosing regimens, point-of-care testing guidance, administration order, cost-effectiveness, and safety of 4-factor PCC in adult patients undergoing on-pump cardiac surgery, thereby informing future research priorities. Method(s): A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search of several databases was conducted on 8 April 2025 without restrictions on the language or date of the publications. Study selection, data extraction, and charting were performed independently by two mutually blinded reviewers. Result(s): A total of 57 primary studies (seven randomised controlled trials, 36 retrospective cohorts, five prospective cohorts, and nine experimental investigations) and 15 reviews with or without meta-analyses were identified. Evidence consistently indicates that PCC reduces postoperative chest tube output and transfusion requirements compared with FFP, although the effect sizes vary. Reported dosing ranged from fixed 500-4000 IU to weight-based 15-30 IU kg-1. Viscoelastic testing guides PCC administration; however, standardised thresholds are lacking. Limited data suggest that PCC may be more cost-effective than FFP, and serious adverse events appear to be rare. No study has directly compared different PCC dosing regimens or prophylactic use in high-risk patients. Conclusion(s): Substantial evidence gaps remain concerning the optimal dose, timing, viscoelastic targets, sequencing with fibrinogen concentrate, and health economic analyses of PCC use in cardiac surgery. High-quality randomised trials addressing these unanswered questions are warranted to refine the clinical guidelines. Copyright © 2026 The Author(s) <134> Accession Number 2046631039 Title Rheumatic mitral valve disease: Comparative outcomes of repair versus replacement. Source Global Cardiology Science and Practice. 2025(6) (no pagination), 2025. Article Number: 60. Date of Publication: 2025. Author Araujo S.; Silva H.; Filho R.; Alves N.; de Lima A.; Aires J.; Chaves F. Institution (Araujo, Silva, Filho, Alves, de Lima, Aires, Chaves) Universidade de Pernambuco, Faculdade de Ciencias Medicas de Pernambuco, Rua Arnobio Marques, 310, Bairro de Santo Amaro, PE, Recife, Brazil Publisher HBKU Press Abstract Rheumatic mitral valve disease remains a major cause of cardiovascular morbidity and mortality in developing countries where rheumatic fever is still prevalent. In advanced stages, surgical treatment becomes necessary, with mitral valve repair/valvuloplasty (MVP) and mitral valve replacement (MVR) representing the main strategies. However, evidence comparing their long-term outcomes is heterogeneous and often conflicting. The objective of this study was to map and synthesize the scientific evidence comparing the long-term results of repair versus replacement in rheumatic mitral disease. A systematic review was conducted in accordance with established methodological guidelines. Searches were performed in PubMed, Virtual Health Library, and Cochrane databases. Eligible studies, published between 2016 and April 2025, included adult patients undergoing surgical treatment with follow-up of at least five years. Nine studies met the inclusion criteria, comprising 36,136 patients, with 12,042 undergoing repair and 24,094 undergoing replacements. Repair was associated with lower early mortality (0.96% versus 2.2%), fewer thromboembolic events (114 versus 323), fewer hemorrhagic events (39 versus 252), and better preservation of left ventricular function. However, reoperation rates were higher after repair (7-19%) compared to replacement (<2%). Quality-of-life measures also favored repair, while replacement remained the preferred strategy in cases of extensive calcification, fibrosis, or severe stenosis. In conclusion, repair, when anatomically feasible, provides superior early outcomes and fewer long-term complications. Surgical decisions should be individualized, considering valve anatomy, patient profile, and surgical expertise. Copyright © 2025 The Author(s), licensee Magdi Yacoub Institute. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY-4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. <135> Accession Number 2046553266 Title Comparative Efficacy of Bifurcation Stenting Techniques for Left Main Disease: A Network Meta-analysis With Reconstructed Time-to-Event Data. Source Journal of the Society for Cardiovascular Angiography and Interventions. (no pagination), 2026. Article Number: 104395. Date of Publication: 2026. Author Al-Shammari A.S.; Khaleel N.I.; Al Sakini A.S.; Badran A.S.; Hasan M.T.; Ayman D.; Elgebaly M.; Jitta S.R.; Islam M.R.; Helmi A.; Hamza K.A.; Khalil I.; Kurmasha Y.H.; Sattar Y.; Sharma S.K.; Daggubati R. Institution (Al-Shammari, Al Sakini) Department of Internal Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq (Khaleel) Department of Cardiovascular Medicine, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad, Iraq (Badran) Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt (Hasan) Department of Internal Medicine, Al-Mabara Hospital - Sharqia branch of the Health Insurance Authority, Zagazig, Egypt (Ayman, Elgebaly) Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt (Jitta) Department of Internal Medicine, Mercy Hospital, St. Louis, MO, United States (Islam) Department of Internal Medicine, Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh (Helmi) Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt (Hamza) Department of Internal Medicine, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq (Khalil) Department of Internal Medicine, Dhaka Medical College and Hospital, Dhaka, Bangladesh (Kurmasha) Department of Internal Medicine, College of Medicine, University of Kufa, Najaf, Iraq (Sattar, Daggubati) Department of Cardiology, West Virginia University Camden Clark Medical Center, Parkersburg, WV, United States (Sharma) Department of Cardiology, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States Publisher Elsevier B.V. Abstract Background Percutaneous coronary intervention for distal left main bifurcation disease remains technically challenging owing to complex anatomy and high ischemic risk. Although multiple stenting techniques exist, the optimal approach is uncertain. Methods Eligible strategies comprised provisional stenting, double-kissing (DK) crush, classic crush, minicrush, culotte, T-stenting, TAP, and nanocrush. The primary outcome was all-cause mortality. Secondary outcomes included cardiac death, myocardial infarction, stent thrombosis, target lesion revascularization, target vessel revascularization, and major adverse cardiovascular events (MACE). A frequentist random-effects network meta-analysis estimated hazard ratios (HRs) with 95% CIs, ranking treatments by P scores. Coherence was evaluated using node-splitting analyses. Individual-patient data were reconstructed from Kaplan-Meier curves for time-to-event outcomes. Results Fifteen studies (3794 patients) were included. DK crush consistently ranked highest for most efficacy and safety outcomes. Compared with classic crush, DK crush was associated with lower risks of myocardial infarction (HR, 0.40; 95% CI, 0.17-0.91), target lesion revascularization (HR, 0.35; 95% CI, 0.15-0.84), target vessel revascularization (HR, 0.30; 95% CI, 0.16-0.57), and MACE (HR, 0.46; 95% CI, 0.32-0.66). Culotte stenting was associated with a higher risk of stent thrombosis (HR, 3.30; 95% CI, 1.07-10.13). No significant differences were observed among strategies for all-cause or cardiac mortality ( P > .05). Node-splitting analyses demonstrated no evidence of important local inconsistency. Conclusions DK crush appears to provide the most effective and durable bifurcation strategy for distal left main percutaneous coronary intervention, reducing ischemia-driven revascularization and MACE. Findings support its preferential use in anatomically complex lesions, provided operator expertise and long-term follow-up are ensured. Copyright © 2026. Published by Elsevier Inc. <136> Accession Number 2046872605 Title Stellate Ganglion Block for the Treatment of Refractory Ventricular Tachycardia and Electrical Storm: A Narrative Review. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Smith S.E.; Walker J.W.; D'Alonzo N.J.; Cios T.J. Institution (Smith, Walker, Cios) Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States (D'Alonzo) Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, United States Publisher W.B. Saunders Abstract Contemporary management of refractory ventricular arrhythmias and electrical storm (ES) emphasizes antiarrhythmic therapy, autonomic modulation, sedation, catheter ablation, mechanical circulatory support, and heart transplantation. The stellate ganglion block (SGB) has been used for decades to treat refractory ventricular tachycardia (VT) and ventricular fibrillation (VF), and has gained more traction in the literature in recent years. The authors summarize the anatomy of the stellate ganglion, the mechanism of action of an SGB, and the physiology of VT, VF and ES. They then review current practices for the treatment of VT and VF and review the current literature supporting the use of SGB as treatment for refractory VT and VF. Finally, they describe practical considerations for the use of SGB for the treatment of VT and VF. Multiple observational studies, case series, retrospective studies, and meta-analyses in recent years have shown that SGB can be effective at reducing arrhythmia episodes in patients with refractory VT or VF; however, the quality of the available literature is weak because of the lack of randomized controlled trials. Despite this, the SGB may play a role as a bridge therapy in patients with refractory VT between initial stabilization and further long-term management. Copyright © 2026 Elsevier Inc. <137> Accession Number 651491166 Title Long-term survival after percutaneous coronary intervention or coronary artery bypass grafting in patients with diabetes and multivessel disease. Source The Journal of thoracic and cardiovascular surgery. (no pagination), 2026. Date of Publication: 12 Jun 2026. Author Ameen C.; Hansson E.C.; Milojevic M.; Omerovic E.; Jeppsson A.; Nielsen S.J. Institution (Ameen) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden (Hansson, Nielsen) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (Milojevic) Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiac Surgery, University Hospital Zurich, University of Zurich, Switzerland (Omerovic) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (Jeppsson) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Abstract OBJECTIVE: To compare mortality risks, survival times and regional differences after coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in patients with diabetes and multivessel disease (MVD) in a large nationwide cohort of patients. METHOD(S): The SWEDEHEART registry was used to identify 26,166 patients with diabetes and MVD who underwent PCI (n=16,739, 64.0%) or CABG (n=9,427, 36.0%) in Sweden from 2006 to 2020. Individual patient data from five mandatory national registries were merged. Inverse probability of treatment weighting was used to compare groups. Sensitivity analyses included multivariable Cox regression and instrumental variable analysis. The median follow-up time was 5.5 years (range: 0-15 years). RESULT(S): Weighted all-cause mortality [hazard ratio 0.80 (95%CI 0.76-0.84)] and cardiovascular mortality [hazard ratio 0.73 (95%CI 0.68-0.78)] risks were lower after CABG compared to PCI. The weighted median survival time was 0.9 years longer (95%CI 0.5-1.4) after CABG compared with PCI, with markedly longer survival found in patients with left main stem stenosis or three-vessel disease [+4.1 (95%CI 3.3-4.9) and +3.4 (95%CI 2.8-4.0) years, respectively]. The results of the sensitivity analyses supported the primary analysis. The PCI-to-CABG ratio varied markedly across Sweden's 19 health care regions, ranging from 0.9 to 7.6. CONCLUSION(S): CABG was associated with significantly lower risk of all-cause and cardiovascular mortality as well as longer weighted median survival time compared to PCI in patients with diabetes and multivessel disease, particularly among patients with left main stem stenosis and/or three-vessel disease. Copyright © 2026. Published by Elsevier Inc. <138> Accession Number 2046519188 Title Management of anticoagulation in patients with heparin-induced thrombocytopenia requiring cardiac surgery with cardiopulmonary bypass: guidance from the ISTH SSC on Perioperative and Critical Care Haemostasis and Thrombosis. Source Journal of Thrombosis and Haemostasis. (no pagination), 2026. Date of Publication: 2026. Author Pishko A.M.; Frere C.; Maier C.L.; Levy J.H.; Connors J.M. Institution (Pishko) Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States (Frere) Department of Hematology, Pitie-Salpetriere Hospital, Assistance Publique-Hopitaux de Paris, Sorbonne Universite, INSERM UMR_S 1166, Paris, France (Maier) Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States (Levy) Department of Anesthesiology, Critical Care and Surgery, Duke University School of Medicine, Durham, NC, United States (Connors) Hematology Division, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, United States Publisher Elsevier B.V. Abstract Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction characterized by thrombocytopenia and a high risk of thrombosis. Patients with HIT and a need for cardiac surgery with cardiopulmonary bypass represent a challenging group, as anticoagulation with unfractionated heparin (UFH) is the primary treatment choice. We conducted a systematic review evaluating intraoperative anticoagulation strategies for patients with a history of HIT who required cardiac surgery with cardiopulmonary bypass. Guidance statements were generated through consensus of the writing group. Of 1732 screened articles, 30 studies were included. Strategies evaluated were (1) direct thrombin inhibitors; (2) UFH after preoperative or intraoperative therapeutic plasma exchange (TPE); (3) UFH in combination with a potent antiplatelet agent; and (4) heparin reexposure in patients with negative functional assays. Of these, bivalirudin has the strongest supporting data and appears effective; still, its association with increased bleeding and practical limitations, including a lack of a reversal agent, limit its use. TPE with or without intravenous immunoglobulin reduces antiplatelet factor 4/heparin antibody titers and allows for intraoperative UFH use, although protocols are heterogeneous. Use of potent antiplatelet agents with UFH reexposure show promise but carry risks of bleeding and hypotension. Thus, alternative strategies of using UFH in combination with TPE or potent antiplatelet agents may be considered on a case-by-case basis. For patients with negative functional assays, evidence suggests that limited intraoperative UFH reexposure carries a low risk of HIT recurrence, provided postoperative monitoring is performed. These guidance statements provide a framework for multidisciplinary decision making in a complex clinical scenario. Copyright © 2026. Published by Elsevier Inc. <139> Accession Number 2046531787 Title Left Atrial Appendage Closure vs. Oral Anticoagulation in Patients With Atrial Fibrillation: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Journal of Arrhythmia. 42(3) (no pagination), 2026. Article Number: e70382. Date of Publication: 01 Jun 2026. Author Chilaka C.; Khan H.D.; Sarfraz M.U.; Farooq Z.; Hassan E.; Sabir R.; Siddique S.; Zahid N.; Rehman M.U.; Salih M.; Umer M.; Alsubari A.M.A.; Ehsan M. Institution (Chilaka) Lagos State University, Nigeria (Khan) Rashid Latif Medical College, Lahore, Pakistan (Sarfraz, Umer, Ehsan) King Edward Medical University, Lahore, Pakistan (Farooq) Punjab Rangers Teaching Hospital, Lahore, Pakistan (Hassan, Sabir) Allama Iqbal Medical College, Lahore, Pakistan (Siddique) Jinnah Postgraduate Medical Center, Karachi, Pakistan (Zahid) National Hospital and Medical Center, Lahore, Pakistan (Rehman) Khyber Teaching Hospital, Peshawar, Pakistan (Salih) Dow University Hospital, Karachi, Pakistan (Alsubari) Faculty of Medicine, Sana'a University, Sana'a, Yemen Publisher John Wiley and Sons Inc Abstract Background: While oral anticoagulants (OACs) remain the cornerstone of stroke prevention, left atrial appendage closure (LAAC) is a potential alternative, particularly for patients with high bleeding risk or contraindications to long-term anticoagulation. Method(s): Multiple databases were searched to identify relevant randomized controlled trials (RCTs), and four trials were shortlisted. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Outcomes assessed included stroke (all, ischemic, hemorrhagic), systemic embolism, major bleeding, non-procedure-related bleeding, and mortality. Risk of bias was evaluated using Rob 2.0, and meta-analyses were conducted using RevMan software. Dichotomous outcomes were reported as risk ratios (RR) while continuous outcomes were reported as mean differences (MD), with 95% confidence intervals (CIs). Result(s): A total of 3116 participants were analyzed across outcomes. LAAC significantly reduced non-procedure-related bleeding (RR: 0.48, 95% CI: 0.37-0.61; p < 0.00001) and all-cause mortality (RR: 0.74, 95% CI: 0.55-0.99; p = 0.04). A marginal reduction was observed in the composite outcome of stroke, systemic embolism, or death (RR: 0.77, 95% CI: 0.59-1.00; p = 0.05). No significant differences were found for major bleeding (RR: 0.82, 95% CI: 0.56-1.22), all strokes (RR: 0.84, 95% CI: 0.56-1.25), ischemic stroke (RR: 1.15, 95% CI: 0.72-1.85), hemorrhagic stroke (RR: 0.46, 95% CI: 0.11-2.02), systemic embolism (RR: 1.52, 95% CI: 0.36-6.41), or cardiovascular/unexplained death (RR: 0.60, 95% CI: 0.29-1.23). Conclusion(s): LAAC offers a viable alternative to standard anticoagulation in selected AF patients with comparable efficacy and a particular benefit in reducing non-procedure-related bleeding and mortality advantages. Copyright © 2026 The Author(s). Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society. <140> Accession Number 651482849 Title Effect of Kolcaba-Based Nursing Care on Comfort and Outcomes in Valve Surgery. Source Pain management nursing : official journal of the American Society of Pain Management Nurses. (no pagination), 2026. Date of Publication: 11 Jun 2026. Author Sir O.; Kasikci M. Institution (Sir) Ataturk University Campus/Faculty of Nursing, Department of Fundamental of Nursing, Ataturk University, Erzurum, Turkey (Kasikci) Ataturk University Campus/Faculty of Nursing, Department of Fundamental of Nursing, Ataturk University, Erzurum, Turkey Abstract PURPOSE: This study aimed to evaluate the effect of nursing care based on Kolcaba's comfort theory on the comfort levels of patients undergoing open heart valve surgery. DESIGN: A randomized controlled trial design was used. METHOD(S): The study was conducted between October 2024 and April 2025 in the Cardiovascular Surgery Department of Van Health Sciences University Training and Research Hospital. Fifty-six eligible patients were randomly assigned to the intervention group (n = 28) or the control group (n = 28). The intervention group received nursing care guided by Kolcaba's comfort theory, while the control group received routine care. Data were collected using the Patient Information Form, General Comfort Scale, Visual Analog Scale (VAS), and Nursing Outcomes Classification (NOC). RESULT(S): Patients in the intervention group showed a statistically significant improvement in overall comfort levels after receiving theory-based nursing care. Post-test scores on the General Comfort Scale were higher in the intervention group compared to the control group. VAS scores decreased significantly in the intervention group, indicating reduced pain. In addition, postoperative NOC outcome scores were significantly higher in the intervention group than in the control group. CONCLUSION(S): Nursing care based on Kolcaba's comfort theory increases the comfort of open heart valve surgery patients, reduces their pain, and has been shown to increase nursing outcome classification scores. CLINICAL IMPLICATION: Kolcaba-based nursing care can enhance postoperative comfort, improve recovery outcomes, and support holistic patient management in valve surgery, guiding nurses to implement structured comfort-focused interventions throughout perioperative care. Copyright © 2026 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved. <141> Accession Number 2046573607 Title Systemic-to-pulmonary artery shunt: a surgical strategy with no expiration date. Source Frontiers in Pediatrics. 14 (no pagination), 2026. Article Number: 1767112. Date of Publication: 21 Apr 2026. Author Ruiz Perez L.E. Institution (Ruiz Perez) Deparment of Cardiothoracic Surgery, Hospital ISSSTE Villahermosa, Tabasco, Mexico Publisher Frontiers Media SA Abstract Background - Systemic-to-pulmonary shunts remain a fundamental surgical option in the palliative management of complex congenital heart defects, particularly in patients with univentricular physiology. Although technically demanding, the procedure has evolved through multiple modifications aimed at simplifying its execution and reducing complications, while maintaining its essential clinical role. Objective - To provide a narrative review of the Blalock-Taussig-Thomas shunt, examining its physiological basis, surgical technique, associated risks and complications, postoperative management, and historical evolution, with the goal of evaluating its continued relevance in the palliative treatment of complex congenital heart defects. Methods - A literature search was conducted in Elsevier, PubMed, and Scopus using the keyword "systemic-to-pulmonary shunt." Studies addressing historical development, technical evolution, clinical indications, and postoperative outcomes were included. The review focused on pediatric populations, specifically prenatal, neonatal, and school-age patients. Studies involving adolescents were excluded to maintain consistency with early developmental stages and the typical clinical context in which these shunts are used. Results & conclusion - The systemic-to-pulmonary shunt remains a valuable and widely used palliative technique for patients with complex congenital heart defects and univentricular physiology. While the original Blalock-Taussig-Thomas technique has historically shown favorable outcomes, differences in complication rates among its variants are influenced by patient selection and institutional experience. Emerging alternatives, such as ductal stenting, may reduce the frequency of surgical shunt placement in selected patients; however, they do not currently replace the systemic-to-pulmonary shunt as a comprehensive or universally applicable strategy. Copyright © 2026 Ruiz Perez. <142> [Use Link to view the full text] Accession Number 2046331203 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 Aug 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 Publisher Lippincott Williams and Wilkins 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. <143> Accession Number 2046228365 Title Cardiovascular safety of proton pump inhibitors in post-percutaneous coronary intervention patients receiving dual antiplatelet therapy: A meta-analysis. Source World Journal of Cardiology. 18(5) (pp 1-12), 2026. Article Number: 119100. Date of Publication: 26 May 2026. Author Sohail R.; Khattak R.; Khan A.; Chaudhry S.; Namal F.; Orciuolo J.; Khan Z.; Shah H.H.; Khan U.; Mansoor H.; Desai S.; Singh M. Institution (Sohail, Khattak, Khan, Chaudhry, Namal, Orciuolo) Internal Medicine, Bayhealth Medical Center, Dover, DE, United States (Khan) Internal Medicine, Indiana University School of Medicine, Southwest Internal Medicine Residency Program, Evansville, IN, United States (Shah) Department of Medicine, Bayhealth Hospital, Kent Campus, Dover, DE, United States (Khan) Department of Medicine, Dow University of Health Sciences, Sindh, Karachi, Pakistan (Mansoor) Department of Medicine, Quaid-e-Azam Medical College, Punjab, Bahawalpur, Pakistan (Desai) Department of Medicine, Temple University, Philadelphia, PA, United States (Singh) Cardiology and Cardiovascular Diseases, Bayhealth Medical Center, Dover, DE, United States Publisher Baishideng Publishing Group Inc Abstract BACKGROUND: Proton pump inhibitors (PPI) are often prescribed alongside dual antiplatelet therapy (DAPT) to mitigate risk of gastrointestinal (GI) bleeding. Despite GI protection, there is emerging concerns about potential interference with antiplatelet efficacy and increased cardiovascular risk. AIM: To determine the cardiovascular impact of PPI on DAPT efficacy. METHOD(S): Online databases were searched from inception until April 2025, and a total of three randomized controlled trials (RCTs) and five observational studies were identified. Data were pooled using a random-effects model, and results were generated using Review Manager in form of risk ratios (RRs) with 95% confidence intervals (CIs). RESULT(S): The RCTs showed no association between PPI use and risk of ACS (RR = 0.84; 95%CI: 0.70-1.00; P = 0.005), cardiac death (RR = 1.25; 95%CI: 0.35-4.38; P = 0.73) and all-cause mortality (RR = 0.77; 95%CI: 0.370-1.60; P = 0.49). Similarly, observational studies confirmed no significant effect of PPI on risk of ACS (RR = 1.22; 95%CI: 0.89-1.66; P = 0.21), cardiac death (RR = 1.30; 95%CI: 0.66-2.58; P = 0.45), all-cause mortality (RR = 1.21; 95%CI: 0.96-1.53; P = 0.10), stent thrombosis (RR = 1.63; 95%CI: 0.83-3.21; P = 0.16), revascularization (RR = 1.08; 95%CI: 0.59-1.97; P = 0.81) and ischemic stroke (RR = 0.82; 95%CI: 0.34-2.02; P = 0.67), yet and increased risk of major adverse cardiovascular event (RR = 1.29; 95%CI: 1.11-1.50; P = 0.001). CONCLUSION(S): Even though RCTs confirmed that PPI use is generally safe in post-percutaneous coronary intervention patients receiving DAPT, observational studies raised suspicion of increased risk warranting a need for further studies. Copyright © Author(s) 2026. <144> Accession Number 2046812787 Title Comparison of oxycodone hydrochloride injection versus sufentanil for postoperative analgesia in patients undergoing minimally invasive cardiac valve replacement: study protocol for a single-centre, randomised, double-blind non-inferiority trial. Source BMJ Open. 16(6) (no pagination), 2026. Article Number: e113082. Date of Publication: 01 Jun 2026. Author Chen X.; Shi Y.; Jin J.; Bao X.; Li Y.; Du H.; Pei L.; Song P.; Zhu Y. Institution (Chen, Shi, Jin, Bao, Li, Du, Song, Zhu) Department of Anesthesiology and Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, Xi'an, China (Pei) Department of Epidemiology and Health Statistics, Xi'an Jiaotong University Health Science Center, Shaanxi, Xi'an, China Publisher BMJ Publishing Group Abstract Introduction: With the advancement of the ERAS (Enhanced Recovery After Surgery) concept, minimally invasive heart valve replacement surgery has become widely performed due to its advantages of smaller trauma and fewer adverse reactions. However, postoperative pain management remains complex and traditional opioid analgesia is often associated with adverse side effects. Oxycodone, an opioid agonist, has strong analgesic effects with relatively few side effects. This study aims to explore the efficacy and safety of oxycodone hydrochloride injection in multimodal pain management following minimally invasive heart valve replacement surgery. Methods and analysis: This is a prospective, double-blind, randomised controlled clinical trial designed as a non-inferiority study. The schedule of enrolment, interventions and outcome assessments is summarised in figure 2. The study period is from October 2024 to September 2027, and between 30 April 2026 and 31 October 2026, a total of 130 patients undergoing minimally invasive heart valve replacement surgery will be planned to recruit and randomly assign in a 1:1 ratio to receive either oxycodone hydrochloride injection or sufentanil for postoperative patient-controlled analgesia. The primary outcome is the Numerical Rating Scale pain score during coughing at 24 hours postoperatively. Secondary outcomes include measures of postoperative pain control, analgesic consumption, adverse events and recovery-related indicators. To address the risk of type I error due to multiple secondary outcomes, secondary endpoints are prespecified and categorised into key secondary outcomes and exploratory outcomes with corresponding statistical analysis strategies planned. This protocol is V.2.0, dated 29 December 2025. Ethics and dissemination: Ethical approval has been obtained from the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (XJTU1AF2024LSYY-389-04). The study will be conducted in accordance with the Declaration of Helsinki, and informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals, scientific conferences and appropriate public channels. Trial registration: ChiCTR2400094930. 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/. <145> Accession Number 2038287607 Title Women Authorship in Cardiothoracic Surgery: Gender Differences in Five High-impact Journals Through 20 Years. Source European Archives of Medical Research. 42(1) (pp 33-38), 2026. Date of Publication: 01 Mar 2026. Author Cetin H.K.; Acikel M.E.T. Institution (Cetin, Acikel) Department of Cardiovascular Surgery, University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey Publisher Kare Publishing Abstract Objective: This study aimed to clarify the contribution of female authors to the cardiothoracic literature by analyzing five high-impact journals. Material(s) and Method(s): Two authors reviewed all articles from 2000, 2010, and 2020 published in five high-impact journals in the cardiothoracic discipline. Only original articles, reviews, and meta-analyses were enrolled in the study. During the review, the first author's name, the senior author's name, and the number of female and male authors were recorded according to years. Articles were also categorized according to subspecificity and region of study. Result(s): A total of 233 papers in 2000, 259 papers in 2010, and 276 papers in 2020 met the study inclusion criteria. The ratio of female authors as first author was 4.3% in 2000, 8.9% in 2010, and 9.8% in 2020, and the difference was statistically higher in favor of 2010 and 2020 (p=0.041). The ratio of female authors increased from 24.9% in 2000 to 35.9% in 2020 (p=0.019). However, the ratio of senior female authors was not statistically significant (p=0.090). The ratio of female first authors for original articles and the ratio of female senior authors for reviews were significantly higher in 2010 and 2020. First female authors in papers about the heart and senior female authors in papers about the thorax were significantly more common in 2010 and 2020. Finally, the ratio of female first authors and senior authors significantly increased from 2000 to 2010 and 2020 only in Europe. Conclusion(s): The present study demonstrated that the proportion of female authors significantly increased over the last 20 years in cardiothoracic surgery. First female authors made progress in articles written about experimental studies, original articles, and meta-analyses, and the heart. Finally, the frequency of female senior authors was significantly increased for experimental studies, review articles, papers about the thorax, and papers from Europe. Copyright © 2026, Kare Publishing. All rights reserved. <146> Accession Number 651484187 Title Comparable Assessment of Perioperative and Postoperative Outcomes in Open Versus Endoscopic Radial Artery Harvest for Patients Undergoing CABG: A Systematic Review and Meta-Analysis. Source Cardiology in review. (no pagination), 2026. Date of Publication: 12 Jun 2026. Author Meghwar S.; Parvez A.; Abbasi S.U.A.M.; Fatima M.; Kumar D.; Lohano G.; Hashmi M.U.H.; Jabeen L.; Sahil F.; Singh K. Institution (Meghwar, Lohano, Singh) Nursing & Midwifery Research Department, Hamad Medical Corporation, Doha, Qatar (Parvez) Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan (Abbasi) Department of Internal Medicine, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan (Fatima) Department of Internal Medicine, People's University of Medical and Health Sciences for Women-Nawabshah, Sindh, Pakistan (Kumar, Jabeen) Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan (Hashmi) Department of Internal Medicine, Nishtar Medical University, Multan, Pakistan (Sahil) Department of Medicine, Liaquat University of Medical and Health Sciences, Pakistan Abstract Coronary artery bypass grafting (CABG) is the standard treatment for multivessel coronary disease. The radial artery (RA) is commonly used because of its good long-term outcomes. RA can be harvested using either endoscopic or open techniques, but the optimal method remains unclear. This systematic review and meta-analysis compares outcomes between both approaches in CABG procedures. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed, Embase, Cochrane Library, and Scopus were searched up to January 2026 for randomized controlled trials comparing endoscopic versus open RA harvesting in CABG. Data were analyzed using a random-effects model in R (version 4.5.2), with risk of bias 2 used for bias assessment. Outcomes assessed included wound and neurological complications, along with graft patency, mortality, and reoperation. Pooled analysis showed a significant reduction in wound infections (risk ratio, 0.58; P = 0.03) and neurological complications (risk ratio, 0.47; P < 0.0001) with endoscopic compared with conventional open harvesting, with consistent results across various follow-up periods. Graft patency showed similar results in both groups (P = 0.49), with no significant differences in reoperation (P = 0.33), in-hospital/30-day mortality (P = 0.47), or length of hospital stay (P = 0.16). However, endoscopic harvesting showed a significant increase in harvest time compared with open harvesting (mean difference, 11.44 minutes; P = 0.04), with no significant differences in aortic clamp time (P = 0.96). Endoscopic RA harvesting in CABG surgery showed significantly reduced wound infections and neurological complications without affecting graft patency or short-term outcomes. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.

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