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

Total documents retrieved: 144 Results Generated From: Embase <1980 to 2026 Week 33> Embase Weekly Updates (updates since 2026-08-10) - (144 records) <1> Accession Number 651270360 Title Outcomes after extracorporeal membrane oxygenation following the norwood procedure: a systematic review and meta-analysis. Source Journal of cardiothoracic surgery. 21(1) (no pagination), 2026. Date of Publication: 23 May 2026. Author Almehandi A.; Altarkait A.; Ali Y.; Alhajri M.; Alenezi M.; Diniz L.; Al-Naseem A.O.; Al Kindi H.; Thani S.A. Institution (Almehandi) Department of Cardiovascular Science, University College London, 118 E Ferry Rd, London, United Kingdom (Altarkait) General Surgery, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait (Ali) Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom (Alhajri) School of Medicine, University of Leeds, Leeds, United Kingdom (Alenezi) Department of Surgery, Al-Adan Hospital, Kuwait City, Kuwait (Diniz) Department of Medical Sciences, Federal Fluminense University, Niteroi, Brazil (Al-Naseem) Department of Surgery, McGill University, Montreal, Canada (Al Kindi) Department of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Sib, Oman (Thani) Pediatric Intensive Care Unit, Royal Hospital, Muscat, Oman Abstract BACKGROUND: Survival following the Norwood procedure has improved substantially, but outcomes for the high-risk subgroup requiring postoperative extracorporeal membrane oxygenation (ECMO) remain unclear. We explored short- and intermediate-term outcomes in these neonates. MAIN BODY: We systematically searched PubMed, EMBASE, Cochrane Central and Web of Science (final search: 25 February 2025). Comparative studies reporting outcomes for patients with versus without postoperative ECMO were included. Primary outcomes were short-term mortality, secondary outcomes included stages-2-and-3 palliation completion, operative times, recovery parameters, and complications. Statistical analysis used RevMan 5.4 to calculate pooled risk ratio (RR), odds ratios (OR) or mean differences (MD) with 95% confidence intervals employing random-effects models; heterogeneity was assessed using I2 statistics and Cochran's Q test. Eight studies (2,612 patients: 15% with ECMO) were included. In-hospital mortality was five times greater in the ECMO group (RR = 5.53, CI = 4.41-6.93, p = 0.0003), though survival to Glenn and Fontan completion were comparable. Cardiopulmonary bypass duration was significantly longer in the ECMO group (MD = 28.07 min, CI = 18.19-37.95, p = 0.0004). Postoperative ICU recovery was significantly prolonged for ECMO patients (MD = 10.56 days, CI = 1.28-19.83, p = 0.03), though hospital recovery was similar. Postoperative atrioventricular valve regurgitation, Norwood reoperation, delayed chest closure, unplanned reoperation or death/transplantation were comparable. Risk of bias (ROBINS-I) was formally assessed. CONCLUSION(S): Our analysis supports that ECMO use post-Norwood procedure identifies a high-risk subgroup with significantly higher early-mortality and resource utilisation. However, this association must be interpreted cautiously due to heterogenous ECMO indications. Future efforts should focus on identifying modifiable risk factors to improve outcomes. Copyright © 2026. The Author(s). <2> Accession Number 2046590760 Title Effect of remote ischaemic preconditioning on acute kidney injury after heart transplantation (RIPCAT): A randomised controlled feasibility trial. Source European Journal of Anaesthesiology. 43(9) (pp 785-789), 2026. Date of Publication: 01 Sep 2026. Author M'Pembele R.; Jagdfeld J.D.; Henning L.S.; Huhn R.; Lurati Buse G.; Boeken U.; Roth S. Institution (M'Pembele, Jagdfeld, Henning, Huhn, Lurati Buse, Roth) From the Department of Anaesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany (Huhn) Department of Anaesthesiology, Kerckhoff Heart and Lung Centre, Bad Nauheim, Germany (Boeken) Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Germany Publisher Lippincott Williams and Wilkins <3> Accession Number 2047615756 Title Colchicine in patients with chronic inflammatory cardiomyopathy: rationale and design of the CMP-MYTHiC. Source ESC Heart Failure. 13(2) (no pagination), 2026. Article Number: xvag058. Date of Publication: 01 Apr 2026. Author Ammirati E.; Cartella I.; Ciabatti M.; Colombo G.; Masetti M.; Pieroni M.; Gallone G.; Peretto G.; Potena L.; Scacciavillani R.; Raineri C.; Caputo A.; Pedrotti P.; Sormani P.; Conti N.; Merlo M.; Imazio M.; Pani A.; Ciliberti M.L.; Gentile P.; Pontone G.; Villatore A.; Pezzullo E.; Palazzini M.; Casella M.; Valsecchi M.G.; Burzotta F.; Carmina V.; Garascia A.; Scarale A.F.; Bernasconi D.P.; Loffredo F.S.; Narducci M.L. Institution (Ammirati, Cartella, Colombo, Pedrotti, Sormani, Conti, Ciliberti, Gentile, Palazzini) De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, Milano, Italy (Ammirati, Gentile) School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, Italy (Ciabatti) Cardiovascular Department, San Donato Hospital, Arezzo, Italy (Masetti, Potena) Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Pieroni) Cardiomyopathy Unit, Department of Clinical and Experimental Medicine, University of Florence, Careggi University Hospital, Florence, Italy (Gallone, Raineri) Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, Turin, Italy (Gallone) Department of Medical Sciences, University of Turin, Turin, Italy (Peretto, Villatore) Disease Unit for Myocarditis and Arrhythmogenic Cardiomyopathies, IRCCS San Raffaele Scientific Institute, Milano, Italy (Peretto, Villatore) Cardiac Electrophysiology Department, IRCCS San Raffaele Scientific Institute, Milano, Italy (Peretto, Villatore) School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy (Potena) Department of Clinical and Surgical Sciences, University of Bologna, Bologna, Italy (Scacciavillani, Burzotta, Carmina, Narducci) Department of Cardiovascular Sciences, CUORE, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (Caputo, Pezzullo, Loffredo) Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, AO dei Colli, Naples, Italy (Merlo) Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy (Merlo) European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart, Trieste, Italy (Imazio) Department of Medicine, University of Udine, Udine, Italy (Imazio) Cardiothoracic Department, University Hospital Santa Maria Della Misericordia, ASUFC, Udine, Italy (Pani) Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, Universita degli Studi di Milano, Milan, Italy (Pani) Department of Oncology and Hemato-Oncology, Universita Degli Studi di Milano, Milan, Italy (Pontone) Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milano, Italy (Pontone) Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy (Casella) Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy (Casella) Department of Clinical, Special, and Dental Sciences, Marche Polytechnic Univ, Ancona, Italy (Casella) Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy (Valsecchi, Bernasconi) Bicocca Bioinformatics, Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (Burzotta) Department of Cardiovascular Sciences, Universita Cattolica del Sacro Cuore, Rome, Italy (Garascia, Scarale) Nuclear Medicine Unit, Hematology, Oncology and Molecular Medicine Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy (Loffredo) Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy Publisher Oxford University Press Abstract Introduction: Acute myocarditis can lead to chronic inflammatory cardiomyopathy (Infl-CMP), a condition characterized by increased risk of ventricular arrhythmias (VA), left ventricular (LV) systolic dysfunction (LVSD), and heart failure (HF). Immunosuppressive therapy is generally not recommended for Infl-CMP when diagnosed non-invasively by cardiac magnetic resonance imaging (CMRI) or fluorodeoxyglucose-positron emission tomography (FDG-PET). We are assessing, in the CMP-MYTHiC trial, whether colchicine (0.5mg in patients <70kg or 1mg in patients >=70kg), an immunomodulatory drug with a good safety profile, can reduce myocardial inflammation in patients with Infl-CMP. Study design: The CMP-MYTHiC, a multicenter investigator-initiated single-blinded randomized controlled trial, screens adult patients diagnosed with Infl-CMP by CMRI or FDG-PET within the prior 3 months at 12 Italian centres. Eligibility is further defined by the presence of VA or LVSD/HF phenotype. VA phenotype is determined by a high burden of premature ventricular complexes (PVCs) on baseline 24-h ECG ambulatory monitoring, non-sustained ventricular tachycardia (NSVT), or sustained ventricular tachycardia (SVT). The LVSD/HF phenotype is characterized by reduced LV ejection fraction (LVEF <50% on echocardiogram or <60% on CMRI) or elevated natriuretic peptide levels. Key exclusion criteria include a history of myocardial infarction, cardiomyopathy attributed to other specific causes, and systemic autoimmune disorders. The efficacy of colchicine compared with placebo will be assessed when CMRI or FDG-PET scans and 24-h ambulatory ECG monitoring are repeated at 6 months after randomization. The primary endpoint of the trial analysed according to the intention-to-treat population is the proportion of patients who are alive and free from any clinical (cardiac death or hospitalization due to HF or VA episodes), arrhythmic (PVC burden increase >=50%, NSVT increase >=30%, or any SVT), or imaging (LVEF reduction >10% or new areas of oedema plus increased inflammation) worsening, and who demonstrate improvement in either imaging (reduction in oedema on CMRI or FDG uptake) or arrhythmic (PVC burden reduction >=70% with no NSVT/SVT) outcomes at 6 months. Assuming 80% power with an overall type I error of 0.025 using one-sided Fisher's Exact test, 40 patients per group are required to demonstrate that the primary endpoint will be reached in 66% of patients in the colchicine group compared with 33% in the placebo. Twenty-nine patients were randomized since December 2023, and the conclusion is expected in 2029. Discussion(s): The results can define the role of colchicine in treating patients with Infl-CMP non-invasively diagnosed by CMRI or FDG-PET. Clinicaltrials.gov identifier: NCT06158698. 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. <4> Accession Number 2046779385 Title Metabolic and vascular outcomes after transition to the MiniMed 780G system in adults >=65 years with type 1 diabetes: a randomised, single-centre study. Source Diabetologia. 69(9) (pp 2421-2431), 2026. Date of Publication: 01 Sep 2026. Author Matejko B.; Cyranka K.; Sudul P.; Susul K.; Krezel J.; Chernovol J.; Maga P.; Malecki M.T.; Klupa T. Institution (Matejko, Cyranka, Sudul, Malecki, Klupa) Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland (Matejko, Cyranka, Sudul, Susul, Klupa) Unit of Psychodiabetology, Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland (Matejko, Cyranka, Sudul, Susul, Maga, Malecki, Klupa) University Hospital in Krakow, Krakow, Poland (Cyranka) Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland (Krezel, Chernovol) Clinical Department of Angiology, University Hospital in Krakow, Krakow, Poland (Maga) Department of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland Publisher Springer Science and Business Media Deutschland GmbH Abstract Aims/hypothesis: Hybrid closed-loop insulin delivery systems are increasingly regarded as the preferred therapy for type 1 diabetes, although evidence in older adults remains limited. The aim of this randomised study was to evaluate the effectiveness and safety of the MiniMed 780G system in individuals with type 1 diabetes aged >=65 years, with HbA<inf>1c</inf><86 mmol/mol (10%), who were naive to this technology, with the primary endpoint based on glycaemic management (time in range). Vascular status and other glycaemic metrics were assessed as secondary outcomes. Method(s): This single-centre, open labelled (outcome assessors were not masked), randomised, controlled, parallel-group trial enrolled 34 participants who were randomly assigned in a 1:1 ratio using a computer-generated randomisation schedule to either advanced hybrid closed-loop (AHCL) therapy or control therapy (multiple daily injections or continuous subcutaneous insulin infusion) and followed for 12 months. Result(s): Twenty-nine participants completed the study. Baseline characteristics, including glycaemic metrics, were comparable across groups (p>0.05). The AHCL group demonstrated a rapid and sustained improvement in glycaemic management, with time in range increasing from 57.4% at baseline to 79.7% at 12 months (p<0.001), accompanied by reductions in hyperglycaemia as reflected by time above range and time above range 2 (nominal p<0.001; p<0.001), and with no increase in hypoglycaemia across time below range and time below range 2 (nominal p=0.463; p=1). Adjusted between-group differences favoured AHCL for time in range (15.7% [95% CI 8.6, 22.6]) and HbA<inf>1c</inf> (-5 mmol/mol; [95% CI -9.7, -0.4 mmol/mol] [-0.46%; -0.89%, -0.04%]). No serious adverse events or episodes of diabetic ketoacidosis or severe hypoglycaemia occurred. Post-occlusive reactive hyperaemia showed a shortening of time to maximal flow in the AHCL group, indicating a favourable numerical trend towards improved microvascular function (nominal p>0.05). Retinal vascular status assessed using artificial intelligence remained stable throughout follow-up in both eyes (nominal p=0.710 and p=0.563, respectively). Conclusions/interpretation: The MiniMed 780G system appears effective for glycaemic management and safe for use in older adults with long-standing type 1 diabetes and a high burden of comorbidities. A non-statistically significant numerical tendency (p>0.05) in the improvement of vascular function that requires further confirmation was also observed. Trial registration: ClinicalTrials.gov NCT06207838 Copyright © The Author(s) 2026. <5> Accession Number 2046223583 Title Efficacy of ivabradine in heart rate reduction after cardiac transplantation: Systematic review and meta-analysis. Source World Journal of Cardiology. 17(12) (no pagination), 2025. Article Number: 113820. Date of Publication: 26 Dec 2025. Author Ahmed F.; Ali R.; Haider F.; Shah H.H.; Farhan K.; Jahangir K.; Kiyani M.; Khan M.S.; Afzaal Z.; Khan S.I.; Nizam M.A.; Usman M.; Gohar N.; Ahmed M.; Mirza T.R.; Sattar Y.; Taha A.; Almendral J.; Alenezi F. Institution (Ahmed, Almendral) Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ, United States (Ali) Department of Medicine, Peoples University of Medical and Health Sciences, Sindh, Nawabshah, Pakistan (Haider) Department of Medicine, Allama Iqbal Medical College, Punjab, Lahore, Pakistan (Shah) Department of Medicine, Bayhealth Hospital, Kent Campus, Dover, DE, United States (Farhan) Department of Medicine, Sindh Medical College, Jinnah Sindh Medical University, Sindh, Karachi, Pakistan (Jahangir) Department of Medicine, Dow Medical College, Sindh, Karachi, Pakistan (Kiyani) Department of Medicine, Medstar Georgetown University Baltimore Program, Baltimore, MD, United States (Khan) Department of Medicine, Jinnah Sindh Medical University, Sindh, Karachi, Pakistan (Afzaal, Usman, Gohar) Department of Medicine, Ameer-Ud-Din Medical College, Punjab, Lahore, Pakistan (Khan) Department of Medicine, Jefferson Torresdale Hospital, Philadelphia, PA, United States (Nizam) Department of Internal Medicine, Trinity Health Livonia Hospital, Michigan City, MI, United States (Ahmed) Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan (Mirza) Department of Medicine, Shalamar Medical and Dental College, Punjab, Lahore, Pakistan (Sattar) Department of Cardiology, West Virginia University, Morgantown, WV, United States (Taha) Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, United States (Alenezi) Department of Medicine, Duke University School of Medicine, Durham, NC, United States Publisher Baishideng Publishing Group Inc Abstract BACKGROUND Persistent sinus tachycardia affects up to 40% of patients after heart transplantation and is linked with graft dysfunction, impaired diastolic filling, and increased morbidity. Conventional rate-limiting therapies such as beta-blockers and calcium channel blockers are quite often contraindicated due to risks of bradyarrhythmia or hypotension. Ivabradine, a selective I(f) channel inhibitor, reduces heart rate (HR) without negative inotropic or hypotensive effects. AIM To evaluate the efficacy and safety of ivabradine in heart transplant recipients. METHODS A comprehensive search of PubMed, EMBASE, Scopus, Cochrane Library, and Google Scholar was conducted from inception to April 15, 2025. Eligible studies evaluated ivabradine in heart transplant recipient vs placebo or metoprolol, reporting HR, mortality, left ventricular mass (LVM), or safety. Data were independently extracted by two reviewers, and quality was assessed. Review Manager 5.4 performed pooled analyses using random-effects models. Mean differences (MD) or standardized MD (SMD) were calculated for continuous outcomes, and risk ratios for dichotomous outcomes. RESULTS Of 415 records identified, four studies comprising 264 patients (126 ivabradine, 138 control) met the inclusion criteria. Ivabradine significantly reduced resting HR compared with controls (MD = -11.06 beats per minute; 95%CI: -19.50 to -2.62; P < 0.00001; I2 = 93%). Sensitivity analysis demonstrated consistent findings (SMD = -6.74; 95%CI: -9.23 to -4.24; I2 = 0%). No significant difference in all-cause mortality was observed (MD = 0.52; 95%CI: 0.17-1.64; P = 0.27; I2 = 85%). Pooled analysis of LVM revealed no significant effect of ivabradine (MD = -3.57 g; 95%CI: -29.21 to 22.08; P = 0.79; I2 = 73%), with sensitivity analysis confirming neutrality. Adverse events were rare and mostly comparable between groups. CONCLUSION Ivabradine reduces HR effectively in heart transplant recipients without added adverse outcomes, supporting its use as safe and well-tolerated alternative when conventional agents are unsuitable. Despite potential clinical benefit, small sample size and heterogeneity the need for larger randomized trials to confirm long-term outcomes and establish ivabradine's role in post-transplant care. Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. <6> Accession Number 2041884431 Title Remimazolam provides better hemodynamic stability than propofol in hypertensive surgical patients: a randomized single-blinded trial. Source Journal of Anesthesia. 40(4) (pp 595-606), 2026. Date of Publication: 01 Aug 2026. Author Wang P.; Chen D.; Yu H.; Sun Y.; Xiong J. Institution (Wang, Chen, Yu, Sun, Xiong) Department of Anesthesiology, Shenzhen University General Hospital, Shenzhen University, Guangdong Province, Shenzhen, China Publisher Springer Abstract Purpose: Hypertensive surgical patients face heightened perioperative cardiovascular risk, and propofol often induces hypotension. This trial aimed to compare remimazolam and propofol for hemodynamic stability in hypertensive patients undergoing non-cardiac surgery, and explore underlying cardiac and vascular mechanisms via continuous monitoring. Method(s): This randomized single-blind trial enrolled 122 adults with controlled hypertension undergoing elective non-cardiac surgery, assigned to remimazolam-based or propofol-based total intravenous anesthesia. Primary outcomes were intraoperative hypotension episodes (mean arterial pressure < 65 mmHg or a > 20% decrease from baseline), norepinephrine bolus frequency and total dose. Hemodynamics were continuously tracked by Continuous Non-Invasive Arterial Pressure Monitor 500, with anesthesia depth maintained at a bispectral index of 40-60. Result(s): Baseline characteristics were comparable. The remimazolam group had fewer hypotension episodes (remimazolam group vs. propofol group, median episodes [interquartile range, IQR], 2 [0-3] vs. 3 [1-5]; p = 0.003), fewer norepinephrine boluses (1 [0-3] vs. 3 [1-5]; p = 0.001), and lower total dose (8 microg [0-24] vs. 24 microg [8-40]; p < 0.001). Remimazolam showed non-significant trends toward smaller reductions in cardiac output (CO, - 8.10% vs. - 13.10%, p = 0.35) and systemic vascular resistance (SVR, - 10.83% vs. - 14.91%, p = 0.46). Extubation time and post-anesthesia care unit stay were similar. Conclusion(s): For hypertensive patients, remimazolam provides superior hemodynamic stability over propofol, evidenced by fewer hypotensive episodes, reduced norepinephrine requirements, and attenuated perturbations in CO and SVR, without delaying recovery. It represents a valuable anesthetic alternative for this high-risk cohort. Copyright © The Author(s) 2025. <7> Accession Number 2046313471 Title Simulation-Based Training for Coronary Artery Bypass Grafting: Systematic Review and Meta-analysis. Source Journal of Surgical Education. 83(9) (no pagination), 2026. Article Number: 104010. Date of Publication: 01 Sep 2026. Author Sidik A.I.; Entsua-Mensah K.; Dontsov V.V.; Ruchkin M.G.; Karpenko I.G.; Sobolev D.; D'Oria M. Institution (Sidik) Department of Cardiovascular Surgery, Peoples Friendship University of Russia (RUDN University), Moscow, Russian Federation (Entsua-Mensah) National Cardiothoracic Centre, Korle Bu Teaching Hospital, Accra, Ghana (Dontsov) Moscow Regional Research, Clinical Institute named after M.F. Vladimirsky, Moscow, Russian Federation (Ruchkin) Department of Cardiac Surgery, Research Institute for Emergency Medicine named after N.V. Sklifosovsky, Moscow, Russian Federation (Karpenko) Department of Cardiothoracic Surgery, A.A. Vishnevskiy Hospital, Moscow, Russian Federation (Sobolev) European Medical Center, Moscow, Russian Federation (D'Oria) Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy Publisher Elsevier Inc. Abstract BACKGROUND: Declining operative exposure and increasing procedural complexity have challenged traditional apprenticeship models in coronary artery bypass grafting (CABG) training. Simulation-based training (SBT) has emerged as a strategy to support technical skill acquisition outside the operating room. This systematic review and meta-analysis evaluated the effectiveness of SBT in improving technical performance and procedural efficiency for CABG anastomosis. METHOD(S): A comprehensive search of PubMed, Scopus, and Web of Science identified studies published between 2000 and 2025 that reported quantitative outcomes following SBT for CABG. Randomized controlled trials, quasi-experimental studies, and pre-post designs were eligible. RESULT(S): Eleven studies with 372 participants met the inclusion criteria. Pooled analysis showed a large improvement in overall technical performance (standardized mean difference 2.18, 95% CI 1.73-2.63; p < 0.00001) and a substantial reduction in anastomosis completion time (standardized mean difference 2.00, 95% CI 0.92-3.08; p = 0.0003). Subgroup analyses demonstrated significant benefits across simulator categories (tissue-based, hybrid, and synthetic) and fidelity levels, with no statistically significant differences between trainee levels. Most studies had low to moderate overall risk of bias. CONCLUSION(S): This review indicates that SBT meaningfully accelerates technical skill acquisition and improves procedural efficiency in CABG anastomosis across trainee levels and simulator types. These findings support the integration of structured simulation into cardiothoracic surgery training curricula. Future research should evaluate long-term skill retention, transferability to real patient surgery, and cost-effectiveness to guide optimal implementation. Copyright © 2026 The Author(s) <8> Accession Number 2041959752 Title Efficacy of PCSK9 Inhibitors on Clinical Outcomes in Patients with Established Atherosclerotic Cardiovascular Disease: A Network Meta-analysis. Source American Journal of Cardiovascular Drugs. 26(2) (pp 193-203), 2026. Date of Publication: 01 Mar 2026. Author Raone L.; Gritti V.; Mandurino-Mirizzi A.; Sparasci F.M.; Scotti V.; Currao A.; Colonna G.; Ferlini M.; De Luca L. Institution (Raone, Sparasci) Department of Molecular Medicine, University of Pavia, Pavia, Italy, Corso Strada Nuova, 65, Pavia, Italy (Raone, Gritti, Sparasci, Currao, Ferlini, De Luca) Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Mandurino-Mirizzi, Colonna) Division of Cardiology, Vito Fazzi Hospital, Lecce, Italy (Mandurino-Mirizzi) Department of Experimental Medicine (DiMeS), University of Salento, Lecce, Italy (Scotti) Centre for Scientific Documentation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Currao) Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy Publisher Adis Abstract Aims: Residual cardiovascular risk remains substantial in patients with atherosclerotic cardiovascular disease (ASCVD) despite high-intensity statin therapy. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), including monoclonal antibodies and small-interfering RNA agents, offer additional risk reduction, yet comparative evidence across individual regimens remains limited. Methods and Results: We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating approved PCSK9i dosages in patients with ASCVD. The primary outcome was major adverse cardiovascular events (MACE); the secondary outcomes included myocardial infarction, stroke, coronary revascularization, cardiovascular mortality, and all-cause death. A total of eight trials involving 49,847 patients were included. Evolocumab (140 mg every 2 weeks or 420 mg monthly) and alirocumab 150 mg every 2 weeks significantly reduced MACE compared with placebo (risk ratios (RR): 0.78, 95% confidence intervals (CI): 0.66-0.93 and RR: 0.47, 95% CI 0.25-0.86, respectively). Evolocumab was also associated with reductions in myocardial infarction, stroke, and revascularization. Alirocumab 150 mg demonstrated the most pronounced effect on revascularization and was superior to both evolocumab and the lower alirocumab dose in this outcome. No regimen significantly reduced cardiovascular or all-cause mortality. Conclusion(s): These findings suggest that PCSK9 inhibitors are effective in ASCVD, with generally similar efficacy across agents; however, regimens achieving lower and sustained low-density lipoprotein cholesterol levels may confer greater benefit, in line with the concept that "the lower, the better." Trial Registration: PROSPERO identifier no. CRD420251022108. Copyright © The Author(s) 2025. <9> Accession Number 2046474123 Title Left Atrial Appendage Closure versus Oral Anticoagulants in Patients with Atrial Fibrillation: Systematic Review. Source Clinical and Applied Thrombosis/Hemostasis. 32 (no pagination), 2026. Article Number: 10760296261459709. Date of Publication: 01 Jan 2026. Author Liu H.; Li Z.; Chen X.; Zhou J. Institution (Liu, Li) Department of Cardiology, Heyuan People's Hospital, Heyuan, China (Chen) Department of Cardiology, Heyuan People's Hospital, The First Clinical College of Guangdong Medical University, Heyuan, China (Zhou) Department of Critical Care Medicine, Heyuan People's Hospital, Heyuan, China Publisher SAGE Publications Inc. Abstract Background: Oral anticoagulants (OACs) remain the standard strategy for stroke prevention in atrial fibrillation (AF) but are limited by bleeding risk, intolerance, and long-term adherence challenges. Left atrial appendage closure (LAAC) has emerged as a catheter-based alternative for thromboembolic prevention in non-valvular AF. This systematic review evaluated the comparative efficacy and safety of LAAC versus OAC therapy in patients with AF. Method(s): PubMed and Embase were systematically searched for randomized controlled trials (RCTs) comparing percutaneous LAAC with OACs, including direct oral anticoagulants (DOACs) and warfarin, in patients with AF. Result(s): Four pivotal randomized trials (PROTECT AF, PREVAIL, PRAGUE-17, and OPTION) were included. Compared with DOAC therapy, LAAC demonstrated non-inferiority for the composite endpoint of all-cause death, stroke, or systemic embolism in OPTION and for the primary composite outcome in PRAGUE-17. LAAC was associated with significantly lower non-procedural bleeding compared with DOACs in OPTION and PRAGUE-17. Compared with warfarin, LAAC achieved non-inferiority for ischemic stroke or systemic embolism beyond 7 days after randomization in PREVAIL and reduced long-term cardiovascular mortality in PROTECT AF. Procedure-related complications declined with increasing operator experience. Conclusion(s): LAAC provides non-inferior thromboembolic protection compared with OAC therapy while reducing long-term bleeding events in selected patients with AF. LAAC represents an important alternative for patients at elevated bleeding risk or with contraindications to long-term anticoagulation. Copyright © The Author(s) 2026. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). <10> Accession Number 2044616028 Title Does Hypotension Prediction Index limit the occurrence of postoperative complications associated with intraoperative hypotension? A systematic review and model-averaged Bayesian meta-analysis of statistically sound studies. Source Journal of Anesthesia. 40(4) (pp 627-640), 2026. Date of Publication: 01 Aug 2026. Author Piscopo R.; Giustiniano E.; Meco M.; Nisi F.; Dalla Corte F.; Piccioni F.; Cecconi M. Institution (Piscopo, Giustiniano, Nisi, Dalla Corte, Piccioni, Cecconi) Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Via A. Manzoni 56, Milan, Rozzano, Italy (Meco) Department of Anesthesia and Intensive Care, San Carlo Clinic, Via Ospedale 21, Milan, Paderno Dugnano, Italy (Piscopo, Nisi, Cecconi) Department of Biomedical Sciences, Humanitas University, Via R. Levi-Montalcini 4, Milan, Pieve Emanuele, Italy Publisher Springer Abstract Intraoperative hypotension (IOH) is considered a potential contributing factor to postoperative complications. In 2018, a machine-learning algorithm to predict hypotension has been included in the HemosphereTM platform (Edwards Lifescience, USA), of which the Hypotension Prediction Index (HPI) is the marker. We conducted a systematic review and Bayesian model-averaged meta-analysis to evaluate whether the limitation of IOH had a limiting effect on postoperative cardiac, pulmonary and renal complications and mortality. Nine randomized controlled trials and one propensity score analysis were included. Out of 978 patients, 488 received HPI monitoring, and 490 received routine monitoring. The Bayesian meta-analysis demonstrated that, in the HPI group, there is overwhelming evidence of a lower time-weighted average (TWA) for mean arterial pressure (MAP) < 65 mmHg and a shorter duration of hypotension. However, HPI-guided management did not demonstrate a convincing reduction in postoperative cardiac, pulmonary or renal complications, nor in mortality, and the certainty of evidence for these outcomes was low to very low. High heterogeneity and low certainty of evidence limit the strength of conclusions for postoperative outcomes. In this model-averaged Bayesian meta-analysis, HPI-guided management consistently reduced intraoperative hypotension, but did not translate into a demonstrable reduction in postoperative complications or mortality. Copyright © The Author(s), under exclusive licence to Japanese Society of Anesthesiologists 2026. <11> Accession Number 647628166 Title Survival Trends of Patients After Mitral Valve Repair for Structural Mitral Regurgitation Compared to the General Population. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Caldonazo T.; Kirov H.; Sakhtianchi B.A.; Tasoudis P.; Fischer J.; Mukharyamov M.; An K.R.; Doenst T.; Runkel A. Institution (Caldonazo, Kirov, Sakhtianchi, Fischer, Mukharyamov, Doenst, Runkel) Jena University Hospital, Jena, Germany (Tasoudis) University of North Carolina, Chapel Hill, United States (An) University of Toronto, Toronto, Canada Publisher Georg Thieme Verlag Abstract Background: Surgical mitral valve repair (MVr) for structural mitral regurgitation (MR) restores valve function. Individual studies suggest that MVr may normalize life expectancy. We performed a systematic review and a meta-analysis of all studies assessing the impact of MVr for structural MR on survival. Method(s): Three databases were assessed searching for studies with survival comparisons to the regional age-matched general population. The primary and single endpoint was long-term mortality. Individual patient data (IPD) were reconstructed from the published Kaplan-Meier curves and was used to calculate overall survival. The Cox proportional hazards regression model was used to assess between-group differences. The hazard ratios (HR) and 95% confidence intervals (CI) of each individual study was calculated. Landmark analysis was performed to check the robustness of the estimated effect. Result(s): Four studies met the criteria for inclusion in the final analysis. The studies' follow-up ranged from 10 to 26 years. The pooled Kaplan-Meier curves of reconstructed IPD show that for the entire follow-up, patients who underwent MVr had higher risk of death compared with the general age-matched population (HR: 0.62, 95% CI: 0.53-0.72, p < 0.01). Due to violation of the HR proportions, a landmark analysis was performed splitting the events after 6 years. There was no survival difference between the groups until 6 years after surgery (HR: 0.83, 95% CI, 0.68-1.03, p = 0.09). From 6 to 26 years of follow-up, curves diverged and the MVr group demonstrated significantly higher risk of death compared with the general age-matched population (HR: 0.45, 95% CI, 0.36-0.56, p < 0.01). The individual studies showed that the decrease in survival after 6 years was associated with an increase in return of MR and need of reoperation. Conclusion(s): MVr for structural MR has the potential to restore life expectancy compared with the general population. However, this effect is limited to the first 6 years after surgery. Risk of death thereafter correlates with the return of severe regurgitation and/or the need for reoperation. <12> Accession Number 647628148 Title Is Negative Pressure Wound Therapy Better for Sternal Wound Healing?. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Taghiyev Z.T.; Sandoval Valderrama J.F.; Niemann B.; Roth P.; Orhan C.; Haj M.; Grieshaber P.; Boning A. Institution (Taghiyev, Sandoval Valderrama, Niemann, Roth, Orhan, Haj, Grieshaber, Boning) Department of Cardiovascular Surgery, University Hospital Giessen, Giessen, Germany Publisher Georg Thieme Verlag Abstract Background: The purpose of this prospective, randomized study is to determine whether the preventive negative pressure wound therapy with PICOTM dressing system could reduce wound complications after the standard median sternotomy in cardiac surgery. Method(s): 256 patients undergoing open cardiac surgery during the period July 2019 to July 2023 were prospectively randomized in two groups: 108 patients were treated with PICOTM (Smith and Nephew Ltd, Hull, England) which was applied for 5 to 7 days, whereas 148 patients in control group received conventional wound dressings. Primary endpoints were superficial and deep sternal wound healing disorders, as well as the rate of sternal instability within 7, 30, and 180 days after surgery. Inverse probability of treatment weighting (IPTW) was used to assess the impact of PICOTM on wound complications. Result(s): After randomization, baseline and procedural characteristics were similar in both groups. In the PICO group the incision was primarily closed in 102 (94.4%) patients and there were seven cases (95.3%) of superficial dehiscence in the control group after 7 days of treatment. The overall 30-day incidence of sternal wound healing disorders was similar in both groups (17 [15.7%] versus 21 [14.2%], p = 0.726). 180 days after surgery, two patients in each group showed a skin dehiscence, while two patients in the PICO group had an instable sternum. Statistically, significantly less wound healing problems occurred in the PICO compared with the conventional group within 7 days after surgery (OR 2.1, 95%CI [1.016 to 4.369], p = 0.045), but not on 30 and 180 days after surgery, respectively (OR 1.0, 95%CI [0.472 to 2.247], p = 0.942 and OR 6.7, 95%CI [0.685 to 66.098], p = 0.102). Conclusion(s): The initial superiority of the PICOTM system to prevent wound infections following open-heart surgery could not be maintained at the 30- and 180-day follow-up. <13> Accession Number 647628149 Title Highlighting Genetic Differences between Barlow's Disease and Fibroelastic Deficiency via Genome-Wide Association Study Meta-Analyses. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Feirer N.; Weber M.; Knoll K.; Miranda L.; Yu M.; Li L.; Lahm H.; Kameric M.; Doppler S.; Gottmann I.; Lichtner P.; Berger K.; Lek M.; Lange R.; Schunkert H.; Hagege A.; Bouatia-Naji N.; Muller-Myhsok B.; Trenkwalder T.; Gruber P.; Krane M.; Dressen M. Institution (Feirer, Knoll, Kameric, Lichtner, Schunkert, Trenkwalder) German Heart Center Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany (Weber) Boehringer Ingelheim, Ulm, Germany (Miranda) Max Planck Institute of Biochemistry, Munich, Germany (Yu) Fudan University, Shanghai, China (Li) Munich Heart Alliance, Munchen, Germany (Lahm, Doppler, Gottmann, Lange, Krane, Dresen) Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, Munich, Germany (Berger) Institut fur Epidemiologie und Sozialmedizin, Munster, Germany (Lek, Gruber) Yale School of Medicine, Division of Cardiac Surgery, Yale, United States (Hagege) European Hospital Georges Pompidou, Paris, France (Bouatia-Naji) Universite de Paris, Paris, France (Muller-Myhsok) Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry Munich, Munich, Germany Publisher Georg Thieme Verlag Abstract Background: Subtypes of mitral valve prolapse (MVP) show a broad spectrum, including the phenotypes fibroelastic deficiency (FED) and Barlow's disease. However, the underlying genetic differences have not yet been analyzed in detail. This study highlights novel risk loci specific for FED and Barlow's disease, respectively. Method(s): The cohort included all consecutive patients who underwent mitral valve surgery for degenerative MVP at the Department of Cardiovascular Surgery or presented with symptomatic MVP at the Department of Cardiology at the German Heart Center Munich between March 2002 and January 2021. The cohort was subdivided into the phenotypes FED and Barlow's disease, based on clinical and morphological characteristics. Intermediate phenotypes were excluded from the subgroup analysis. Subgroups were analyzed via GWAS and investigated in meta-analyses with GWAS datasets stratified from data from the MVP France study. Phenome-wide association study (PheWAS) was performed with datasets from UK Biobank. Result(s): Within our cohort of 2,140 MVP patients, 84.5% (n = 1,809) suffered from severe mitral regurgitation that required surgery. The MVP France cohort included 1,412 patients and 2,439 controls, resulting in 3,552 patients and 11,439 controls included in our analyses. GWAS meta-analysis included 997 FED cases and 788 Barlow's disease cases. Two genome-wide significant loci (p < 5e-8) associated with Barlow's disease were identified. For Barlow's disease, 35 further SNPs also showed a significant correlation (p < 5e-5) in 32 risk loci. In association with FED, one highly significant (p < 5e- 8) locus was identified. Further 35 SNPs showed a significant FED correlation (p < 5e-5) in 30 risk loci. PheWAS revealed an association with paroxysmal supraventricular tachycardia for one locus correlating with FED on chromosome 4 and for one locus correlating with Barlow's disease on chromosome 10. Also, associations with left ventricular hypertrophy and ventricular arrhythmia were revealed for risk loci that correlate with Barlow's disease. Conclusion(s): This study presents the first GWAS identifying risk loci associated with FED and Barlow's disease. PheWAS links lead SNPs to several other cardiac conditions. These findings could initiate a paradigm shift in understanding the genetic differences between FED and Barlow's disease. <14> Accession Number 647771002 Title The Role of Artificial Intelligence in the Advancement of Mechanical Circulatory Support: A Systematic Review. Source ASAIO Journal. Conference: 71st Annual Meeting of the American Society for Artificial Internal Organs, ASAIO 2025. New Orleans, LA United States. 71(Supplement 3) (pp 149), 2025. Date of Publication: 01 May 2025. Author Woodland E.R.; Matlis G.C.; Palazzolo T.C.; Throckmorton A.L. Institution (Woodland, Matlis, Palazzolo, Throckmorton) Biomedical Engineering, Drexel University, School of Biomedical Engineering, Science, and Health Systems, North Wales, PA, United States Publisher Lippincott Williams and Wilkins Abstract Background: In recent years, there has been a notable surge in the ability of machines to perform complex and intelligent human-centered tasks, particularly within the domain of cardiovascular health. Transformative advancements in artificial intelligence (AI) and machine learning (ML) algorithms reflect the tremendous potential for such analyses to meaningfully extend into design, translational development, and clinical usage of medical devices, including mechanical circulatory support (MCS) therapies. Here, we investigate and report the devices, applications, limitations, and strategies in which AI is currently being employed in MCS and the new opportunities of AI approaches to transform the field of MCS. Method(s): To effectively assess the scope and impact of AI in MCS, we conducted a systematic literature review. A comprehensive search of four recognized research databases (Google Scholar, OVID Medline, ProQuest, and PubMed) was performed using the following Boolean string: "(Artificial Intelligence) AND AI AND (Mechanical Circulatory Support) AND MCS NOT (Heart Transplant) NOT (Cardiogenic Shock) NOT (Critical Care)." This strategy was designed to identify the application of AI in MCS only. Database search results were then screened by titles and abstracts to remove sources that could be identified as beyond the scope of the review or as duplicates. 271 of the 295 papers were removed during the screening process, leaving 24 remaining. These were reviewed in their entirety. Result(s): The majority of relevant publications covered two main subjects: the prediction and management of postoperative outcomes, and the development of personalized device-patient matching and timing. AI modeling has been instrumental in successful predictions of complications, recovery trajectories, and long-term survival. It has also been employed to inform clinical decision-making. Barriers to broad implementation of AI include the need for sizable, high-quality datasets to achieve algorithm training benchmarks, the lack of organized and incomplete databases, such as INTERMACS, and limited computational resources. Emerging frontiers of MCS recognize the potential for AI and ML techniques to refine and improve image recognition capabilities, diagnostic assessment, device placement, and post-implantation monitoring approaches in the future. Conclusion(s): AI-driven advancements demonstrate a promising convergence of computational power and clinical expertise, offering personalized, efficient, and informed clinical management of MCS patients. In order to realize broad implementation, we must overcome challenges and address limitations, including data integrity, model accuracy, resource access, and clinical acceptance. <15> Accession Number 647770915 Title Predictors of new-onset right bundle branch block after heart transplantation: a systematic review and meta-analysis. Source ASAIO Journal. Conference: 71st Annual Meeting of the American Society for Artificial Internal Organs, ASAIO 2025. New Orleans, LA United States. 71(Supplement 3) (pp 136), 2025. Date of Publication: 01 May 2025. Author Mostafa N.; Almaadawy O.; Hamed B.; Dervis M.; Asad A.; Zreigh S.; Mostafa H.A.; Elbenawi H.; Ahmed M.M. Institution (Ahmed) Cardiovascular Medicine, University of Florida, Gainesville, FL, United States (Mostafa) Ain Shams University, Cairo, Egypt (Almaadawy) MedStar Health, Baltimore, MD, United States (Hamed, Mostafa) Al Azhar University, Cairo, Egypt (Dervis, Asad, Zreigh) Ankara Yilidirim Beyazit University, Ankara, Turkey (Elbenawi) Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States Publisher Lippincott Williams and Wilkins Abstract Background: New right bundle branch block (RBBB) has a high prevalence among heart transplant recipients with several studies finding an association between RBBB and poor clinical outcomes. Crucially, the predictors of RBBB development after heart transplantation are not yet well established. Our study aims to evaluate the pre-operative hemodynamic and demographic predictors associated with increased risk of new-onset RBBB following heart transplantation. Method(s): A systematic literature search was conducted on PubMed, Scopus, Web of Science, and Cochrane Library to identify studies comparing heart transplant patients with RBBB and without RBBB from inception to 15 November 2024. Random-effects models were used to estimate the pooled mean difference with 95% confidence interval (CI) using OpenMeta[Analyst] software. Result(s): Seven studies incorporating 1310 patients were included in our meta-analysis. Compared to patients who did not develop conduction abnormalities, patients who developed RBBB had significantly higher graft ischemia time (mean difference 10.0; 95% CI: 2.00 - 17.91; P = 0.01) and pulmonary vascular resistance (mean difference 0.44; 95% CI: 0.21 - 0.68; P < 0.001) at preoperative catheterization. There was no difference between the two groups in terms of preoperative mean pulmonary artery pressure (mean difference 1.83; 95% CI: -0.86 - 4.53; P = 0.18) or the mean age of donors (mean difference 1.51; 95% CI: -0.30 - 3.31; P = 0.10) [Figure 1]. There was no statistically significant heterogeneity between the studies. Conclusion(s): Our meta-analysis identified that patients with RBBB after heart transplantation had a prolonged graft ischemia time and higher pulmonary vascular resistance. There was no association between RBBB and mean pulmonary artery pressure or donor age. Larger-scale studies on the pre-operative hemodynamics present before heart transplantation are needed to support our findings and exclude the impact of possible confounders. (Figure Presented). <16> Accession Number 647628294 Title ERAS in High-risk Patients: Improvement of Clinical Outcomes. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Casper J.; Krey M.; Dolata L.; Gemander C.; Sarwari H.; Yalin Y.; Pecha S.; Chindris V.; Schulte-Uentrop L.; Girdauskas E.; Reichenspurner H.; Petersen J. Institution (Casper) Universitatsklinikum Hamburg Eppendorf, Hamburg, Germany (Krey) University Medical Center Hamburg-Eppendorf, Hamburg, Germany (Dolata, Sarwari, Yalin) University Heart and Vascular Center Hamburg, Hamburg, Germany (Gemander) Uni, Hamburg, Germany (Pecha, Schulte-Uentrop, Reichenspurner, Petersen) HamburgGermany (Chindris) Universitatskjlinikum Hamburg-Eppendorf, Martinistrase, Hamburg- Nord, Germany (Girdauskas) University Heart Center, Augsburg, Germany Publisher Georg Thieme Verlag Abstract Background: Enhanced Recovery After Surgery (ERAS) uses a multidisciplinary, evidence-based approach to improve overall outcomes and length of stay for patients undergoing surgery. Multimorbid patients in particular could benefit from the ERAS protocol. This study aims to show the effects of an ERAS routine in patients undergoing high-risk surgery according to the ERAS guidelines. Method(s): The ERAS protocol with preoperative appointments and dedicated prehabilitation was applied to a total of 93 patients from June 2023 to July 2024. According to the ERAS guidelines, procedures such as root repair/replacement, ascending aortic replacement, Ross procedure, redo procedures, and combined valve procedures are defined as high-risk procedures. Of the 93 ERAS patients, 31 patients were considered high risk for ERAS (high risk group) compared with 62 low-risk patients (low-risk group). Result(s): The high-risk group was significantly younger (high-risk: 57.5 +/- 7.8 versus low-risk: 60.9 +/- 6.2; p = 0.024) and had a higher EURO-Score II (high-risk: 1.5 +/- 0.89 versus low-risk: 0.87 +/- 45; p = 0.001). Other baseline characteristics were similar in both groups. Cardiopulmonary bypass time (p = 0.205) and aortic cross-clamp time (high-risk: 101.9 +/- 46.2 versus low-risk: 84.3 +/- 23.9; p = 0.088) were similar in both groups. Extubation in the OR was possible in 35.4% of the high-risk group and 34% of the low-risk group (p = 0.932). Reintubation was required for postoperative bleeding in 2/31 patients (high-risk) and 2/62 (low-risk) patients. Admission to PACU-24 instead of ICU was possible in 32% of high-risk and 53% of low-risk patients (p = 0.056). One low-risk patient had postoperative delirium. ICU readmission was required in 2/31 (high-risk) and 2/62 (low-risk) patients (p = 0.470). ICU stay (high-risk: 28.5 +/- 23.4 versus low-risk: 32.9 +/- 30.7; p = 0.481) and postoperative hospital stay (high-risk: 8.6 +/- 3.8 versus low-risk: 7.2 +/- 2.9; p = 0.084) were similar in both groups. Conclusion(s): ERAS protocols can also be safely implanted in more complex patients such as combined valve procedures, Ross procedures, and/or redo procedures. However, a dedicated multi-professional team with a dedicated ERAS nurse is required to manage these multimorbid patients within the ERAS protocol. <17> Accession Number 647628209 Title Prognostic Impact of Prior Percutaneous Coronary Interventions in Patients Undergoing Coronary Artery Bypass Grafting-A Systematic Review and Meta-analysis. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Kirov H.; Caldonazo T.; Woehlecke H.; Fischer J.; Runkel A.; Mukharyamov M.; Doenst T. Institution (Kirov, Caldonazo, Woehlecke, Fischer, Runkel, Mukharyamov, Doenst) Jena University Hospital, Jena, Germany Publisher Georg Thieme Verlag Abstract Background: There is controversy on the effect of percutaneous coronary intervention (PCI) on outcomes of patients undergoing coronary artery bypass grafting (CABG). We meta-analytically assessed the prognostic impact of prior PCI in patients with coronary artery disease (CAD) who underwent CABG. Method(s): We performed a systematic review and meta-analysis of studies comparing patients who underwent CABG and had prior PCI in the past with patients who underwent CABG as primary treatment of CAD. Three databases were assessed. The study selection and data extraction were performed by two independent investigators and checked by a senior author. The primary endpoint was perioperative mortality. The secondary outcomes were perioperative myocardial infarction (MI), neurological events (NE), bleeding, acute renal failure (ARF), and hospital length of stay (LOS). The overall odds ratio (OR) and standard mean difference (SMD), as well as the 95% confidence interval (CI) were calculated using random-effects model. Result(s): After screening of all records found through the systematic search, 18 studies met the criteria for inclusion in the final analysis. Risk of perioperative mortality in patients undergoing direct CABG was lower than in those with prior PCI (OR: 0.86, 95% CI, 0.77-0.97, p = 0.02). There was no significant difference between the groups regarding perioperative MI (OR: 0.83, 0.62-1.13, p = 0.24), NE (OR: 0.97, 0.81-1.15, p = 0.71), bleeding (OR: 0.79, 0.60-1.05, p = 0.10), ARF (OR: 0.83, 0.59-1.16, p = 0.27), and hospital LOS (SMD: 0.26, -0.18 to 0.70, p = 0.24). Conclusion(s): CABG in patients with prior PCI appears to be associated with higher rates of perioperative mortality when compared with patients who underwent CABG as primary treatment of CAD. <18> Accession Number 647628297 Title Survival Trends of Patients after Coronary Artery Bypass Grafting and Sex-specific Differences-A Meta-analysis of Reconstructed Time-to-event Data. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Kirov H.; Caldonazo T.; Toshmatov S.; Tasoudis P.; Fischer J.; Runkel A.; Mukharyamov M.; Doenst T. Institution (Kirov, Caldonazo, Toshmatov, Fischer, Runkel, Mukharyamov, Doenst) Jena University Hospital, Jena, Germany (Tasoudis) University of North Carolina, Chapel Hill, United States Publisher Georg Thieme Verlag Abstract Background: Randomized evidence suggest that coronary artery bypass grafting (CABG) has the potential to improve life expectancy. Women are considered to have worse outcomes after CABG, but they are generally underrepresented in randomized trials. Registry data and trial sub-analyses provide controversial results for CABG in women. We systematically assessed the survival-improving potential of CABG in both sexes by analyzing studies that assessed CABG outcomes compared with the age-matched general population. Method(s): Three databases were assessed (MEDLINE, ScienceDirect, and Cochrane Library). Primary and single outcome was long-term all-cause mortality. Reconstruction of time-to-event data was performed. Sex-specific data from the arms were separately extracted. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Landmark analysis was performed to check the robustness of the estimated effect. Result(s): A total of 1,352 studies were retrieved. Eight studies encompassing 142,165 patients were included in the analysis. For the entire 19 years observation period, patients who underwent CABG had worse survival than the general population in both male (HR = 1.14, 95% CI, 1.05-1.23, p = 0.002) and female patients (HR = 1.21, 95% CI, 1.01-1.47, p = 0.045). However, the curves separated only after approximately 10 years which coincided with a violation of the proportional of hazard ratio assumption of the analysis. Performing landmark analyses suggest that there is no difference in life expectancy compared with the general population in the first decade. The direct comparison of men versus women suggests that very long-term survival was slight better in women (HR: 1.04, 95% CI, 1.01-1.08). Conclusion(s): Both men and women after CABG for treatment of CAD experience similar life expectancy in the first decade compared with the general population. Beyond 10 years, life expectancy becomes worse than the general population and is the worst in men. It may be speculated that this difference is due to graft occlusions. <19> Accession Number 647628226 Title Safety and Efficacy of Contemporary Rapid Deployment Valves-A Comparative Analysis. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Wilbring M.; Alexiou K.; Matschke K.; Wrobel A.S.; Kappert U.; Arzt S. Institution (Wilbring, Alexiou, Matschke, Wrobel, Kappert, Arzt) Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany Publisher Georg Thieme Verlag Abstract Background: Presently two differently designed rapid deployment valves (RDV) are commercially available-the Edwards INTUITY and the Corcym Perceval Plus. This study compares valve performances in a large consecutive cohort. Method(s): All consecutive isolated aortic valve replacements (AVR) or AVR in combination with CABG were included between 2016 and 2022 using either the INTUITY (n = 309) or the Perceval Plus (n = 338). Multiple valve procedures or non-IFU-conform implantations were ruled out. The final study group consisted of 647 patients. Preoperative aortic annular diameter (CT scan and 3D echocardiography), intraoperative adverse events (AE), predischarge hemodynamic parameters as well as permanent pacemaker implantation (PPI) rates were analyzed. Predischarge transthoracic echocardiography was performed by a single examiner between postoperative day 5 and 6. Result(s): Mean preoperative annular diameter differed not significantly between both groups (INTUITY 24.7 +/- 2.4 mm versus Perceval Plus 24.2 +/- 2.2 mm; p = 0.06). Intraoperative AE were likewise counterbalanced by means of valve malpositioning (INTUITY 3.6% versus Perceval Plus 2.4%; p = 0.49), repeated x-clamp (INTUITY 2.9% versus Perceval Plus 2.4%; p = 0.49), and use of a different prosthesis (INTUIYT 4.2% versus Perceval Plus 1.8%; p = 0.10). Postoperative mean effective orifice area generally differed not significantly (INTUITY 1.73 +/- 0.25 cm versus Perceval Plus 1.70 +/- 0.23 cm ; p = 0.15), but was significantly larger with the Perceval Plus in patients with an aortic annulus <=23 mm (n = 114; Perceval Plus 1.59 +/- 0.22 cm versus INTUITY 1.44 +/- 0.18 cm ; p = 0.04). Postoperative PVL (>trace) was less frequent in Perceval Plus (2.4% versus 5.5%; p = 0.04) and PPI rate was comparable (INTUITY 6.2% versus Perceval Plus 5.9%; p = 1.00). No case of valve thrombosis was documented. Conclusion(s): Both RDVs are safe and highly effective with mainly comparable hemodynamic outcomes at a high safety profile with low rates of permanent pacemaker implantations. The INTUITY had higher rates of PVL, whereas the Perceval Plus provided larger EOAs in smaller aortic annulus. <20> Accession Number 647628181 Title Sutureless Aortic Valve Replacement Superior to Transcatheter Aortic Valve Implantation: A State-of-the-Art Systematic Review, Meta-Analysis. Source Thoracic and Cardiovascular Surgeon. Conference: 54th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery, DGTHG. Hamburg Germany. 73(Supplement 1) (no pagination), 2025. Date of Publication: 11 Feb 2025. Author Ali-Hasan-Al-Saegh S.; Takemoto S.; Shafiei S.; Yavuz S.; Arjomandi Rad A.; Amanov L.; Merzah A.; Salman J.; Ius F.; Kaufeld T.; Schmack B.; Popov A.F.; Sabashnikov A.; Ruhparwar A.; Weymann A. Institution (Ali-Hasan-Al-Saegh) MHH, Hannover, Germany (Takemoto) Harvard Medical School, Boston, United States (Shafiei) Clinic for Cardiac and Thoracic Vascular Surgery, Marburg, Germany (Yavuz) Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey (Arjomandi Rad) Imperial College London, London, United Kingdom (Amanov, Merzah, Salman, Ius, Kaufeld, Ruhparwar) Hannover Medical School, Hannover, Germany (Schmack, Popov, Weymann) Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany (Sabashnikov) Royal Brompton and Harefield NHS Foundation Trust, Harefield, United Kingdom Publisher Georg Thieme Verlag Abstract Background: The management of patients with aortic valve pathologies can sometimes fall into a gray zone, where the optimal treatment approach is not straightforward. The comparative benefits of sutureless aortic valve replacement (SUAVR) using the bioprosthesis versus transcatheter aortic valve implantation (TAVI) for the gray zone of aortic valve replacement procedures remain a topic of debate. To further explore this issue, we conducted a study with pairwise, singlearm, and Kaplan-Meier-based meta-analyses to compare the outcomes of SUAVR with the bioprosthesis versus TAVI, as well as to evaluate the efficacy, safety, and durability of SUAVR with the bioprosthesis over mid-term and long-term followup periods. Method(s): The PubMed, PubMed Central, OVID Medline, Cochrane Library, Embase, and Web of Science databases were systematically searched. All study types were included, except study protocols and animal studies, without time restrictions. The final search was performed in May 2024. Result(s): No statistically significant differences were observed in permanent pacemaker implantation (PPI) rates between the two groups. SUAVR showed a lower incidence of new-onset myocardial infarction but was associated with higher rates of new-onset atrial fibrillation and major bleeding. TAVI had higher rates of left bundle branch block and major vascular complications. Conclusion(s): Our findings show that SUAVR has a lower incidence of complications and a favorable mid-term overall survival compared with TAVI. SUAVR has more advantages compared with TAVI and can be considered a valuable and promising option for the grey zone of aortic valve pathologies. <21> [Use Link to view the full text] Accession Number 2043620841 Title Will prothrombin complex concentrate replace plasma in cardiac surgical bleeding in North America?. Source Current Opinion in Anaesthesiology. Publish Ahead of Print (no pagination), 2026. Article Number: 46031. Date of Publication: 04 Dec 2025. Author Bartoszko J.; Gabarin N.; Tanaka K.; Callum J. Institution (Bartoszko) Department of Anesthesia and Pain Management, University Health Network, Sinai Health, Women's College Hospital, University of Toronto, Canada (Bartoszko) Peter Munk Cardiac Centre and Toronto General Hospital Research Institute, University Health Network, Canada (Bartoszko) Departments of Anesthesiology and Pain Medicine, Canada (Gabarin) Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada (Tanaka) Department of Anesthesiology, University of Oklahoma Health, Oklahoma City, OK, United States (Callum) Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, ON, Canada Publisher Lippincott Williams and Wilkins Abstract Purpose of review - There is increasing interest in four-factor prothrombin complex concentrate (4F-PCC) for treatment of acquired coagulopathic bleeding in cardiac surgery. Plasma, traditionally the treatment of choice, has a different composition compared with 4F-PCC. This review summarizes the current evidence. Recent findings - Because of its rapid reconstitution at the bedside and small administration volume, the use of 4F-PCC over plasma is rising - particularly with new clinical trial evidence suggesting 4F-PCC has efficacy and safety advantages. This is reinforced by mechanistic evidence supporting the role of 4F-PCC in normalizing or improving thrombin generation, an important aspect of secondary hemostasis often impacted in cardiac surgery. Four randomized controlled trials contribute to the human evidence base for the use of 4F-PCC in cardiac surgery. FARES-II, the largest study to date, demonstrated that 4F-PCC has improved hemostatic efficacy and a superior safety profile compared with plasma. Three additional studies are underway to confirm these findings. Summary - The use of 4F-PCC for the treatment of coagulopathic bleeding in cardiac surgery is supported by high-quality clinical evidence. Several unanswered questions remain regarding sex- and race-specific efficacy, the mechanism through which 4F-PCC may reduce serious adverse events, and its use in procedures that were under-represented in existing clinical trials. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. <22> Accession Number 2041920422 Title Watchman FLX versus Amplatzer amulet for percutaneous left atrial appendage occlusion: A systematic review and meta-analysis. Source Journal of Cardiology. 88(2) (pp 109-115), 2026. Date of Publication: 01 Aug 2026. Author de Pontes V.B.; Carvalho P.E.P.; Felix N.; Nogueira A.; Clemente M.R.C.; Gastaldelo V.; Preda A.; Garot P. Institution (de Pontes, Gastaldelo) Division of Medicine, Centro Universitario das Faculdades Associadas de Ensino, Sao Joao da Boa Vista, Brazil (Carvalho) Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States (Felix) Division of Medicine, Federal University of Campina Grande, Campina Grande, Brazil (Nogueira) Division of Medicine, Escola Bahiana de Medicina e Saude Publica, Salvador, Brazil (Clemente) Division of Medicine, Petropolis Medical School, Rio de Janeiro, Brazil (Preda) De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, Italy (Garot) Institut Cardiovasculaire Paris Sud (ICPS), Hopital Jacques Cartier, Ramsay-Sante, Massy, France Publisher Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai) Abstract Background The comparative safety and efficacy of Watchman FLX (Boston Scientific, Marlborough, MA, USA) and Amplatzer Amulet (Abbott, Abbott Park, IL, USA) devices for left atrial appendage occlusion (LAAO) remain unclear. Objective To compare Watchman FLX and Amplatzer Amulet devices for LAAO. Methods We systematically searched PubMed, Embase, and Cochrane Library for studies comparing Watchman FLX versus Amulet in patients with atrial fibrillation (AF) undergoing percutaneous LAAO. We applied a random-effects model to pool risk ratios (RR) with corresponding 95 % confidence intervals (CI) for binary endpoints. Results We included five studies comprising 1316 patients with AF undergoing LAAO for high bleeding risk. A total of 629 (47.8 %) patients underwent LAAO with Watchman FLX. Amulet was associated with lower rates of stroke or transient ischemic attack (TIA) (RR 2.31; 95 % CI 1.02-5.25; p = 0.04; I2 = 0 %), but no differences were observed in terms of peridevice leak (RR 1.57; 95 % CI 0.86-2.89; p = 0.14; I2 = 0 %) between Watchman and Amulet devices. Additionally, no differences were found in terms of device-related thrombus (RR 2.01; 95 % CI 0.87-4.68; p = 0.10; I2 = 0 %), or pericardial effusion (RR 1.00; 95 % CI 0.17-5.96; p = 1.00; I2 = 59.7 %) between both groups. Conclusion This meta-analysis indicates a lower risk of stroke or TIA with Amulet compared to Watchman FLX. Copyright © 2025 Elsevier Ltd. <23> Accession Number 651304973 Title Superficial intercostal plane blocks for post-sternotomy pain control rationale and design for the EPOCH CardioLink-10 randomized clinical trial. Source Current opinion in cardiology. 41(5) (pp 467-473), 2026. Date of Publication: 01 Sep 2026. Author Dhingra N.K.; Dennis F.; Hassan S.M.A.; Quan A.; Teoh H.; Chin K.; Ricci M.J.; Tran J.D.; Li J.; Verma R.; de Vasconcelos Papa F.; Lee Y.; Chang A.P.; Igualada J.; Morales J.F.; Ghiringhelli J.P.; Derry K.L.; George T.; Mazine A.; Rotstein O.D.; Adams C.; Cook R.C.; Hassan A.; Nagpal A.D.; Yau T.M.; Spence J.D.; Sutherland K.; Martinka P.M.; Noss C.D.; Dougherty J.L.; de Jager P.; Gregory A.J.; Arora R.C.; Verma S.; Alli A.; Mazer C.D. Institution (Dhingra, Yau) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network (Dhingra, Hassan, Rotstein, Yau, Verma) Department of Surgery, University of Toronto (Dennis, Hassan, Quan, Teoh, Verma) Division Cardiac Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto (Dennis, Hassan, Verma, Mazer) Department of Pharmacology and Toxicology, University of Toronto (Teoh) Division of Endocrinology and Metabolism (Chin, Ricci, Tran, Li, de Vasconcelos Papa, Lee, Igualada, Morales, Derry, George, Alli, Mazer) Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto (Ricci, de Vasconcelos Papa, Lee, Chang, Ghiringhelli, Derry, George, Alli, Mazer) Department of Anesthesiology and Pain Medicine (Tran, Mazer) Department of Physiology, University of Toronto, Toronto, ON, Canada (Verma) School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland (Chang) Department of Anesthesia, Sunnybrook Health Sciences Center (Ghiringhelli) Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, ON, Canada (Mazine) Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, VIC, Australia (Rotstein) Division of General Surgery, Li Ka Shing Knowledge Institute, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada (Adams) Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (Cook) Division of Cardiac Surgery, Vancouver General Hospital (Cook) Division of Cardiovascular Surgery, University of British Columbia, Vancouver, BC, Canada (Hassan) MaineHealth Maine Medical Center, Portland, Maine, USA (Nagpal) Division of Cardiac Surgery (Nagpal) Division of Critical Care, London Health Science Centre, Western University, London, United Kingdom (Spence) Departments of Anesthesia, Critical Care and Health Research Methods, Evidence, and Impact, Population Health Research Institute, McMaster University, Hamilton, ON (Sutherland, Martinka) Department of Anesthesiology and Perioperative Medicine, Royal Columbian Hospital, New Westminster, BC, Canada (Martinka) Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada (Noss, Gregory) Department of Anesthesiology, Perioperative and Pain Medicine & Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (Dougherty, de Jager) Department of Anesthesia, Pain Management & Peri-operative Medicine, Dalhousie University, Halifax, NS, Canada (Arora) Departments of Surgery and Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, United States Abstract PURPOSE OF THE TRIAL: Inadequate pain control following cardiac surgery remains a significant clinical and socioeconomic burden. Superficial parasternal intercostal plane (SPIP) blocks are not widely utilized for reducing pain and opioid consumption post-cardiac surgery because the available evidence is weak and inconsistent. METHOD(S): The double-blind, placebo-controlled, multicenter EPOCH CardioLink-10 trial was designed to evaluate how continuous bilateral SPIP blocks affect opioid consumption and recovery-related endpoints among individuals who have undergone cardiac surgery via median sternotomy. Participants from four Canadian sites are randomized to receive either 0.2% ropivacaine or placebo (0.9% sodium chloride) for 48-h following bilateral catheter insertion into the SPIP. The primary outcome is cumulative postoperative opioid use (morphine milligram equivalents) up to 72-hours post-catheter insertion. Secondary endpoints include median pain scores and the incidence of delirium over the 72-hours post-catheter insertion; cumulative postoperative opioid use up to hospital discharge; and participant-reported quality of recovery 24-96 h post-surgery. SUMMARY: EPOCH CardioLink-10 is to date the largest randomized controlled trial to evaluate an Enhanced Recovery After Surgery (ERAS) intervention among individuals who are recuperating from cardiac surgery with median sternotomy. Its overarching goal is to obtain robust data to improve clinical care and inform on post-cardiac surgery pain management guidelines. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <24> Accession Number 2038434939 Title Rhomboid intercostal and sub serratus plane block for post-operative analgesia after laparoscopic cholecystectomy: a randomized control study. Source Anaesthesia, Pain and Intensive Care. 30(5) (pp 591-598), 2026. Date of Publication: 01 May 2026. Author Elhouty M.G.; Elawady M.S.; Elbahrawy K.M. Institution (Elhouty, Elawady, Elbahrawy) Faculty of Medicine, Mansoura University, Egypt Publisher Faculty of Anaesthesia, Pain and Intensive Care, AFMS Abstract Background & objective: The "Rhomboid intercostal and subserratus plane" block (RISS) is a relatively new block technique that proved its efficacy in different thoracic procedures. Its analgesic effect after laparoscopic cholecystectomy is under valuated. The aim of the study was to evaluate the effectiveness of RISS block in providing and maintaining postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Method(s): This prospective trial included 90 patients who were randomly divided into two groups: the RISS group that received the block (n = 45) and the control group that received no block (n = 45). Result(s): Baseline demographic characteristics and operative durations were comparable between the two groups (P > 0.05). The RISS group demonstrated significantly more stable intraoperative hemodynamics, evidenced by lower heart rate and arterial pressure values compared to the control group (P < 0.05). Pain scores were also significantly lower in the RISS group during the first 12 postoperative hours (P < 0.05). Furthermore, the time to first rescue analgesia was markedly prolonged (729.11 vs. 23.89 minutes), and total postoperative fentanyl consumption was substantially reduced (45.11 vs. 153.24 microg) in the RISS group compared to controls (both P < 0.05). Consequently, patients who received the RISS block reported significantly higher satisfaction levels (P < 0.05). Conclusion(s): Bilateral RISS block is an effective option to provide postoperative analgesia for patients undergoing laparoscopic cholecystectomy. It should be performed as a part of a multimodal analgesia. Copyright © 2026, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved. <25> Accession Number 2038414319 Title Bacteriological Profile and Antibiotic Resistance of Pleural Infections: A literature Review. Source Tunisie Medicale. 104(7) (pp 850-855), 2026. Date of Publication: 01 Jul 2026. Author Idrissi A.; Saddari A.; Ezrari S.; El Kandouni S.; Benaissa E.; Ben Lahlou Y.; Elouennass M.; Maleb A. Institution (Idrissi, Saddari, Ezrari, El Kandouni, Maleb) Laboratory of Microbiology, Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco (Idrissi, Saddari, El Kandouni, Maleb) Laboratory of Microbiology, Mohammed VI University Hospital, Oujda, Morocco (Benaissa, Ben Lahlou, Elouennass) Department of Bacteriology, Mohammed V Teaching Military Hospital, Rabat, Morocco (Benaissa, Ben Lahlou, Elouennass) Epidemiology and Bacterial Resistance Research Team/BIO-INOVA Centre, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco Publisher Societe Tunisienne des Sciences Medicales Abstract Pleural infection remains a medical challenge with serious consequences for the health and lives of individuals worldwide. The diagnosis of pleural effusion (PE) infection shows that the isolated micro-organisms exhibit substantial resistance to standard prescribed antibiotics. Therefore, the selection of appropriate antibiotics for treatment should be based on microbiological findings. Understanding the microbiology of pleural infections is essential for making informed choices about antibiotic therapy. The objective of this review is to analyze studies that have attempted to identify the types of bacteria involved, antibiotic sensitivity and resistance profiles, factors associated with pleural infections. Studies showed that bacteria isolated from pleural effusion have shown increasing antibiotic resistance, which should influence the choice of empirical antimicrobial therapy. This also highlights the importance of closely monitoring the dissemination and emergence of drug-resistant bacterial agents. Copyright © 2026, Societe Tunisienne des Sciences Medicales. All rights reserved. <26> Accession Number 2047661945 Title Sex Differences in the Effects of Perioperative Rehabilitation on Postoperative Pulmonary Complications After Cardiac Valve Surgery: A Prespecified Subgroup Analysis of the PORT Randomized Trial. Source International Journal of Women's Health. 18 (no pagination), 2026. Article Number: 576395. Date of Publication: 2026. Author Tan S.; Liu Z.; Cai X.; Bai B.; Jiang Z.; Zhang S.; Chen X.; Xu J.; Zhang G.; Guo L.; Ge Q.; Ma H. Institution (Tan, Liu, Cai, Bai, Jiang, Zhang, Chen, Zhang, Guo, Ma) Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, Guangzhou, China (Tan, Liu, Cai, Zhang, Chen, Zhang, Guo, Ge, Ma) Department of Intensive Care Medicine, Peking University Third Hospital, Beijing, China (Xu) Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, Guangzhou, China (Xu) School of Medicine, South China University of Technology, Guangdong, Guangzhou, China Publisher Dove Medical Press Ltd Abstract Purpose: To evaluate whether biological sex modifies the association between perioperative rehabilitation and short-term postoperative pulmonary outcomes in patients undergoing cardiac valve surgery. Patients and Methods: This prespecified subgroup analysis was based on the PORT randomized controlled trial, a single-center prospective study including 818 adults undergoing elective valve surgery. Patients were randomized to usual care or additional perioperative rehabilitation. Usual care followed standard institutional protocols without structured therapist-led rehabilitation. The intervention group received a supervised program including patient education, inspiratory muscle training, active cycle of breathing techniques, and early mobilization from admission to discharge. The primary endpoint was a composite of in-hospital mortality, postoperative pulmonary complications (PPCs), and prolonged hospitalization (>7 days). Key secondary endpoints were radiologically confirmed pneumonia and pneumothorax within 7 days and before discharge. Sex-stratified multivariable Cox models were used to estimate adjusted hazard ratios (HRs), adjusting for age, body mass index, left ventricular ejection fraction category, Global Initiative for Chronic Obstructive Lung Disease category, hypertension, and smoking history. Result(s): Perioperative rehabilitation was not associated with a significant reduction in the primary composite outcome in either sex. Among female patients, it was associated with lower risks of PPCs (adjusted HR 0.55, 95% CI 0.36-0.83; P = 0.005) and pneumonia (adjusted HR 0.48, 95% CI 0.33-0.70; P < 0.001), with a lower risk of pneumothorax also observed (adjusted HR 0.40, 95% CI 0.17-0.99; P = 0.047). No significant associations were observed in male patients. A significant sex-by-treatment interaction was identified for pneumonia (P for interaction = 0.041). Conclusion(s): Perioperative rehabilitation was associated with improved short-term pulmonary outcomes in female patients, particularly for pneumonia, whereas no significant benefit was observed in males. These findings suggest a potential sex-specific response, which requires confirmation in future multicenter studies. Copyright © 2026 Tan et al. <27> Accession Number 2046499311 Title Concomitant Left Atrial Appendage Occlusion and Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis. Source Journal of the Society for Cardiovascular Angiography and Interventions. 5(8) (no pagination), 2026. Article Number: 105446. Date of Publication: 01 Aug 2026. Author Gajula K.S.; Lingamsetty S.S.P.; Pamreddy H.R.; Banga A.; Jitta S.R.; Doma M.; Cherukuri K.; Vahdat K.; Ramsaran E.; Goldsweig A.M. Institution (Gajula, Cherukuri, Vahdat, Ramsaran) Department of Cardiovascular Medicine, Saint Vincent Hospital, UMass Chan Medical School, Worcester, MA, United States (Lingamsetty) Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Pamreddy) Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, United States (Banga) Department of Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, United States (Jitta) Department of Internal Medicine, Mercy Health St. Louis, St. Louis, MO, United States (Doma) Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Goldsweig) Department of Cardiovascular Medicine, Baystate Medical Center, and Division of Cardiology, University of Massachusetts-Baystate, Springfield, MA, United States Publisher Elsevier B.V. Abstract Background Atrial fibrillation (AF) is prevalent among patients undergoing transcatheter aortic valve replacement (TAVR) and increases risks of thromboembolism and bleeding with chronic anticoagulation. Concomitant left atrial appendage occlusion (LAAO) during TAVR may reduce long-term stroke and bleeding risks. Methods PubMed, Embase, and Cochrane databases were searched through May 2025 for studies comparing TAVR + LAAO versus TAVR + standard medical therapy in patients with atrial fibrillation. Random-effects models were used to pool risk ratios (RRs) or mean differences with 95% CIs. Results Four studies (2 randomized controlled trials, 2 observational; n = 563, mean age 82 years) were included; 279 patients (49.5%) underwent TAVR + LAAO. Thirty-day outcomes showed no differences in mortality (RR 0.91; 95% CI, 0.28-3.01), stroke/transient ischemic attack (RR 0.27; 95% CI, 0.04-1.66), or major bleeding (RR 0.27; 95% CI, 0.04-1.66). Over a 9.8-month to 2-year follow-up, all-cause mortality (RR 0.95; 95% CI, 0.68-1.32), cardiac death (RR 0.95; 95% CI, 0.60-1.50), stroke/transient ischemic attack (RR 1.33; 95% CI, 0.30-5.83), and major bleeding (RR 1.06; 95% CI, 0.71-1.59) remained similar. Contrast use and hospital length of stay were comparable. Conclusions Concomitant TAVR plus LAAO appears feasible, with no statistically significant differences in short-term outcomes versus TAVR plus standard medical therapy; however, certainty is low, and findings are hypothesis-generating, warranting larger randomized trials and prospective registries. Copyright © 2026 The Author(s). <28> Accession Number 2038440132 Title Prosthesis-patient mismatch with intra-annular self-expanding valves: an analysis of the PORTICO IDE trial. Source EuroIntervention. 22(13) (pp e741-e747), 2026. Date of Publication: 2026. Author Fontana G.P.; Waksman R.; Salemi A.; Cohen M.; Abernethy W.; Hermiller J.; Baker C.; Montarello J.; Kleiman N.; Sondergaard L.; Gnall E.; Rodriguez R.; Gada H.; Brinkman W.; Weissman N.J.; Mahoney P.; Makkar R. Institution (Fontana) Cardiovascular Institute, HCA Los Robles Health System, Thousand Oaks, CA, United States (Waksman, Weissman) MedStar Washington Hospital Center, Washington DC, United States (Salemi, Cohen) Newark Beth Israel, Newark, NJ, United States (Abernethy) Mission Health & Hospitals, Asheville, NC, United States (Hermiller) St. Vincent Hospital, Carmel, IN, United States (Baker) USC University Hospital, Los Angeles, CA, United States (Montarello) St. Andrew's Hospital, Adelaide, Australia (Kleiman) The Houston Methodist Hospital, Houston, TX, United States (Sondergaard) Rigshospitalet, Copenhagen, Denmark (Sondergaard) Abbott, Santa Clara, CA, United States (Gnall, Rodriguez) Lankenau Institute for Medical Research, Penn Wynne, PA, United States (Gada) Pinnacle Health System, Pittsburgh, PA, United States (Brinkman) The Heart Hospital Baylor Scott and White, Plano, TX, United States (Weissman) MedStar Health Research Institute, Columbia, MD, United States (Mahoney) East Carolina Heart Institute, Greenville, NC, United States (Makkar) Cedars-Sinai Medical Center, Los Angeles, CA, United States Publisher Europa Group Abstract BACKGROUND: Aortic valve replacement in small aortic annuli is associated with an increased risk of impaired haemodynamics. AIMS: We sought to evaluate haemodynamic outcomes and prosthesis-patient mismatch (PPM) in aortic stenosis (AS) patients treated with Portico, Evolut, and SAPIEN 3 transcatheter aortic valves (TAVs) in small (diameter <=23 mm) and large (diameter >23 mm) aortic annuli. METHOD(S): PORTICO IDE was a prospective, multicentre, international, premarket randomised controlled trial comparing Portico to Evolut and SAPIEN 3 TAVs. An independent core laboratory evaluated the mean transvalvular pressure gradient (MG) and the effective orifice area (EOA), and PPM was calculated based on the core lab results. RESULT(S): A total of 675 patients with severe AS at high or extreme surgical risk were included (Portico: 362 patients; Evolut: 109; SAPIEN 3: 204). At 30 days, the EOA and rates of severe PPM in small aortic annuli were similar between Portico and Evolut (EOA 1.65 cm2 vs 1.78 cm2; p=0.09; PPM 3.3% vs 3.0%; p=1.0) with a higher MG (8.5 mmHg vs 6.9 mmHg; p=0.034) for Portico. No significant differences were observed between Portico and Evolut for large aortic annuli (MG 8.3 mmHg vs 7.4 mmHg; p=0.069; EOA 1.93 cm2 vs 2.02 cm2; p=0.18; PPM 5.4% vs 3.2%; p=0.83). Portico was superior to SAPIEN 3 in both small (MG 8.5 mmHg vs 13.7 mmHg; p<0.0001; EOA 1.65 cm2 vs 1.40 cm2; p<0.0001; PPM 3.3% vs 26.3%; p<0.0001) and large annuli (MG 8.3 mmHg vs 10.9 mmHg; p<0.0001; EOA 1.93 cm2 vs 1.67 cm2; p<0.0001; PPM 5.4% vs 10.9%; p=0.0014). At 5 years, the rate of structural valve deterioration in patients with small aortic annuli was significantly lower in patients treated with Portico (2.2%) versus SAPIEN 3 (13.9%; p=0.03). CONCLUSION(S): Haemodynamic performance was similar for the intra-annular Portico and supra-annular Evolut. Portico haemodynamics outperformed the balloon-expandable SAPIEN 3 for PPM and mean gradient in both small and large aortic annuli. Copyright © Europa Group 2026. All rights reserved. <29> Accession Number 2048048631 Title Cost-effectiveness of transcatheter aortic valve replacement in patients with severe aortic stenosis and low surgical risk: perspective of a middle-income country's public health system. Source International Journal of Cardiology. 462 (no pagination), 2026. Article Number: 134673. Date of Publication: 01 Nov 2026. Author Pereira G.A.R.; Polanczyk C.A.; da Silva Etges A.P.B.; Saadi R.P.; Bertoldi E.G. Institution (Pereira) Department of Cardiology, Hospital de Clinicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil (Pereira, Polanczyk, Bertoldi) Federal University of Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil (Bertoldi) School of Medicine, Federal University of Pelotas (UFPel), RS, Pelotas, Brazil (Polanczyk, da Silva Etges, Bertoldi) Institute for Health Technology Assessment (IATS) - CNPq/Brazil (Project No. 465518/2014-1), RS, Porto Alegre, Brazil (Polanczyk) Hospital Moinhos de Vento, RS, Porto Alegre, Brazil (da Silva Etges) Federal University of Rio Grande do Sul (UFRGS), RS, Porto Alegre, Brazil (Saadi) Department of Cardiovascular Surgery, Hospital Mae de Deus, RS, Porto Alegre, Brazil Publisher Elsevier Ireland Ltd Abstract Background: Randomized controlled trials comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and low surgical risk have demonstrated noninferiority of TAVR regarding all-cause mortality and stroke outcomes in 5- and 10-year follow-up. Nevertheless, TAVR remains a costly intervention, and its widescale adoption may affect healthcare expenditure in low- and middle-income countries. This study aimed to conduct a cost-utility analysis comparing TAVR and SAVR in patients with severe aortic stenosis at low surgical risk, from the perspective of the Brazilian Unified Health System (Sistema Unico de Saude - SUS). Method(s): A Markov model was developed to simulate a hypothetical cohort of patients with severe aortic stenosis over a lifetime horizon. A systematic review was performed to inform efficacy and effectiveness inputs. Cost data were derived from Brazilian patient cohorts who underwent TAVR or SAVR and were expressed in international dollars (Int$). Incremental cost-effectiveness ratios (ICERs) were calculated and sensitivity analyses were performed. Result(s): The estimated lifetime cost was Int$ 32,341 for TAVR and Int$ 19,778 for SAVR. Lifetime quality-adjusted life-years (QALYs) were 9.90 and 9.71, respectively. The ICER for TAVR was Int$ 64,617 per QALY gained, exceeding the Brazilian willingness-to-pay threshold of Int$ 47,619 per QALY. In probabilistic sensitivity analysis, TAVR was cost-effective in 32.8% of simulations. Conclusion(s): In patients with severe aortic stenosis at low surgical risk, TAVR was unlikely to be cost-effective compared with SAVR from the perspective of the Brazilian Unified Health System, primarily driven by cost differences between strategies. Copyright © 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <30> Accession Number 2045764193 Title Intravascular Imaging-Guided Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Unprotected Left Main Stenosis. Source Catheterization and Cardiovascular Interventions. 108(2) (pp 415-425), 2026. Date of Publication: 01 Aug 2026. Author Wanha W.; Kuzma L.; Swieczkowski M.; Dabrowski E.; Iwanczyk S.; Lesiak M.; Kowalewski M.; Dobrzycki S.; Kralisz P.; Kowalowka A.; Makhoul M.; Morshed K.; Wita K.; Gocol R.; Hudziak D.; Wojakowski W.; De la Torre Hernandez J.M.; Cortese B. Institution (Wanha, Wojakowski) Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (Wanha, Cortese) DCB Academy, Milan, Italy (Wanha, Kuzma, Kowalewski) Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland (Kuzma, Swieczkowski, Dabrowski, Dobrzycki, Kralisz) Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland (Kuzma, Kowalewski) Thoracic Research Centre, Collegium Innovative Medical Forum, Bydgoszcz, Poland (Kuzma) Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom (Iwanczyk, Lesiak) Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland (Kowalowka, Gocol, Hudziak) Department of Cardiac Surgery, Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland (Makhoul) Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom (Makhoul, Morshed) Rambam Medical Centre, Haifa, Israel (Wita) First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland (De la Torre Hernandez) Servicio de Cardiologia, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain (Cortese) Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, United States (Cortese) Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy Publisher John Wiley and Sons Inc Abstract Background: Randomized clinical trials comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery (LMCA) stenosis have indicated lower repeat revascularization after CABG. Aim(s): This multi-center study aimed to investigate outcomes of intravascular imaging (IVI)-guided PCI compared with CABG for treating LMCA stenosis. Method(s): Analysis included 855 patients (396 PCI) from 18 centers. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE: cardiovascular death, myocardial infarction, stroke, and target vessel revascularization at 2 years). Propensity score matching (PSM) analysis was used to limit differences among the groups. Cox regression event rates were calculated for matched groups. Result(s): In the overall cohort, no difference in MACCE was observed (HR 0.97, 95% CI 0.72-1.32, p = 0.84). PSM resulted in 230 pairs, with no significant differences in baseline, procedural characteristics, and SYNTAX score between the two groups. The matched cohorts had no significant differences for the primary endpoint (HR 0.85, 95% CI 0.65-1.43, p = 0.85). No differences for all-cause mortality rates between the two groups were found at 2 years (10% in the PCI and 11% in the CABG arm, p = 0.65). During follow-up, patients undergoing CABG had lower rates of myocardial infarction (8.7% vs. 14.8%, p = 0.04). More frequent stroke incidence was noticed (8.7% vs. 0%, p < 0.001). There was no significant difference in the incidence of target vessel revascularization between PCI and CABG (3.91% vs. 2.61%, p = 0.43). Conclusion(s): IVI-guided PCI for LMCA stenosis provides similar 2-year outcomes to CABG. Lower MACCE rates with PCI were observed in patients with lower anatomic complexity. Copyright © 2026 Wiley Periodicals LLC. <31> Accession Number 2048027815 Title The evolution of robotic-assisted thoracic surgery: current platforms, emerging technologies, and future perspectives - a narrative review. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 792. Date of Publication: 01 Dec 2026. Author Kuzmych K.; Lococo F.; Nachira D.; Senatore A.; Calabrese G.; Vita M.L.; Petracca-Ciavarella L.; Congedo M.T.; Meacci E.; Margaritora S. Institution (Kuzmych, Lococo, Nachira, Senatore, Calabrese, Vita, Petracca-Ciavarella, Congedo, Meacci, Margaritora) Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy Publisher Springer Nature Abstract Robotic-assisted thoracic surgery (RATS) has undergone rapid technological evolution over the past two decades, progressively expanding from early minimally invasive applications to increasingly complex thoracic procedures. This narrative review examines the historical development of robotic platforms in thoracic surgery, the emergence of new approaches and alternative robotic systems, and future technological perspectives. A literature search was conducted using PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and the Cochrane Library to identify relevant English-language publications through May 2026. Early robotic systems established the feasibility of robotic thoracic procedures, particularly mediastinal surgery and selected pulmonary resections, while also defining the technical limitations that shaped early practice, including demanding docking, arm-collision issues, dependence on bedside assistance, and lack of console-controlled stapling. The da Vinci Xi refined multiport robotic surgery through improved arm design, overhead boom architecture, simplified docking, and integrated stapling, supporting greater standardization and broader adoption of robotic thoracic surgery. In parallel, reduced-port approaches, including biportal and uniportal RATS, emerged through technical adaptation of existing platforms. The da Vinci SP introduced a dedicated single-port architecture, whereas the da Vinci 5 represents a further step toward haptic feedback and data-driven robotic surgery. Emerging systems such as Versius, Hugo RAS, Toumai, and Shurui SP reflect a diversifying robotic landscape, with modular, portable, and lower-cost design, that may influence future access and adoption. Future developments include artificial intelligence, augmented reality, digital twins, autonomous assistance, and remote surgery. Overall, robotic thoracic surgery is evolving from a purely mechanical platform toward a more integrated digital surgical environment, although the clinical impact, accessibility, training requirements, and long-term benefits of many emerging technologies remain to be fully established. Copyright © The Author(s) 2026. <32> Accession Number 2047607360 Title Colchicine in coronary heart disease: from inflammatory biology to secondary prevention. Source Clinical and Experimental Rheumatology. 44 (pp 1306-1311), 2026. Date of Publication: 14 Jul 2026. Author Imazio M. Institution (Imazio) Department of Medicine, University of Udine, and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, Udine, Italy Publisher Clinical and Experimental Rheumatology S.A.S. Abstract Inflammation is now recognised as a central mechanism in atherosclerosis and its clinical complications, shifting coronary heart disease management beyond exclusive lipid lowering and antithrombotic therapy. In this setting, colchicine is a potential low-cost anti-inflammatory candidate for cardiovascular prevention. While the CANTOS trial provided proof of principle that targeting inflammation can reduce recurrent cardiovascular events independently of lipid lowering, randomised colchicine trials such as COLCOT and LoDoCo2 showed reductions in major adverse cardiovascular events in patients with recent myocardial infarction and chronic coronary disease, respectively. Later meta-analyses generally confirmed benefit for major adverse cardiovascular events, myocardial infarction, stroke, and coronary revascularisation, although without a consistent mortality reduction and with gastrointestinal intolerance as the most common adverse effect. This review summarises the biological rationale, clinical trial evidence, safety profile, practical use, limitations, and current place of colchicine in coronary heart disease highlighting that colchicine is a real available cheap option for secondary prevention at least in chronic coronary syndromes. © Copyright CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2026. <33> Accession Number 2045328038 Title Management algorithm for pulmonary vein stenosis: An evaluation of available surgical data. Source Heart Rhythm O2. 7(7) (pp 1353-1360), 2026. Date of Publication: 01 Jul 2026. Author Bauer J.; Chorazy K.; Schwarz S.; Taghavi S.; Aigner C.; Vetchy V.; Gerges C.; Lang I.; Moser B. Institution (Bauer, Chorazy, Schwarz, Taghavi, Aigner, Moser) Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria (Vetchy) Department of Biomedical Imaging and Guided Therapy, Medical University of Vienna/General Hospital Vienna, Vienna, Austria (Gerges, Lang) Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University of Vienna, Vienna, Austria (Bauer, Chorazy, Schwarz, Taghavi, Aigner, Moser) Comprehensive Center for Chest Diseases, Medical University of Vienna, Vienna, Austria Publisher Elsevier B.V. Abstract Background Pulmonary vein stenosis (PVS) is a rare complication after radiofrequency ablation for patients with atrial fibrillation. However, the impact of a high-grade stenosis on a patient's hemodynamic situation and quality of life can be severe. Percutaneous balloon angioplasty or stent implantation are interventional treatment options for severe and symptomatic PVS. Owing to significant postinterventional restenosis rates, the management of PVS remains challenging, and the investigation of other options, such as surgical correction, is warranted. Objectives In this study, a structured literature review on surgical treatment strategies for PVS was performed. Based on these findings and multidisciplinary clinical experience, we developed a pragmatic management algorithm to guide individualized treatment decisions for patients with severe or recurrent PVS. Methods A literature review was conducted using PubMed, following the population, intervention, comparison, and outcome framework. A treatment algorithm was designed as a decision flowchart. Results The literature search identified 7 publications on cardiothoracic surgical techniques for the treatment of PVS, describing 11 cases. Although the most common surgical approach was pericardial patchplasty, sutureless techniques and a combination of operations, including endarterectomy, bypass, widening plasty after stent implantation, suturing the vein directly to the left auricle, or the use of pulmonary homograft tissue, were also described in the literature. Conclusion Managing PVS is challenging, especially in cases of restenosis. These patients should be discussed in a multidisciplinary setting, including cardiology, radiology, and thoracic surgery. We propose a treatment algorithm that may aid in individual decision making and serve as a starting point for future discussions. Copyright © 2026 Heart Rhythm Society. <34> Accession Number 2046873729 Title Spindle Cell Cardiac Lipoma in an Adolescent: A Case Report and Systematic Review of Cases. Source JACC: Case Reports. 31(33) (no pagination), 2026. Article Number: 108811. Date of Publication: 19 Aug 2026. Author Soh S.L.; Wee I.J.Y.; Murray Binti Jeffery Murray R.L.; Sivalingam S.; Roslan A. Institution (Soh, Murray Binti Jeffery Murray, Sivalingam) Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia (Wee) Health Services Research Unit, Singapore General Hospital, Singapore, Singapore (Roslan) Department of Cardiology, Sunway Medical Centre, Kuala Lumpur, Malaysia Publisher Elsevier Inc. Abstract Background: Spindle cell lipoma is a benign adipocytic neoplasm that typically arises in subcutaneous soft tissues and is exceptionally rare in the heart. Case Summary: A 13-year-old male patient was referred for evaluation of a cardiac murmur. Transthoracic echocardiography demonstrated multiple intracardiac masses involving the aortic valve, interventricular septum, and posterior left ventricular wall, resulting in severe aortic regurgitation and moderate aortic stenosis. Cardiac magnetic resonance imaging revealed a large lobulated mass arising from the left coronary cusp of the aortic valve with extension into the left ventricular outflow tract. Given diagnostic uncertainty, surgical resection with mechanical aortic valve replacement was performed. Histopathology confirmed a spindle cell lipoma. Recovery was uncomplicated, with no residual mass on follow-up imaging. Discussion(s): A systematic review identified only 2 previously reported adult cases, both involving cardiac valves. Imaging was nonspecific, and definitive diagnosis relied on histopathology. Take-Home Message: Spindle cell cardiac lipoma is a rare but clinically significant cause of valvular cardiac masses; histopathological confirmation is essential, and surgical excision appears curative. Copyright © 2026 The Authors <35> Accession Number 2047980022 Title Combined Transcatheter Aortic Valve Implantation and Endovascular Aortic Repair: A Review. Source Hellenic Journal of Vascular and Endovascular Surgery. 8(2) (pp 65-73), 2026. Date of Publication: 2026. Author Karaolanis G.; Bekas N.; Nikas D. Institution (Karaolanis, Bekas) Vascular Unit, Department of Surgery, University Hospital of Ioannina, School of Medicine, Ioannina, Greece (Nikas) Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece Publisher Rotonda Publications Abstract Background: The coexistence of severe aortic valve stenosis and aortic aneurysmal disease presents a complex therapeutic challenge, particularly in elderly patients at high surgical risk. Advances in minimally invasive techniques have enabled combined transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR / TEVAR) as an alternative to open surgery. Method(s): A comprehensive review of the literature was performed to identify published studies reporting outcomes of combined TAVI and endovascular aortic repair, either as a simultaneous or staged strategy. Study characteristics, procedural details, and reported outcomes were analyzed descriptively. Result(s): The available evidence consists predominantly of case reports and small case series involving high-risk patients. Both simultaneous and staged approaches were reported, with TAVI most commonly performed prior to aortic repair. Procedural success rates were high, and short- to mid-term outcomes were generally favorable. Complications were infrequently reported in small studies, although larger series of isolated procedures indicate that relevant adverse events may occur. Conclusion(s): Combined TAVI and endovascular aortic repair appear to be a feasible and minimally invasive treatment option for selected high-risk patients with concomitant aortic valve and aortic pathology. However, evidence remains limited, and optimal patient selection and procedural sequencing are yet to be defined. Larger studies and prospective registries are required to establish standardized treatment strategies. Copyright © 2026 Rotonda Publications. All rights reserved. <36> Accession Number 2038442657 Title Efficacy of Sirolimus Versus Paclitaxel-Coated Balloons for Coronary Revascularization: An Updated Meta-Analysis with GRADE Assessment. Source Journal of the Saudi Heart Association. 38(2) (no pagination), 2026. Article Number: 17. Date of Publication: 2026. Author Wijayanto M.A.; Tristan C.D.; Kynaya E.M.; Rahma A.A.; Harimurti P.S.; Mangkuanom A.S.; Alkatiri A.A.; Firman D.; Siswanto B.B. Institution (Wijayanto, Tristan, Kynaya, Rahma) Faculty of Medicine, Universitas Sebelas Maret, Central Java, Surakarta, Indonesia (Harimurti) Faculty of Medicine, Universitas Indonesia, West Java, Depok, Indonesia (Mangkuanom, Alkatiri, Firman, Siswanto) Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Publisher Saudi Heart Association Abstract Drug-coated balloons are an emerging strategy for coronary revascularization. Despite their increasing use, the comparative efficacy of sirolimus-versus paclitaxel-coated balloons (SCB vs PCB) remains uncertain. This updated meta-analysis evaluated clinical and angiographic outcomes of SCB and PCB in percutaneous coronary intervention (PCI). A comprehensive search of PubMed, Scopus, and ScienceDirect was performed on August 28, 2025. Studies directly comparing SCB and PCB were included. The primary endpoint was target lesion failure (TLF), which was defined as cardiac death, target vessel myocardial infarction (TVMI), or target lesion revascularization (TLR). On follow-up angiography, secondary endpoints consisted of minimal lumen diameter (MLD), late lumen loss (LLL), and diameter stenosis. Pairwise meta-analyses, subgroup analyses, and sensitivity analyses were performed. The certainty of evidence was evaluated with GRADE. Thirteen studies with 5947 patients (4097 SCB and 1850 PCB) were analyzed. SCB and PCB showed no significant differences in TLF (RR 1.10, 95% CI 0.84 to 1.44), cardiac death (RR 1.19, 95% CI 0.56 to 2.53), TLR (RR 1.12, 95% CI 0.91 to 1.37), and TVMI (RR 1.82, 95% CI 0.58 to 5.72). Subgroup analyses by lesion type and study design were consistent. Angiographic outcomes were comparable between groups, except for smaller insegment MLD with SCB (MD-0.10 mm, 95% CI-0.18 to-0.02; p = 0.01), although this finding was not robust in sensitivity analysis. Certainty of evidence was moderate for clinical outcomes and low to moderate for angiographic outcomes, primarily downgraded due to imprecision and inconsistency. In conclusion, SCB and PCB demonstrated comparable efficacy in PCI, with no significant differences in clinical and angiographic endpoints, irrespective of lesion types. Copyright © 2026 Saudi Heart Association. <37> Accession Number 2048131756 Title Epigenetics, inflammation and postoperative complications: a scoping review. Source British Journal of Anaesthesia. (no pagination), 2026. Date of Publication: 2026. Author Wilson R.; Fern C.; Woolcock K.; Goodyear C.; Shelley B. Institution (Wilson, Fern, Shelley) Anaesthesia, Perioperative Medicine and Critical Care Research Group, School of Medicine, Scotland, Glasgow, United Kingdom (Wilson, Woolcock, Goodyear) School of Infection and Immunity, University of Glasgow, Scotland, Glasgow, United Kingdom (Wilson, Shelley) Department of Anaesthesia, Golden Jubilee National Hospital, Scotland, Clydebank, United Kingdom Publisher Elsevier Ltd Abstract Background: Excessive postoperative inflammation is associated with multisystem complications after surgery, culminating in morbidity, mortality and increased healthcare costs. Epigenetic modifications regulate gene transcription without altering DNA sequences and can augment powerful inflammatory responses. Translational studies have emerged, investigating how epigenetic mechanisms influence perioperative inflammation and complications. This scoping review consolidates studies in this expanding field and provides informed recommendations for future research. Method(s): The protocol for this scoping review was created using best-practice guidelines and was prospectively registered and published. Searches were conducted using Medline and Embase and included studies published in English between 1946 and 2025. Two reviewers independently screened titles and abstracts, then full texts of studies before data extraction. Included studies investigated postoperative complications alongside epigenetic mechanisms and inflammation. Result(s): Studies (n=15 451) were assessed for title and abstract screening, and 26 articles were included in the review. Included studies were published between 2016 and 2025. Cardiac surgery was investigated most often, followed by general and colorectal surgery. Several surgical specialities were not represented. Most studies investigated microRNA mechanisms, investigating either a small number of microRNAs (<=8) or using whole transcriptome approaches. DNA methylation and histone modifications were investigated less commonly. Complications were variably defined in the included studies, and most studies focused on a small number of complications. Inflammation was heterogeneously assessed, with most studies using C-reactive protein and interleukin-6 or both, whereas other studies used broader proteomic approaches to quantify inflammation. Conclusion(s): DNA methylation and histone modifications are less researched epigenetic mechanisms in perioperative inflammation. Future studies should recruit patients with homogeneous surgical insults. Studies should use standard measures of inflammation to enhance generalisability, whereas experimental approaches (including transcriptomics and proteomics) could advance mechanistic understanding in exploratory studies. Future research would benefit from consistent use of validated definitions of postoperative complications to enable comparison between studies. Copyright © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <38> Accession Number 2044869803 Title Metabolic Conditioning for Renal Protection During Cardiopulmonary Bypass: A Narrative Review. Source Artificial Organs. 50(8) (pp 1118-1124), 2026. Date of Publication: 01 Aug 2026. Author El Dsouki Y.; Hallak P.; Condello I.; Lorusso R. Institution (El Dsouki, Lorusso) Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (El Dsouki, Lorusso) Cardiovascular Research Centre Maastricht (CARIM), Maastricht, Netherlands (Hallak) Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Condello) School of Medicine and Surgery, University of Insubria, Varese, Italy Publisher John Wiley and Sons Inc Abstract Background: Acute kidney injury (AKI) remains one of the most frequent and prognostically relevant complications following cardiac surgery, even in the era of modern cardiopulmonary bypass (CPB) management and goal-directed perfusion. Cardiac surgery-associated AKI (CSA-AKI) is associated with increased postoperative morbidity, prolonged hospitalization, neurocognitive complications, and reduced early as well as long-term survival. Although optimization of macrocirculatory parameters and oxygen delivery has demonstrated benefits, renal injury often occurs despite apparently adequate perfusion and oxygenation. Recent evidence suggests that CPB-related metabolic stress and protein catabolism contribute to renal vulnerability. Indeed, intravenous amino acid administration has emerged as a novel metabolic strategy for renal protection. Material(s) and Method(s): This narrative review was informed by a structured literature search of PubMed/MEDLINE, Embase, and the Cochrane Library, covering publications from database inception through March 2025. Search terms included combinations of "acute kidney injury," "cardiac surgery," "cardiopulmonary bypass," "amino acids," "intravenous amino acid infusion," "renal protection," and "goal-directed perfusion". Randomized controlled trials, meta-analyses, systematic reviews, secondary analyses, and relevant narrative reviews published in English were considered. Particular emphasis was placed on high-quality evidence, including the PROTECTION randomized trial, contemporary meta-analyses, and consensus or expert reviews addressing cardiac surgery-associated acute kidney injury and perioperative metabolic interventions. Result(s): The literature search identified 124 records; 18 articles were included in the final narrative synthesis after title, abstract, and full-text evaluation. The selected literature comprised a multicenter randomized controlled trial, secondary analyses of randomized data, meta-analyses/systematic reviews, narrative or expert reviews, and observational or mechanistic studies addressing CSA-AKI. The evidence indicates that CSA-AKI results from an interaction between altered renal perfusion, inflammation, ischemia-reperfusion injury, and CPB-induced metabolic derangement. Intravenous amino acid infusion was consistently associated with reduced postoperative AKI incidence, particularly in patients with preexisting chronic kidney disease, without significant safety concerns. These findings support amino acid administration as a metabolic adjunct to goal-directed perfusion rather than a standalone intervention. Conclusion(s): Intravenous amino acid infusion is a recent strategy to reduce AKI in cardiac surgery. By targeting the CPB-induced metabolic stress, amino acid administration complements goal-directed perfusion and expands current AKI prevention paradigms beyond hemodynamic optimization alone. Future research should focus on CPB-specific timing, dosing strategies, and integration of metabolic support into multimodal AKI prevention bundles. Copyright © 2026 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC. <39> Accession Number 2045977475 Title Short Versus Extended Duration of Triple Antithrombotic Therapy After Percutaneous Coronary Intervention in Patients Requiring Oral Anticoagulation: A Retrospective Single-Center Study. Source Catheterization and Cardiovascular Interventions. 108(2) (pp 548-553), 2026. Date of Publication: 01 Aug 2026. Author Kurpad K.P.; Vorla M.; Bin-Farooq T.; Mehta R.; Adoni N.; Kanakadandi U.B.; Moussa I.D.; Mehta S.S. Institution (Kurpad, Bin-Farooq, Adoni, Kanakadandi, Moussa, Mehta) Division of Cardiology, Carle Foundation Hospital, Urbana, IL, United States (Kurpad, Vorla, Bin-Farooq, Adoni, Kanakadandi, Moussa, Mehta) CICOM/University of Illinois Urbana Champaign, Champaign, IL, United States (Vorla) Department of Internal Medicine, Carle Foundation Hospital, Urbana, IL, United States (Mehta) Loyola University, Illinois, Chicago, IL, United States Publisher John Wiley and Sons Inc Abstract Background: Balancing ischemic and bleeding risks in patients undergoing percutaneous coronary intervention (PCI) who require anticoagulation remains a clinical challenge. While dual antithrombotic therapy (DAT) with a P2Y12 inhibitor and an oral anticoagulant reduces long-term bleeding risk, the optimal duration of triple antithrombotic therapy (TAT) in the immediate post-procedural phase is uncertain. Aim(s): We aimed to evaluate clinical outcomes of short-duration ({7 days) of TAT to extended-duration (>= 7 days) of triple therapy following PCI. Method(s): We conducted a retrospective observational study of 172 patients who underwent PCI. Of these, 109 received TAT for < 7 days, and 63 received TAT for >= 7 but < 28 days. The primary outcome was a composite endpoint of cardiovascular mortality, myocardial infarction, target lesion revascularization, and definite or probable stent thrombosis at 1 year. Secondary outcomes were gastrointestinal bleeding (BARC > 3) and intracranial hemorrhage. Result(s): There were no statistically significant differences between the two groups in composite outcome (cardiovascular mortality, myocardial infarction, target vessel revascularization, or stent thrombosis at 1 year). Similarly, rates of major bleeding events did not differ significantly between the groups. Conclusion(s): Early de-escalation of TAT (within 7 days) demonstrated similar clinical outcomes to longer durations (< 7 days). Larger randomized controlled trials are warranted to further validate these findings. Copyright © 2026 Wiley Periodicals LLC. <40> Accession Number 2038393067 Title Preserve or Cover? The Isolated Left Vertebral Artery in Totally Endovascular Zone 2 TEVAR. Source Reviews in Cardiovascular Medicine. 27(5) (no pagination), 2026. Article Number: 52503. Date of Publication: 01 May 2026. Author Marzano A.; Di Marzo L.; Mansour W. Institution (Marzano, Di Marzo, Mansour) Vascular Surgery Unit, Department of General and Specialized Surgery and Anesthesiology, "Sapienza" University of Rome, Rome, Italy Publisher IMR Press Limited <41> Accession Number 2047603939 Title Effect of Albumin Concentration and Timing on Acute Kidney Injury After Adult Cardiac Surgery: A Systematic Review and Meta-analysis. Source Annals of Cardiac Anaesthesia. 29(3) (pp 325-334), 2026. Date of Publication: 01 Jul 2026. Author Abo T.; Umibe T.; Nakano K.; Tongu Y.; Oya K. Institution (Abo, Umibe, Oya) Department of Surgery, National Center for Global Health and Medicine, Japan Institute for Global Health and Medicine, Tokyo, Japan (Nakano, Tongu) Department of Internal Medicine, National Center for Global Health and Medicine, Japan Institute for Global Health and Medicine, Tokyo, Japan Publisher Wolters Kluwer Medknow Publications Abstract The effect of hyperoncotic (20%-25%) human albumin on cardiac-surgery-associated acute kidney injury (CS-AKI) is uncertain. This study evaluated whether intraoperative or postoperative administration of 20%-25% albumin influences the risk of CS-AKI compared with crystalloids or iso-oncotic (4%-5%) albumin. Systematic review and meta-analysis of randomized controlled trials (RCTs) and risk-adjusted cohort studies were conducted. Risk ratios (RRs) were pooled using random-effects models. Literature search of PubMed, Embase (Ovid), and Cochrane CENTRAL was carried out from January 1, 1995, to July 17, 2025. Adults undergoing on-pump CS. Four eligible studies-two RCTs and two cohort studies, encompassing 6651 patients-were included. About 20%-25% of human albumin was administered either intraoperatively or within 24 h postoperatively. Comparators were crystalloids or 4%-5% albumin. The primary outcome was the incidence of any-stage AKI within 7 days of surgery. Pooled analysis showed 20%-25% albumin increased the risk of CS-AKI (RR 1.10, 95% confidence interval [CI] 1.05-1.16; I2 =0%). Restriction to RCTs yielded a similar result (RR 1.12, 95% CI 1.04-1.20). The increased risk was consistent for both intraoperative (RR 1.09) and postoperative (RR 1.12) administration, but the interaction between infusion timing was non-significant (P = 0.59). Infusion of 20%-25% albumin is associated with a modest but consistent increase in postoperative AKI, independent of infusion timing from intraoperative to postoperative within 24 h. Until adequately powered trials resolve the remaining imprecision, routine perioperative administration of hyperoncotic albumin should be approached with caution. Copyright © 2026 Annals of Cardiac Anaesthesia. <42> Accession Number 2047595024 Title Effect of preoperative prehabilitation in adults undergoing cardiac surgery on physical status and perioperative complications: a systematic review and meta-analysis. Source Minerva Anestesiologica. 92(5) (pp 458-468), 2026. Date of Publication: 01 May 2026. Author Gil-Casado C.; Fernandez-Vazquez U.; Luna-Rojas P.; Diaz-Vidal P.; Diz-Ferreira E.; Diz J.C. Institution (Gil-Casado, Fernandez-Vazquez, Luna-Rojas, Diaz-Vidal) School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain (Diz-Ferreira) Well-Move Research Group, School of Medicine, University of Vigo, Vigo, Spain (Diz) Department of Anesthesia and Postoperative Critical Care, Alvaro Cunqueiro Hospital, Vigo, Spain (Diz) Department of Functional Biology and Health Sciences, Well-Move Research Group, University of Vigo, Vigo, Spain Publisher Edizioni Minerva Medica Abstract BACKGROUND: Many patients scheduled for cardiac surgery have low cardiorespiratory fitness, which is associated with increased perioperative morbidity and mortality. There is limited evidence to suggest that prehabilitation can reduce perioperative complications. The objective was to evaluate the impact of prehabilitation comprising physical exercise on the cardiorespiratory fitness of cardiac patients, and on quality of life, hospital stay, postoperative complications and mortality. METHOD(S): A systematic review and meta-analysis, following the PRISMA statement, encompassing randomized controlled trials on prehabilitation for adult patients undergoing cardiac surgery. The protocol was pre-registered on Open Science Framework. RESULT(S): We included eight studies comprising 894 patients. The prehabilitation group exhibited a greater improvement in preoperative six-minute walk test than the control group (MD 36.65 m; 95% CI 1.72, 71.58; P=0.04). The number of patients demonstrating a clinically relevant improvement was not significantly different between the groups (OR 1.86; 95% CI 0.82, 4.21). The prehabilitation group exhibited a shorter hospital stay (MD -1.01 days; 95% CI -2, -0.02; P=0.04). No differences were observed in other outcomes. Overall, the certainty of the evidence was low. CONCLUSION(S): Our findings suggest an association between prehabilitation and preoperative enhancement in cardiorespiratory fitness. However, the effect size is modest and may have marginal clinical significance. It remains unclear whether prehabilitation can improve clinical outcomes beyond the reduction of hospital length of stay. Further research is required to provide evidence of the efficacy of these programs. Copyright © 2026 Edizioni Minerva Medica. All rights reserved. <43> Accession Number 2047644608 Title Standard-dose unfractionated heparin versus low-dose unfractionated heparin and low-molecular-weight heparin in extracorporeal life support (RATE): an open-label, randomised, non-inferiority trial. Source The Lancet. 408(10552) (pp 357-366), 2026. Date of Publication: 25 Jul 2026. Author Minnen O.V.; Lansink-Hartgring A.O.; van Amstel R.B.E.; van den Bogaard B.; Bunge J.J.H.; Delnoij T.S.R.; Droogh J.M.; Koppenhagen L.V.; Kraemer C.V.E.; Kuijpers M.; Maas J.J.; Metz J.D.; van de Poll M.C.G.; Raasveld S.J.; dos Reis Miranda D.; Vart P.; Vermeulen K.M.; Vlaar A.P.J.; van den Bergh W.M.; van Haeren M.M.T.; Koopmans M.; Muller M.C.A.; Donker D.W.; Meuwese C.L.; Akin S. Institution (Minnen, Lansink-Hartgring, Droogh, van den Bergh) Department of Critical Care, University Medical Center Groningen, Groningen, Netherlands (Minnen) Department of Anesthesiology, University Medical Center Groningen, Groningen, Netherlands (Vart) Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, Netherlands (van Amstel, Raasveld, Vlaar) Department of Intensive Care Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands (Raasveld) Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands (van den Bogaard, Metz) Department of Intensive Care, OLVG, Amsterdam, Netherlands (Bunge, dos Reis Miranda) Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, Netherlands (Bunge) Department of Cardiology, Erasmus Medical Center, Rotterdam, Netherlands (Delnoij, van de Poll) Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, Netherlands (van de Poll) Department of Surgery, Maastricht University Medical Center, Maastricht, Netherlands (Koppenhagen, Kuijpers) Department of Intensive Care Medicine, Isala Clinics, Zwolle, Netherlands (Kraemer, Maas) Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, Netherlands (van de Poll) School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands (Vermeulen) Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands Publisher Elsevier B.V. Abstract Background In patients receiving extracorporeal membrane oxygenation (ECMO), standard practice is full-dose intravenous unfractionated heparin (UFH) targeting an activated partial thromboplastin time of 2.0-2.5 times baseline to reduce thrombotic risk. This approach can increase bleeding without further reducing thrombosis compared with low-dose UFH. Robust evidence to guide anticoagulation targets is absent because anticoagulation targets in ECMO have never been assessed in a sufficiently powered randomised trial. We aimed to determine whether low-dose UFH or therapeutic low-molecular-weight heparin (LMWH) is non-inferior to standard-dose UFH in patients receiving ECMO. Methods In this open-label, three-arm, randomised, non-inferiority trial at seven Dutch intensive care units (ICUs), adults aged 18 years or older supported with veno-venous or veno-arterial ECMO at the ICU without vital indication for full-dose anticoagulation (eg, mechanical mitral valve) were randomly assigned to intravenous standard-dose UFH (activated partial thromboplastin time 2.0-2.5 times baseline), intravenous low-dose UFH (1.5-2.0 times baseline), or therapeutic subcutaneous LMWH. The primary outcome was a composite of severe bleeding during ECMO support, severe thromboembolic complications during ECMO support, or all-cause mortality at 6 months, and was assessed in all randomly assigned patients with deferred informed consent and 6-month follow-up data according to the intention-to-treat principle. Non-inferiority was met if the upper 95% CI limit for the absolute risk difference was less than 7.5 percentage points. This trial is registered at ClinicalTrials.gov ( NCT04536272 ) and the Dutch trial register (NL7976). Findings Between Oct 22, 2020, and Sept 12, 2024, 330 patients were enrolled: 110 were randomly assigned to standard-dose UFH, 110 to low-dose UFH, and 110 to LMWH. Of 330 enrolled patients, 320 (225 [70%] males, 95 [30%] females; median age 56 years [IQR 45-65]; 255 [80%] White ethnicity) were analysed at 6 months. The composite primary outcome occurred in 87 (81%) of 107 patients with standard-dose UFH, 78 (72%) of 108 with low-dose UFH (absolute risk difference -9.1 percentage points [95% CI -20.3 to 2.1]), and 79 (75%) of 105 with LMWH (-6.1 percentage points [-17.2 to 5.0]), meeting non-inferiority for both interventions. The frequency of severe bleeding was lower with low-dose UFH and LMWH than with standard-dose UFH (63 [58%] patients and 62 [59%] vs 70 [65%]), without excess severe thromboembolic complications (11 [10%] and nine [9%] vs 12 [11%]), although these differences did not reach statistical significance. At 6 months, 54 (50%) patients in the standard-dose UFH group, 45 (42%) in the low-dose UFH group, and 46 (44%) in the LMWH group had died. Interpretation Low-dose UFH and therapeutic LMWH were non-inferior to standard-dose UFH. This finding supports reconsideration of anticoagulation targets in ECMO. Given the global expansion of ECMO, these findings suggest that reduced anticoagulation targets could substantially reduce bleeding-related harm. Funding ZonMw. Copyright © 2026 Elsevier Ltd. <44> Accession Number 651721969 Title Determinants and Implementation of Hybrid Cardiac Rehabilitation in Adolescents and Young Adults With Congenital Heart Disease: Insight From the QUALIREHAB Study. Source Journal of the American Heart Association. 15(14) (pp e049698), 2026. Date of Publication: 21 Jul 2026. Author Andrianoely M.; Desir A.; Huguet H.; Picot M.-C.; Audie M.; Lagorce S.; Venna A.; Rheault M.; Batterton M.-K.; Weissland T.; Marguin G.; Auer A.; Guillaumont S.; Amedro P. Institution (Andrianoely, Amedro) IHU Liryc, INSERM 1045 University of Bordeaux Bordeaux France, France (Andrianoely) Just Coaching Paris France (Desir, Venna, Rheault, Batterton, Amedro) Heart & Lung Center, Heart Research Institute Children's National Hospital Washington DC USA (Huguet, Picot) Epidemiology and Clinical Research Department, Clinical Investigation Center, INSERM 1411 Montpellier University Hospital Montpellier France, France (Audie, Lagorce, Amedro) Pediatric and Congenital Cardiology Department, M3C National Reference Center Bordeaux University Hospital Bordeaux France, France (Audie) Rehabilitation Center Le Hillot Pessac France, France (Venna, Amedro) George Washington University School of Medicine & Health Sciences Washington District of Columbia USA (Weissland) IMS Bordeaux University of Bordeaux Talence France, France (Marguin) Patient advocacy "Petit Coeur de Beurre" Paris France, France (Auer, Guillaumont) Pediatric Cardiac Rehabilitation Center Saint-Pierre Institute Palavas-Les-Flots France, France (Guillaumont) Pediatric and Congenital Cardiology Department, M3C Regional Reference CHD Center Montpellier University Hospital Montpellier France, France Abstract BACKGROUND: The QUALIREHAB (Cardiac Rehabilitation in Youth With Congenital Heart Disease) trial demonstrated the efficacy of a hybrid cardiac rehabilitation model in adolescents and young adults with congenital heart disease. This post hoc mixed-methods study aimed to identify baseline predictors of clinical improvement and to characterize key components supporting implementation and scalability. METHOD(S): Seventy participants aged 13 to 25 years from the intervention arm were analyzed. Clinical improvement was defined as a clinically meaningful increase in cardiopulmonary fitness (increase in peak oxygen uptake >=3.5 mL/kg per min) or health-related quality of life (Pediatric Quality of Life Inventory increase >=4.3 points). Multivariable logistic regression models identified predictors of clinical improvement. Semistructured interviews with patients and health care professionals explored experiences, barriers, and implementation mechanisms. RESULT(S): The absence of prior cardiac surgery or interventional catheterization was independently associated with short-term improvement in peak oxygen uptake. At 1 year, male sex and lower baseline ventilatory anaerobic threshold were associated with greater peak oxygen uptake improvement. Lower baseline ventilatory anaerobic threshold was also the only predictor of clinically meaningful health-related quality of life improvement. Qualitative findings highlighted the accessibility and acceptability of the hybrid model but underscored the need for higher-intensity and more varied exercise modalities, integrated digital tools, continuous psychological support, family involvement, and structured postrehabilitation follow-up to sustain long-term benefits. CONCLUSION(S): Among treated participants, male sex, absence of prior cardiac surgery, and marked baseline deconditioning were associated with greater clinical improvement, supporting a shift from standardized toward tailored cardiac rehabilitation in congenital heart disease. By addressing key logistical and psychosocial barriers, this scalable framework offers a pragmatic model for routine care implementation and may be transferable to other pediatric chronic conditions. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03690518. <45> Accession Number 2048124175 Title Milrinone versus Dobutamine as Supportive Agent for Right Ventricular Dysfunction after Cardiopulmonary Bypass: A Randomized Comparative Study. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Hegazy M.A.; Abdelbaser I.; Abdellatif A.; Mamdouh M.; Atallah A.; Farid A.; Elsayed H.M.; Alseoudy M. Institution (Hegazy, Abdelbaser, Abdellatif, Mamdouh, Farid, Elsayed, Alseoudy) Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt (Hegazy) Department of Anesthesia and Intensive Care, Emirates Health Services, United Arab Emirates, Sharjah, United Arab Emirates (Atallah) Ministry of Health, Aga, Egypt Publisher W.B. Saunders Abstract Objectives: To compare milrinone versus dobutamine for right ventricular (RV) dysfunction after cardiopulmonary bypass (CPB). Design(s): Randomized, open-label, parallel-group controlled trial. Setting(s): A tertiary cardiac surgery center. Participant(s): Adults (N = 88) with new RV systolic dysfunction (tricuspid annular plane systolic excursion [TAPSE] <=17 mm) post-CPB. Intervention(s): Milrinone (loading 50 microg/kg over 10 minutes, then 0.3-0.8 microg/kg/min) or dobutamine (2-10 microg/kg/min). Measurements & Main Results: The co-primary outcomes were duration of mechanical ventilation (clinical) and change in TAPSE over 24 hours (echocardiographic). Secondary outcomes included RV fractional area change, pulmonary artery systolic pressure (PASP), left ventricular outflow tract velocity-time integral, intensive care unit stay, arrhythmias, hypotension, and vasopressor need. Both groups had similar baseline characteristics. TAPSE improved significantly over 24 hours in both groups (p < 0.001). After adjustment for baseline TAPSE and left ventricular ejection fraction, milrinone was associated with modestly higher TAPSE at 24 hours (adjusted difference 1.82 mm, 95% CI 0.72-2.92, p = 0.001), though the clinical significance of this difference is uncertain. Milrinone required more norepinephrine than dobutamine (93.2% v 72.7%, p = 0.021). Other clinical outcomes did not differ significantly. In an exploratory subgroup analysis of patients with baseline post-CPB PASP >40 mmHg (n = 30), milrinone produced greater TAPSE improvement at 1, 6, and 24 hours (p < 0.05 for each), with a statistically significant interaction (p = 0.010); norepinephrine use was similar between groups in this subgroup (93.8% v 85.7%, p = 0.586). In patients with PASP <=40 mmHg (n = 58), the drugs were equivalent. Conclusion(s): Milrinone and dobutamine provide comparable overall RV recovery, though milrinone was associated with modestly higher adjusted TAPSE at 24 hours of uncertain clinical significance and increased norepinephrine requirements. An exploratory subgroup analysis suggests milrinone may provide superior RV functional recovery in patients with elevated post-CPB PASP (>40 mmHg), though this hypothesis-generating finding requires prospective validation. Copyright © 2026 Elsevier Inc. <46> Accession Number 2048126489 Title A Pilot Randomized Trial of Continuous Finger-Cuff Blood Pressure Monitoring With Hemodynamic-Guided Management Versus Oscillometric Monitoring in Open Thoracic Surgery. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Dolnimitsakul S.; Chaichalothorn M.; Songchuen N. Institution (Dolnimitsakul, Chaichalothorn, Songchuen) Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand Publisher W.B. Saunders Abstract Objectives: Intraoperative hypotension is associated with adverse postoperative outcomes. This pilot randomized controlled trial evaluated whether hemodynamic-guided management using continuous noninvasive finger-cuff blood pressure monitoring reduces intraoperative hypotension compared with standard intermittent oscillometric monitoring in patients undergoing open thoracic surgery. Design(s): Pilot randomized controlled trial. Setting(s): Single tertiary university hospital. Participant(s): Forty adult patients undergoing elective open thoracic surgery under general anesthesia. Intervention(s): Patients were randomized to either hemodynamic-guided management using continuous finger-cuff blood pressure monitoring with the Hypotension Prediction Index and waveform-derived parameters (protocolized intervention) or standard care using intermittent oscillometric blood pressure monitoring. Measurements and Main Results: The primary outcome was the time-weighted average (TWA) of mean arterial pressure (MAP) <65 mmHg. The TWA of hypotension was significantly lower in the finger-cuff group compared with the oscillometric group (median [interquartile range], 0 [0-0] v 0.11 [0-0.40]; p = 0.001). The incidence and duration of hypotensive episodes were also reduced. Fewer patients in the hemodynamic-guided group required vasopressor therapy, primarily ephedrine, than in the oscillometric group (35% v 80%; p = 0.004). No significant differences were observed in postoperative serum creatinine or cognitive outcomes, and no cases of acute kidney injury or postoperative delirium occurred. Conclusion(s): In this pilot randomized trial, hemodynamic-guided management using continuous noninvasive finger-cuff monitoring was associated with reduced intraoperative hypotension and vasopressor use compared with intermittent oscillometric monitoring. These findings support the feasibility and potential benefit of continuous noninvasive hemodynamic monitoring; however, larger studies are required to confirm clinical outcome benefits. Copyright © 2026 Elsevier Inc. <47> Accession Number 2047957370 Title Excessive Daytime Sleepiness, Morning Tiredness, and Prognostic Biomarkers in Patients with Chronic Coronary Syndrome. Source International Journal of Pharmacy Research and Technology. 16(2) (pp 1373-1386), 2026. Date of Publication: 01 Jul 2026. Author Bardeskar A.M. Institution (Bardeskar) Department of cardiology, Malla Reddy Institute of Medical Sciences, Hyderabad, India Publisher Advanced Scientific Research Abstract Background: Sleep-related breathing disorders (SRBD) are related to cardiovascular outcomes in patients with chronic coronary syndrome (CCS). Whether SRBD-related symptoms are associated with prognostic biomarkers in patients with CCS is not established. Method(s): Associations between frequency (never/rarely, sometimes, often, always) of self-reported SRBD-related symptoms (excessive daytime sleepiness [EDS]; morning tiredness [MT]; loud snoring; multiple awakenings/ night; gasping, choking, or apnea when asleep) and levels of biomarkers related to cardiovascular prognosis (high-sensitivity C-reactive protein [hs-CRP], interleukin 6 [IL-6], high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro B-type natriuretic peptide [NT-proBNP], cystatin C, growth differentiation factor 15 [GDF-15] and lipoprotein-associated phospholipase A activity) were assessed at baseline in 15,640 patients with CCS on optimal secondary preventive therapy in the STABILITY trial. Cross-sectional associations were assessed by adjusted linear regression models testing for trends with the never/rarely category serving as reference. Result(s): EDS was associated (geometric mean ratio, 95% confidence interval) with increased levels of IL-6 (often 1.07 [1.03-1.10], always 1.15 [1.10-1.21]), GDF-15 (often 1.03 [1.01-1.06], always 1.07 [1.03-1.11]), NT-proBNP (always 1.22 [1.12-1.33]), and hs-cTnT (always 1.07 [1.01-1.12]). MT was associated with increased levels of IL-6 (often 1.05 [1.01-1.09], always 1.09 [1.04-1.15]), and GDF-15 (always 1.06 [1.03-1.10]). All symptoms were to some degree associated with higher levels of hs-CRP and loud snoring was also associated with decreased levels of NT-proBNP and hs-cTnT. Conclusion(s): In patients with CCS, stepwise increased frequency of SRBD-related symptoms, such as EDS and MT, were associated with gradually higher levels of IL-6 and GDF-15, each reflecting distinct pathophysiological pathways. Copyright (c) 2026 Authors. This work is licensed under a Creative Commons Attribution 4.0 International License. https://creativecommons.org/licenses/by/4.0/ <48> Accession Number 2048112707 Title Coagulation-Friendly Environment in Cardiac Surgery: A Narrative Review. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Yevenes F.; Bolliger D.; Di Dedda U.; Ahmed A.; Koller T.; Unic Stojanovic D.; Lance M. Institution (Yevenes) Intensive Care Unit, Instituto Nacional del Torax, Santiago, Chile (Bolliger) Clinic for Anesthesiology, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland (Bolliger) Medical Faculty, University of Basel, Basel, Switzerland (Di Dedda) Department of Cardiac Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, San Donato Milanese, Italy (Ahmed) Department of Anaesthesia and Critical Care, Glenfield Hospital, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom (Ahmed) Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom (Koller) Department of Anaesthesiology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain (Unic Stojanovic) Medical Faculty, University of Belgrade, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia (Lance) Medical College, Aga Khan University, Nairobi, Kenya Publisher W.B. Saunders Abstract Perioperative bleeding remains a major complication in cardiac surgery and is associated with increased morbidity, mortality, and transfusion requirements. While patient blood management strategies and goal-directed hemostatic therapies have improved outcomes, the role of fundamental physiological conditions such as acid-base balance, temperature, calcium homeostasis, and hematocrit remains underexplored in clinical research. These factors may critically modulate coagulation and influence the efficacy of hemostatic interventions. This comprehensive narrative review assesses the in vitro and in vivo impact of acidosis, hypothermia, hypocalcemia, and anemia on hemostasis and proposes the concept of a coagulation-friendly environment as a prerequisite for effective bleeding management in cardiac surgery. Optimization of these variables represents an essential foundation for effective hemostatic therapy and may improve bleeding outcomes when integrated into patient blood management strategies. Copyright © 2026 Elsevier Inc. <49> Accession Number 2045571558 Title Direct Oral Anticoagulants Compared to Warfarin Early After Cardiac Surgery: A Pilot Randomized Controlled Trial. Source CJC Open. 8(8) (pp 1109-1118), 2026. Date of Publication: 01 Aug 2026. Author Wang E.H.Z.; Turgeon R.; Chu E.; Sun T.; Bashir J.; Peng D.; Cook R.; Atherstone J.; Gwozd T.; Ye J. Institution (Wang, Turgeon) Pharmacy Department, St. Paul's Hospital, Vancouver, BC, Canada (Wang, Turgeon) Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada (Chu) Pharmacy Department, Vancouver General Hospital, Vancouver, BC, Canada (Sun) Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada (Bashir, Peng, Cook, Ye) Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada (Peng) Centre for Cardiovascular Innovation, Vancouver, BC, Canada (Atherstone) Department of Anesthesiology, Vancouver General Hospital, Vancouver, BC, Canada (Gwozd) Vancouver General Hospital, Vancouver, BC, Canada Publisher Elsevier Inc. Abstract Background: The goal was to conduct a pilot randomized controlled trial (RCT) of direct oral anticoagulants (DOACs) early after cardiac surgery to determine the feasibility of a larger RCT. Method(s): We conducted an open-label, 2-site, pilot RCT of adults undergoing cardiac surgery with an indication for anticoagulation, excluding mechanical valves and bioprosthetic mitral valve replacements. We randomized patients 1:1 to receive a DOAC or warfarin started during the index hospitalization with a standardized time of postoperative initiation and bridging for high thrombosis risk. The coprimary feasibility outcome goals were recruitment of >= 70% eligible patients and adherence to the anticoagulation protocol in >= 80% patients. The primary clinical composite outcome included all-cause mortality, major bleeding, stroke, systemic embolism, or pericardial effusion requiring intervention within 3 months. Result(s): Between October 2022 and February 2024, a total of 547 patients were screened, 163 met inclusion criteria, 104 were randomized, and 100 were analyzed (50 in each group). The median age was 72 years; 22% were female; 54% had preexisting atrial fibrillation; 37% had postoperative atrial fibrillation, with a median Congestive Heart Failure, Hypertension, Age >= 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA<inf>2</inf>DS<inf>2</inf>-VASc) score of 3 and a Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly (> 65 Years), Drugs/Alcohol Concomitantly (HAS-BLED) score of 2. We recruited 64% of eligible patients, and anticoagulation protocol adherence was 91%. The clinical composite outcome occurred in 8% with DOAC (2 major bleeding, 1 pericardial effusion, 1 death) vs 4% with warfarin (2 strokes); log-rank P = 0.42. Conclusion(s): Although the a priori recruitment goal was not met, this trial supports the need for and provides valuable insights into key challenges to mitigate, thereby guiding the design of a large, definitive multicentre RCT comparing DOACs vs warfarin in cardiac surgery patients. Clinical Trial Registration: NCT05006287. Copyright © 2026 The Authors <50> Accession Number 2047615159 Title Preoperative Risk Assessment and Shared Decision-Making in Older Patients Eligible for Cardiac Surgery: Protocol for a Non-Randomized Prospective Study. Source Healthcare (Switzerland). 14(13) (no pagination), 2026. Article Number: 1900. Date of Publication: 01 Jul 2026. Author Dieen M.S.H.; Blokzijl F.; Kuijpers M.; Paans W.; Bayon M.A.; Festen S.; Dieperink W.; Bouma W.; Rienstra M.; Mariani M.A. Institution (Dieen, Paans, Dieperink) Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, Groningen, Netherlands (Dieen, Blokzijl, Paans, Dieperink) Department of Critical Care, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Blokzijl, Kuijpers, Bayon, Bouma) Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Festen) Department of Geriatric Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands (Rienstra) Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzepein 1, Groningen, Netherlands (Mariani) Department of Cardiothoracic Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, Netherlands Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: The number of older patients undergoing cardiac surgery is increasing, and a substantial proportion of these patients are frail. Frailty is associated with increased mortality, psychological complications, functional decline, and reduced health-related quality of life, complicating treatment decision-making. Currently, treatment recommendations are formulated by the multidisciplinary Heart Team and are mainly based on disease-related parameters. To better integrate patient preferences, geriatric assessment, and shared decision-making into routine cardiothoracic practice, a nurse-led preoperative outpatient pathway was developed: the Preoperative RIsk assessment and shared decision-Making in patients Eligible for cardiac surgery (PRIME) clinic. This study aims to evaluate whether the implementation of PRIME consultation influences Heart Team treatment recommendations and to assess its cost-effectiveness. Method(s): This single-center, non-randomized prospective study is conducted in the Netherlands. Patients aged >=70 years who are eligible for cardiac surgery and have two or more risk factors for adverse postoperative outcomes are included. All patients are initially discussed in the Heart Team, resulting in a treatment recommendation. Patients in the intervention group subsequently visit the PRIME clinic, where a comprehensive geriatric assessment and a shared decision-making consultation are performed. Following this visit, patients are re-evaluated by the Heart Team. The primary outcome is the comparison between the initial and subsequent Heart Team treatment recommendations. Secondary outcomes include health-related quality of life and cost-effectiveness. Discussion(s): This prospective exploratory study evaluates the implementation of a novel, patient-centered preoperative care model integrating geriatric assessment and shared decision-making into routine cardiac surgical practice. By focusing on outcomes meaningful to older patients and their relatives, the study contributes to the development of value-based, individualized surgical care. Trial registration: The PRIME study was registered in ClinicalTrials.gov (trial registration number: NCT06616129). Copyright © 2026 by the authors. <51> Accession Number 651775383 Title Pre- and Immediate Postoperative Prediction Model for Organ Dysfunction or Death Early After Cardiac Surgery: A Post Hoc Analysis of a Multicenter Randomized Trial. Source Journal of the American Heart Association. 15(14) (pp e044394), 2026. Date of Publication: 21 Jul 2026. Author Dresen E.; Heyland D.K.; Lee Z.Y.; O'Brien B.; Elke G.; Radke D.I.; Meybohm P.; Schoenrath F.; Sundermann S.H.; von Dossow V.; McDonald B.; Christopher K.B.; Fremes S.E.; Mohammadi S.; Niemann B.; Boning A.; Mazer C.D.; Ke L.; Zarbock A.; Day A.G.; Stoppe C. Institution (Dresen, Lee, Meybohm, Stoppe) Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine University Hospital Wurzburg Wurzburg Germany, Germany (Heyland, Day) Clinical Evaluation Research Unit and Department of Critical Care Medicine Queen's University Kingston Ontario Canada, Canada (Lee) Department of Anaesthesiology, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia, Malaysia (Lee, O'Brien, Stoppe) Department of Cardiac Anesthesiology and Intensive Care Medicine Deutsches Herzzentrum der Charite Berlin Germany, Germany (Lee, O'Brien, Schoenrath, Sundermann, Stoppe) Charite - Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin Berlin Germany, Germany (O'Brien, Schoenrath, Sundermann, Stoppe) German Centre for Cardiovascular Research (DZHK), partner site Berlin Berlin Germany, Germany (Elke) Department of Anaesthesiology, Intensive Care, Pain and Emergency Medicine St. Bernward Hospital Hildesheim Germany, Germany (Radke) Department of Anesthesiology and Intensive Care Medicine University Medical Center Schleswig-Holstein, Campus Kiel Kiel Germany (Schoenrath, Sundermann) Department of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charite Berlin Germany, Germany (von Dossow) Heart and Diabetes Centre North Rhine Westphalia, Institute of Anesthesiology and Pain Therapy Ruhr-University Bochum Bad Oeynhausen Germany, Germany (McDonald) Division of Cardiac Anesthesiology University of Ottawa Heart Institute Ottawa Ontario Canada, Canada (Christopher) Division of Renal Medicine Brigham and Women's Hospital Boston Massachusetts USA (Fremes) Division of Cardiac Surgery, Sunnybrook Health Sciences Centre, Schulich Heart Centre University of Toronto Toronto Ontario Canada, Canada (Mohammadi) Quebec Heart and Lung University Institute Laval University Quebec City Quebec Canada, Canada (Niemann) Department of Thoracic and Cardiovascular Surgery University Medical Center Gottingen Gottingen Germany, Germany (Boning) Department of Adult and Pediatric Cardiovascular Surgery Giessen University Hospital Giessen Germany, Germany (Mazer) Li Ka Shing Knowledge Institute of St. Michael's Hospital and Departments of Anesthesiology and Pain Medicine, Physiology, Pharmacology St. Michael's Hospital, University of Toronto Toronto Ontario Canada, Canada (Ke) Department of Critical Care Medicine Jinling Hospital, Medical School of Nanjing University Nanjing Jiangsu China, China (Ke) National Institute of Healthcare Data Science Nanjing University Nanjing China, China (Zarbock) Department of Anesthesiology, Intensive Care and Pain Medicine University Hospital Munster Munster Germany, Germany (Zarbock) Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School The University of Texas Health Science Center at Houston Houston Texas USA (Zarbock, Stoppe) Center for Outcomes Research and Department of Anesthesiology UTHealth Houston Texas USA (Day) Kingston Health Sciences Centre - Research Institute Kingston Ontario Canada, Canada Abstract BACKGROUND: Development of organ dysfunction or death is still common in patients undergoing cardiac surgery. Yet, current risk stratification tools fail to adequately incorporate both preoperative vulnerability and immediate postoperative physiological derangements. This study aims to develop a predictive model integrating these critical timepoints to identify high-risk patients for presence of organ dysfunction or death 48 hours after surgery. METHOD(S): This is a post hoc analysis of an international, multicenter, randomized, controlled trial in patients undergoing cardiac surgery (n=1394). Prespecified patient characteristics (age, Clinical Frailty Scale, at nutrition risk, combined procedures, urgent surgery, moderate-severe chronic kidney disease, left ventricular ejection fraction, European System for Cardiac Operative Risk Evaluation II, cardiopulmonary bypass duration, sex, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score) were included in logistic regression models employing bootstrap validation. RESULT(S): A total of 434 (31.1%) patients had organ dysfunction or died 48 hours after surgery. The preoperative model identified Clinical Frailty Scale, nutrition risk, urgent surgery and European System for Cardiac Operative Risk Evaluation II as significant predictors of organ dysfunction or death 48 hours after surgery (optimism-corrected area under the receiver operating characteristic curve, 0.644 [95% CI, 0.610-0.678]). Incorporation of postoperative variables (Sequential Organ Failure Assessment score at intensive care unit admission, and cardiopulmonary bypass duration) improved predictive performance (area under the receiver operating characteristic curve, 0.773 [95% CI, 0.745-0.801]). CONCLUSION(S): Incorporation of variables collected the day of surgery substantially improved the ability to predict organ dysfunction or death 48 hours after surgery compared with using presurgical variables only. This pragmatic, clinically actionable model may enable targeted resource allocation and personalized interventions and may provide a stratification tool for future research. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT02002247. <52> Accession Number 2047981024 Title Vasopressin-Based Versus Norepinephrine-Based Strategy in Vasoplegic Syndrome After Cardiac Surgery: A Randomized Controlled Trial. Source Journal of Intensive Care Medicine. (no pagination), 2026. Date of Publication: 2026. Author Cui H.; Meng Y.; Peng S.; Fan S.; Li L.; Li Z.; Zhang Y. Institution (Cui, Meng, Peng, Fan, Li, Li, Zhang) Adult Surgical Intensive Care Unit, Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China (Cui, Meng, Peng, Fan, Li, Li, Zhang) National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Publisher SAGE Publications Inc. Abstract Background: Vasoplegic syndrome (VS) is a prevalent complication associated with cardiac surgery that is typically managed with norepinephrine (NE). We conducted a comparative analysis of clinical and physiological effects of vasopressin (VP)-based strategy versus an NE-based strategy as first-line management for VS following cardiopulmonary bypass (CPB). Method(s): This single-center, randomized controlled trial included 90 patients who underwent VS following CPB. Patients were randomized to a VP-based strategy (0.01-0.1U/min) or an NE-based strategy (0.01-0.1mug/kg/min), with standardized rescue NE allowed in both groups if hemodynamic targets were not met. The primary outcome was the length of hospital stay. Secondary outcomes included hemodynamic stability, lactate clearance, cardiac biomarkers, left ventricular ejection fraction (LVEF), and endocrine markers (copeptin and Arginine Vasopressin(AVP)). Result(s): The VP-based strategy significantly reduced the length of hospital stays compared to NE-based (Median 7.0 days [IQR 6.0-8.0] vs Median 8.0 days [IQR 7.0-11.0]; Per-protocol p = .0036). Patients treated with VP achieved higher mean arterial pressure (MAP) and systemic vascular resistance index (SVRI) at 12 and 24 h (P < .05). Furthermore, the VP-based group showed faster lactate normalization and a more pronounced reduction in cardiac biomarkers. Endocrine markers (copeptin and AVP) peaked significantly higher in the VP-based group but did not correlate with clinical outcomes ( r < .15, p > .05). Adverse event rates were balanced between groups. Conclusion(s): A VP-based strategy provided effective hemodynamic stabilization and is associated with shorter hospital stays compared to NE-based strategy in patients with VS following cardiac surgery. While NE continues to be effective, these findings suggest VP may be considered a viable early alternative or adjunctive vasopressor strategy for managing VS in the post-operative setting. Copyright © The Author(s) 2026 <53> Accession Number 2046223608 Title Temporal trends in characteristics and outcomes of patients undergoing percutaneous mitral valve repair. Source World Journal of Cardiology. 17(12) (no pagination), 2025. Article Number: 110450. Date of Publication: 26 Dec 2025. Author Kaddoura R.; Dakhil Z.; Al-Badriyeh D.; Abushanab D.; Rafie I.; Al-Hijji M. Institution (Kaddoura) Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, DA, Doha, Qatar (Dakhil) Department of Intervention, Ibn Al-Bitar Cardiac Center, Baghdad, Iraq (Al-Badriyeh) College of Pharmacy, QU Health, Qatar University, Doha, Qatar (Abushanab) Drug Information Center, Hamad Medical Corporation, Doha, Qatar (Rafie, Al-Hijji) Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar Publisher Baishideng Publishing Group Inc Abstract BACKGROUND Observational studies reported characteristics and outcomes of patients with secondary mitral valve regurgitation (MR) who underwent transcatheter edge-to-edge repair of the mitral valve. No study investigated the temporal trend of patient characteristics and outcomes in comparison with the published randomized trials. AIM To investigate the temporal trend in baseline characteristics and outcomes of patients with secondary MR who underwent transcatheter edge-to-edge repair of the mitral valve in the real world compared with those from the published landmark trials. METHODS A comprehensive systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL databases, and the identified observational studies were divided into two five-year recruitment periods. The first period included 36 studies that enrolled patients between 2008 and 2012, and the second period included 25 studies that recruited patients between 2013 and 2017-2018. Pooled variables of each five-year recruitment period were compared with those of the landmark trials. A random-effects model was used for statistical comparisons. RStudio and RevMan software were used for the analysis. RESULTS Overall, there were no major variations in the findings between the first and the second five-year recruitment periods. EVEREST program vs observational studies: Patients in the EVEREST program were more likely to have non-ischemic MR etiology [odds ratio (OR) = 3.59, 95% confidence interval (CI): 2.92-4.42] and atrial fibrillation (OR = 1.71, 95%CI: 1.42-2.06). They were less likely to receive angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (OR = 0.72, 95%CI: 0.58-0.90) and implantable cardiac device (OR = 0.41, 95%CI: 0.33-0.49) as well as less likely to be symptomatic at hospital presentation without a difference in MR grade <= 2+ or mortality at 12-month follow-up. COAPT trial vs observational studies: COAPT patients were more likely to have prior myocardial infarction (OR = 1.62, 95%CI: 1.27-2.06) and renal insufficiency (OR = 2.66, 95%CI: 2.05-3.45). They were more likely to receive beta-blockers (OR = 2.54, 95%CI: 1.68-3.85) and an implanted cardiac device (OR = 2.20, 95%CI: 1.71-2.84). There was no difference in procedure success or mortality. MITRA-FR trial vs observational studies: MITRA-FR patients were less likely to have atrial fibrillation (OR = 0.49, 95%CI: 0.34-0.69) and renal insufficiency (OR = 0.18, 95%CI: 0.11-0.28) but more likely to have a history of myocardial infarction (OR = 1.48, 95%CI: 1.06-2.05) and to receive diuretics (OR = 19.81, 95%CI: 2.75-142.48) and implantable cardiac devices (OR = 1.69, 95%CI: 1.21-2.37). At hospital presentation, they were less likely to be symptomatic (OR = 0.25, 95%CI: 0.18-0.35) without a difference in MR grades 3+ and 4+. There was no difference in terms of MR grade or mortality at 12-month follow-up. CONCLUSION Patients in the landmark studies may have favourable or unfavourable characteristics when compared to those in the observational studies, but this did not translate into different outcomes over time. Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved. <54> Accession Number 2044236909 Title Safety and efficacy of tirzepatide in transplant recipients: a systematic review and meta-analysis. Source Frontiers in Pharmacology. 17 (no pagination), 2026. Article Number: 1735987. Date of Publication: 2026. Author Provenzani A.; Mancuso B.; Stitch R.; Tuzzolino F.; Giusti M.A.; Mattina A. Institution (Provenzani, Tuzzolino, Giusti, Mattina) IRCCS ISMETT, Palermo, Italy (Provenzani, Giusti, Mattina) UPMC Italy, Palermo, Italy (Mancuso, Stitch) Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, United States Publisher Frontiers Media SA Abstract Introduction: Tirzepatide has demonstrated cardiovascular and metabolic benefits in the general population; however, evidence in post-transplant patients is very limited. The aim of this systematic review and meta-analysis is to evaluate the safety and efficacy of tirzepatide in solid organ transplant recipients. Method(s): We searched PubMed-MEDLINE, Embase, and Cochrane Library databases. All randomized controlled trials (RCTs) and observational studies were considered. Efficacy outcomes included improvements to glycemic outcomes demonstrated by reductions to hemoglobin A1c and changes to weight, measured by body mass index. Safety was assessed through patients who discontinued tirzepatide treatment due to adverse drug reactions. Result(s): No randomized controlled trials (RCTs) or other interventional clinical trials were identified in the available literature. Four non-randomized observational studies were found and included. Using the Weighted Median of the Difference of Medians statistical test, tirzepatide was associated with absolute reductions in hemoglobin A1c of -1.4% (95% CI: -1.7 to -0.4) and body mass index of -1.2 kg/m2 (95% CI: -5.9 to -1.1) in solid organ transplant recipients. Pooled proportions indicated a tirzepatide discontinuation rate of 3.1% (95% CI: 0.0-7.1) due to adverse drug reactions, suggesting the therapy was well tolerated in this population. Conclusion(s): Tirzepatide was associated with reductions in hemoglobin A1c and body mass index and was generally well tolerated in solid organ transplant recipients. These findings suggest a potential role for tirzepatide in the management of obesity and post-transplant diabetes mellitus, pending confirmation in larger prospective studies. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251154851, identifier CRD420251154851. Copyright © 2026 Provenzani, Mancuso, Stitch, Tuzzolino, Giusti and Mattina. <55> Accession Number 2038434767 Title Insertion of a transesophageal echocardiography probe using McGRATH video laryngoscope in cardiac surgery patients: A prospective randomized study. Source Anaesthesia, Pain and Intensive Care. 30(5) (pp 633-637), 2026. Date of Publication: 01 May 2026. Author Abdalwahab A.; Abuzaid A.; Abdelal I.; Elsherbeny A. Institution (Abdalwahab, Elsherbeny) Anaesthesia Department, Faculty of Medicine Cairo University, Cairo, Egypt (Abdalwahab, Abuzaid, Abdelal, Elsherbeny) Anesthesia Department, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia Publisher Faculty of Anaesthesia, Pain and Intensive Care, AFMS Abstract Background & objective: Insertion of a transoesophageal echocardiography (TEE) probe during cardiac surgery is generally safe but may be associated with oropharyngeal and oesophageal complications. Assistance with a conventional Macintosh laryngoscope can reduce insertion-related injury; however, consistent visualization of the oesophageal inlet is often limited. The McGRATH video laryngoscope provides indirect video imaging and may improve anatomical visualization during probe placement. This study evaluated whether McGRATH-assisted TEE probe insertion improves ease of insertion and reduces insertion-related complications compared with the conventional Macintosh laryngoscope. Methodology: A prospective randomised controlled trial. Was conducted at a large tertiary Cardiac Centre from June to December 2025. 100 adult patients scheduled for elective cardiac procedures under general anaesthesia requiring intraoperative TEE monitoring were randomised to either McGRATH-assisted insertion (M group) or Macintosh-assisted insertion (C group). TEE probe insertion guided by either the McGRATH video laryngoscope or a conventional Macintosh laryngoscope. Primary outcomes included visibility of the oesophageal inlet and duration of probe insertion. Secondary outcomes were number of insertion attempts, insertion-related complications, and anaesthesiologist satisfaction. Result(s): The visibility of the oesophageal inlet was significantly higher in the McGRATH than in the Macintosh group (84% vs 38%, P < 0.001). The duration of TEE probe insertion was significantly shorter in the McGRATH group (P < 0.001). The incidence of complications was significantly lower in the McGRATH group compared with the Macintosh group (2% vs 12%). Conclusion(s): Use of the McGRATH video laryngoscope facilitated TEE probe insertion by improving visualization of the oesophageal inlet, reducing insertion time, and lowering the incidence of insertion-related complications. Copyright © 2026, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved. <56> Accession Number 2047828675 Title Cosmetic outcomes of postoperative scar taping after surgical incisions: A systematic review. Source JPRAS Open. 51 (pp 374-386), 2026. Date of Publication: 01 Sep 2026. Author Lee D.K.R.; Duru D.O.; Nicolet G.; Kiew C.Y.K.; Abood A.; Wong K.Y. Institution (Lee, Duru) School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom (Nicolet) University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland (Kiew) Imperial College London, South Kensington, Ayrton Road, London, United Kingdom (Abood, Wong) Department of Plastic and Reconstructive Surgery, Addenbrookes Hospital, Hills Rd, Cambridge, United Kingdom Publisher Elsevier Ltd Abstract Background: The application of silicone sheets to surgical wounds is currently recommended for hypertrophic scar and keloid prophylaxis after closure of surgical incisions. The use of other types of tapes that differ in cost and biomechanical properties has been reported, although a formal synthesis on this topic within recent years has yet to be undertaken. Methods & materials: MEDLINE, Embase and Cochrane were comprehensively searched between January 2000 - December 2025, following the PRISMA guidelines. Included studies evaluated cosmetic outcomes of adult patients (>=18 years) undergoing surgical wound taping following primary wound closure. Randomised controlled trials, comparative cohort studies, and case series (n>=5) were eligible. Result(s): In the 14 included studies, microporous tapes and Steri-Strips were most popular, encompassing 217 and 159 patients respectively. Cosmetic outcomes were assessed at a mean of 5.13 months (range 21 days to 12 months), using heterogeneous tools including SCAR-Q, Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale, and Visual Analogue Scales. The application of tapes after primary closure showed significant improvements in scar cosmesis compared to patients without any interventions (n=75), with some evidence suggesting that more inexpensive paper tapes produce clinically similar results to gold-standard silicone sheets. Conclusion(s): Surgical wound taping using adhesives other than silicone sheets appears to be an effective strategy for improving scar cosmesis. Further randomised controlled trials studies using a consistently layered primary closure methods and directly comparing different types of tapes including silicone sheets using longer follow up and standardised reporting outcomes are needed. Copyright © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <57> Accession Number 2047828370 Title Cardiac Sympathetic Neuromodulation in the Management of Refractory Electrical Storm: A Narrative Review. Source Journal of Clinical Medicine. 15(14) (no pagination), 2026. Article Number: 5540. Date of Publication: 01 Jul 2026. Author Lopez Gonzalez J.M.; Garcia Iglesias D.; Jimenez Gomez B.M.; Baeza L.; Fernandez Del Valle D.; Alonso Fernandez V.; Diaz Molina B.; Vives M.; Rubin Lopez J.M. Institution (Lopez Gonzalez, Jimenez Gomez, Baeza, Fernandez Del Valle) Central University Hospital of Asturias, Department of Anesthesiology, Perioperative and Pain Medicine, Oviedo, Spain (Garcia Iglesias, Alonso Fernandez, Diaz Molina, Rubin Lopez) Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain (Garcia Iglesias, Rubin Lopez) Instituto de Investigacion Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain (Vives) Department of Anesthesiology, Perioperative and Pain Medicine, University Clinic of Navarra, Pamplona, Spain Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Electrical storm (ES) is a life-threatening clinical condition characterized by recurrent ventricular arrhythmias within a 24 h period, carrying a high mortality rate. Despite conventional therapies, including hemodynamic optimization, antiarrhythmic drugs, implantable cardioverter-defibrillator (ICD) reprogramming, and catheter ablation, a subset of patients develop refractory ventricular arrhythmias. In this setting, cardiac sympathetic neuromodulation can interrupt arrhythmic circuits by reducing efferent sympathetic outflow to the myocardium. Stellate ganglion block (SGB) with local anaesthetic (LA) is a temporary pharmacological blockade used as rescue therapy; in the largest prospective series (the STAR study), 92% of treated patients achieved at least a 50% reduction in arrhythmic events in the 12 h following the procedure. Because the effect of anaesthetic blockade is transient, more durable interventions have been explored, including percutaneous radiofrequency or chemical neurolysis and surgical cardiac sympathetic denervation (CSD), although current evidence is largely confined to small, uncontrolled case series. This narrative review synthesizes the available evidence on cardiac sympathetic neuromodulation-spanning SGB, percutaneous neurolysis, and surgical CSD-in refractory ES, positioning these interventions primarily as a means of stabilizing patients and bridging to definitive therapy rather than as established survival-modifying treatments. Furthermore, this review describes the primary anatomical foundations of the cervicothoracic sympathetic nervous system and the various techniques for SGB, along with their most relevant clinical indications. The risks and complications associated with these interventions are also addressed. Finally, clinical implications and potential future research directions in this field are discussed, with the aim of providing guidance for the comprehensive management of critically ill patients with refractory ES. Copyright © 2026 by the authors. <58> Accession Number 2045233462 Title Formulation-Specific Cardiovascular Outcomes with High-Dose Eicosapentaenoic Acid: A Systematic Review and Meta-analysis. Source American Journal of Cardiovascular Drugs. 26(4) (pp 453-465), 2026. Date of Publication: 01 Jul 2026. Author Faheem M.A.; Azeem B.; Ali T.; Asim R.; Muhammad T.S.; Dogar M.-E.-A.; Naveed M.A. Institution (Faheem, Naveed) Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan (Azeem, Ali, Asim, Muhammad, Dogar) Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan Publisher Adis Abstract Background/Objective: Residual cardiovascular risk persists despite intensive statin therapy in patients with established atherosclerotic cardiovascular disease (CVD). Omega-3 fatty acids, particularly high-dose eicosapentaenoic acid (EPA), have been proposed as adjunctive therapy, yet trial results conflict, likely due to formulation differences. We conducted a formulation-focused meta-analysis to determine whether high-dose EPA-dominant supplementation reduces cardiovascular events and to quantify the impact of mixed EPA/docosahexaenoic acid (DHA) regimens on efficacy. Method(s): Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched MEDLINE, Embase, CENTRAL, and trial registries through May 2025 for randomized controlled trials, including placebo-controlled and open-label designs, of high-dose EPA-dominant omega-3 (>= 1.8 g/day; >= 50% EPA) in adults with established CVD or other high-risk settings. Six trials (n = 42,738; 31-85% male) were eligible. Random-effects models generated pooled risk ratios (RRs), with I2 assessing heterogeneity; sensitivity analyses excluded mixed EPA/DHA formulations. Imaging surrogate outcomes were summarized narratively when study modalities were not directly comparable. Result(s): EPA-based therapy significantly reduced hospitalizations for unstable angina (RR 0.75, 95% CI 0.66-0.87; I2 = 0%). Overall effects on recurrent myocardial infarction and revascularization were not statistically significant, but both became significant after exclusion of STRENGTH, the only mixed EPA/DHA cardiovascular outcomes trial. No significant effect was observed for ischemic stroke, cardiovascular death, or high-sensitivity C-reactive protein (hs-CRP). CHERRY and EVAPORATE both suggested attenuation of plaque progression, but these imaging studies were not pooled because intravascular ultrasound and coronary computed tomography angiography-derived measures were not directly comparable. Conclusion(s): High-dose EPA-dominant therapy was associated with fewer unstable angina hospitalizations, and formulation appeared to modify clinical benefit. Among blinded, placebo-controlled, cardiovascular outcomes trials, 4 g/day icosapent ethyl is the only formulation independently associated with reduced cardiovascular events. Larger formulation-specific trials are needed to clarify the roles of purified EPA, mixed EPA/DHA regimens, and patient selection. Registration: PROSPERO identifier number: CRD420251063069. Copyright © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026. <59> Accession Number 2038435592 Title Efficacy of Beta-blocker Therapy in Post-myocardial Infarction Patients with Preserved or Mildly Reduced Ejection Fraction: A Systematic Review and Meta-analysis. Source Journal of Cardiac Critical Care. 10(3) (pp 163-172), 2026. Date of Publication: 01 Jul 2026. Author Mata E.; Resende B.; Pinto A.M.; Portugues J.; Ribeiro S.; Gameiro J.; Lourenco A.; Goncalves L. Institution (Mata, Pinto, Portugues, Ribeiro, Lourenco) Department of Cardiology, Unidade Local de Saude do Alto Ave, Guimaraes, Portugal (Resende, Gameiro, Goncalves) Department of Cardiology, Unidade Local de Saude de Coimbra, Coimbra, Portugal Publisher Scientific Scholar LLC Abstract Objectives: Beta-blockers improve outcomes after myocardial infarction (MI) in patients with reduced left ventricular ejection fraction (LVEF), but their benefit in patients with preserved ejection fraction (pEF) or mildly reduced ejection fraction (mrEF) remains unclear in the era of modern reperfusion and optimized therapy. This study evaluates the long-term impact of beta-blockers in this population. Material(s) and Method(s): Following a systematic search of four databases, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in post-myocardial infarction patients with LVEF >=40%, comparing long-term beta-blocker therapy with usual care. Primary outcomes were all-cause mortality and recurrent MI; secondary outcomes included cardiovascular (CV) mortality, heart failure hospitalization (HFH), malignant ventricular arrhythmias, ischemic stroke, and unplanned coronary revascularization. Data were pooled using random-effects models. Result(s): Four multicenter RCTs (9892 patients in the beta-blocker group and 9934 in the control group) conducted between 2017 and 2024 were included, with a median follow-up of 3.5-3.7 years. Beta-blocker therapy was not associated with a significant reduction in all-cause mortality (hazard ratio [HR]: 0.98, confidence intervals [CI] 0.85-1.12) or recurrent MI (HR: 0.88, CI 0.74-1.05). No benefit was observed for secondary outcomes, including CV mortality, HFH, malignant arrhythmias, ischemic stroke, or unplanned revascularization. Heterogeneity was low to moderate, and study quality was moderate overall, with high certainty for primary outcomes. Conclusion(s): In contemporary reperfusion-era populations with pEF or mrEF, long-term beta-blocker therapy after MI does not confer significant reductions in mortality or recurrent MI. These findings challenge the historical paradigm of universal post-MI beta-blockade and support a more selective, individualized approach guided by LVEF. Copyright © 2026 Published by Scientific Scholar on behalf of Journal of Cardiac Critical Care TSS. <60> Accession Number 2041513507 Title Association of Hypoxic Burden With Cardiovascular Events: A Risk Stratification Analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea Cohort. Source Chest. 168(6) (pp 1481-1493), 2025. Date of Publication: 01 Dec 2025. Author Peker Y.; Celik Y.; Zinchuk A.; Sands S.A.; Redline S.; Azarbarzin A. Institution (Peker) Department of Pulmonary Medicine, Koc University School of Medicine, and Koc University Research Center for Translational Medicine, Istanbul, Turkey (Peker, Celik, Sands, Redline, Azarbarzin) Division of Sleep and Circadian Disorders, Brigham and Women's Hospital & Harvard Medical School, Boston, MA, United States (Peker) Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, United States (Peker) Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (Peker) Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden (Zinchuk) Department of Internal Medicine, School of Medicine, Yale University, New Heaven, CT, United States Publisher Elsevier Inc. Abstract Background: The apnea-hypopnea index (AHI), the standard measure of OSA, has limitations in reflecting disease severity. Research Question: Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI of >= 30 events/h? Study Design and Methods: This secondary analysis of the Randomized Intervention With CPAP in Coronary Artery Disease and Sleep Apnea observational cohort included 368 adults with OSA (AHI >= 15 events/h) with (n = 155) and without (n = 244) excessive daytime sleepiness (EDS), defined as an Epworth Sleepiness Scale score of >= 10. HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time. Patients were classified as having high or low HB based on the median (60.7%min/h). The primary outcome was the incident of the first MACCE. Cox proportional hazard models assessed associations in the full cohort and by CPAP allocation and adherence (nonadherent or no positive airway pressure [PAP] group, n = 262; adherent [adjusted PAP use >= 4 h/night for all nights at 1-year follow-up], n = 106). In an exploratory analysis, participants were grouped into 4 categories based on median AHI and HB (low and low, low and high, high and low, and high and high, respectively). Result(s): Over a median follow-up of 4.7 years, high HB was associated with MACCEs (adjusted hazard ratio, 1.87; 95% CI, 1.17-2.98; P = .009), particularly among untreated or nonadherent patients and those with baseline EDS. AHI of >= 30 events/h was not associated significantly with MACCEs (P = .366). When modelled continuously, HB and AHI each were associated with MACCEs; however, compared with low AHI and low HB, only high HB, regardless of AHI level, was linked to increased risk. In contrast, high AHI and low HB was not associated with MACCEs. Interpretation(s): High HB, but not AHI of >= 30 events/h, was associated with MACCEs in adults with moderate to severe OSA. Although AHI was associated with outcomes when modelled continuously, elevated risk seemed to be driven primarily by high HB. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT00519597; URL: www.clinicaltrials.gov Copyright © 2025 The Author(s) <61> Accession Number 634192869 Title Effect of a Restrictive vs Liberal Blood Transfusion Strategy on Major Cardiovascular Events among Patients with Acute Myocardial Infarction and Anemia: The REALITY Randomized Clinical Trial. Source JAMA. 325(6) (pp 552-560), 2021. Date of Publication: 09 Feb 2021. Author Ducrocq G.; Gonzalez-Juanatey J.R.; Puymirat E.; Lemesle G.; Cachanado M.; Durand-Zaleski I.; Arnaiz J.A.; Martinez-Selles M.; Silvain J.; Ariza-Sole A.; Ferrari E.; Calvo G.; Danchin N.; Avendano-Sola C.; Frenkiel J.; Rousseau A.; Vicaut E.; Simon T.; Steg P.G. Institution (Ducrocq, Steg) Universite de Paris, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris, France (Gonzalez-Juanatey) Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain (Puymirat, Danchin) Universite de Paris, AP-HP, Hopital Europeen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), Paris, France (Lemesle) Institut Coeur Poumon, Centre Hospitalier Universitaire de Lille, Faculte de Medecine de Lille, Universite de Lille, Institut Pasteur de Lille, Inserm U1011, Lille, France (Lemesle) French Alliance for Cardiovascular Trials (FACT), Paris, France (Cachanado, Rousseau, Simon) Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris, AP-HP, Hopital St Antoine, Paris, France (Durand-Zaleski, Frenkiel) AP-HP Health Economics Research Unit, Hotel Dieu Hospital, INSERM UMR 1153 CRESS, Paris, France (Arnaiz, Martinez-Selles) Clinical Trials Unit, Clinical Pharmacology Department, Hospital Clinic, Barcelona, Spain (Arnaiz, Martinez-Selles) Servicio de Cardiologia, Hospital Universitario Gregorio Maranon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain (Silvain) Sorbonne Universite, ACTION Study Group, Institut de Cardiologie, Hopital Pitie-Salpetriere (AP-HP), INSERM UMRS 1166, Paris, France (Ariza-Sole) University Hospital Bellvitge, Heart Disease Institute, Barcelona, Spain (Ferrari) Universite Cote d'Azur, CHU de Nice, Hopital Pasteur 1, Service de Cardiologie, Nice, France (Calvo) Area Del Medicament, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain (Avendano-Sola) Clinical Pharmacology Service, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (Vicaut) AP-HP, Department of Biostatistics, Universite Paris-Diderot, Sorbonne-Paris Cite, Fernand Widal Hospital, France (Simon) Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hopital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Universite, Paris, France (Steg) Royal Brompton Hospital, Imperial College, London, United Kingdom Publisher American Medical Association Abstract Importance: The optimal transfusion strategy in patients with acute myocardial infarction and anemia is unclear. Objective(s): To determine whether a restrictive transfusion strategy would be clinically noninferior to a liberal strategy. Design, Setting, and Participant(s): Open-label, noninferiority, randomized trial conducted in 35 hospitals in France and Spain including 668 patients with myocardial infarction and hemoglobin level between 7 and 10 g/dL. Enrollment could be considered at any time during the index admission for myocardial infarction. The first participant was enrolled in March 2016 and the last was enrolled in September 2019. The final 30-day follow-up was accrued in November 2019. Intervention(s): Patients were randomly assigned to undergo a restrictive (transfusion triggered by hemoglobin <=8; n = 342) or a liberal (transfusion triggered by hemoglobin <=10 g/dL; n = 324) transfusion strategy. Main Outcomes and Measures: The primary clinical outcome was major adverse cardiovascular events (MACE; composite of all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization prompted by ischemia) at 30 days. Noninferiority required that the upper bound of the 1-sided 97.5% CI for the relative risk of the primary outcome be less than 1.25. The secondary outcomes included the individual components of the primary outcome. Result(s): Among 668 patients who were randomized, 666 patients (median [interquartile range] age, 77 [69-84] years; 281 [42.2%] women) completed the 30-day follow-up, including 342 in the restrictive transfusion group (122 [35.7%] received transfusion; 342 total units of packed red blood cells transfused) and 324 in the liberal transfusion group (323 [99.7%] received transfusion; 758 total units transfused). At 30 days, MACE occurred in 36 patients (11.0% [95% CI, 7.5%-14.6%]) in the restrictive group and in 45 patients (14.0% [95% CI, 10.0%-17.9%]) in the liberal group (difference, -3.0% [95% CI, -8.4% to 2.4%]). The relative risk of the primary outcome was 0.79 (1-sided 97.5% CI, 0.00-1.19), meeting the prespecified noninferiority criterion. In the restrictive vs liberal group, all-cause death occurred in 5.6% vs 7.7% of patients, recurrent myocardial infarction occurred in 2.1% vs 3.1%, emergency revascularization prompted by ischemia occurred in 1.5% vs 1.9%, and nonfatal ischemic stroke occurred in 0.6% of patients in both groups. Conclusions and Relevance: Among patients with acute myocardial infarction and anemia, a restrictive compared with a liberal transfusion strategy resulted in a noninferior rate of MACE after 30 days. However, the CI included what may be a clinically important harm. Trial Registration: ClinicalTrials.gov Identifier: NCT02648113. Copyright © 2021 American Medical Association. All rights reserved. <62> Accession Number 650349161 Title Clinical efficacy and safety of robotic-assisted thoracic surgery after neoadjuvant therapy in non-small cell lung cancer: a systematic review and meta-analysis. Source Updates in surgery. 78(4) (pp 1781-1796), 2026. Date of Publication: 01 Aug 2026. Author Liang G.; Peng H.; Li Y. Institution (Liang, Peng, Li) Department of Cardiothoracic Surgery, First Affiliated Hospital of Guangxi Medical University, NO 6 Shuangyong Road, Nanning, Guangxi, China <63> Accession Number 2047955253 Title Thrombolytic therapy versus cardiac surgery for left-sided prosthetic heart valve thrombosis: A systematic review and meta-analysis. Source American Heart Journal Plus: Cardiology Research and Practice. 69 (no pagination), 2026. Article Number: 100849. Date of Publication: 01 Sep 2026. Author Bagheri B.; Eskandari S.; Soltani S.; Jalalian R.; Charati J.Y.; Moradi M.; Iranian M. Institution (Bagheri, Eskandari, Soltani, Jalalian) Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Charati, Moradi) Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran, Islamic Republic of (Iranian) Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher Elsevier Inc. Abstract Introduction: The optimal treatment of prosthetic heart valve thrombosis (PVT) remains vigorously debated in international guidelines. The present study was designed to compare the efficacy and safety of thrombolytic therapy and surgery in left-sided PVT, incorporating recent data to inform clinical decision-making. Method(s): This study is a systematic review with meta-analysis. We searched PubMed, Scopus, and Embase up to Jun 30, 2025. Eligible studies were those reporting treatment strategies and outcomes of patients with left-sided PVT. The primary outcome was treatment success (survival for surgery; complete or partial improvement of valve function and hemodynamic success not requiring surgery after thrombolysis). Result(s): 114 studies were included, representing 6514 patients with 6744 PVT episodes. The success rate in both treatment groups was the same: 83.9% (95% CI: 82.2-85.4; I2 = 19.8%) for thrombolysis versus 85.1% (95% CI: 83.3-86.7; I2 = 27%) for surgery (P-value = 0.607). The mortality rate was lower with thrombolysis (8.5%; 95% CI: 7.5-9.8; I2 = 0%) than surgery (15%; 95% CI: 13.4-16.8; I2 = 26.3%) (P-value = 0.001). Other secondary outcomes showed no significant differences. In the slow/very slow thrombolytic infusion subgroup analysis, the success rate was 91.4% (95% CI: 87-94; I2 = 44.9%) and the mortality was 2.1% (95% CI: 1.2-3.3; I2 = 0%). Conclusion(s): This systematic review suggests that fibrinolytics are a reasonable option alongside surgery for left-sided PVT, with similar success rates and lower mortality. However, due to observational evidence, results should be interpreted cautiously and randomized controlled trials (RCTs) are needed. Copyright © 2026 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <64> Accession Number 2047758380 Title Anesthetic Techniques and Postoperative Cognitive Dysfunction in Older Adults: Current Evidence and Perioperative Strategies. Source Medicina (Lithuania). 62(7) (no pagination), 2026. Article Number: 1214. Date of Publication: 01 Jul 2026. Author John H.T.; Sebastian M.A.; Francis M.R.; Pine K.; Moisa C.C.M.; Negrut N.; Ferician A. Institution (John, Pine, Moisa, Negrut) Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania (Sebastian, Francis) Faculty of Medicine, Medical University-Pleven, 1, Saint Kliment Ohridski Street, Pleven, Bulgaria (Negrut) Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania (Ferician) Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: With the rising number of geriatric surgical patients, postoperative cognitive dysfunction (POCD) has become a major concern, linked to impairments in memory, attention, and executive function. POCD increases morbidity, prolongs hospitalization, and diminishes quality of life. This review examines the mechanisms underlying POCD, with emphasis on neuroinflammation, blood-brain barrier (BBB) disruption, and oxidative stress, and evaluates the impact of anesthetic techniques on cognitive outcomes in the elderly. Material(s) and Method(s): This narrative review used a targeted literature search to identify relevant clinical, translational, and mechanistic evidence on POCD in older surgical patients. The evidence was synthesized qualitatively, with attention to heterogeneity in study populations, anesthetic techniques, cognitive assessment methods, and follow-up duration. Result(s): Neuroinflammation, BBB compromise, oxidative stress, perioperative stress responses, and patient vulnerability appear to contribute to POCD. Evidence comparing anesthetic techniques remains heterogeneous. Some studies suggest associations between general anesthesia, volatile agents, and early postoperative cognitive changes, whereas other comparative and randomized studies do not demonstrate consistent long-term cognitive differences between general, regional, neuraxial, volatile, and intravenous anesthetic approaches. Regional and neuraxial techniques may reduce anesthetic or opioid exposure in selected patients, but they should not be interpreted as definitively superior for POCD prevention. Adjunctive and multimodal strategies, including dexmedetomidine and non-opioid analgesics, show potential benefits, although evidence remains variable. Conclusion(s): Individualized anesthetic planning, early risk stratification, avoidance of excessive anesthetic depth, hemodynamic optimization, multimodal analgesia, and postoperative recovery strategies may help reduce modifiable contributors to POCD. Current evidence does not support a definitive hierarchy of anesthetic techniques for preventing POCD, and further high-quality studies are needed. Copyright © 2026 by the authors. <65> Accession Number 2045910274 Title Analgesic efficacy and safety of erector spinae plane block after sternotomy and minimally invasive cardiac surgery: A systematic review and Meta-analysis of randomized trials. Source Journal of Clinical Anesthesia. 112 (no pagination), 2026. Article Number: 112240. Date of Publication: 01 Jun 2026. Author Perez-Moreno D.; Forero M.; Contreras M.F.; Mora-Arteaga J.A. Institution (Perez-Moreno) Pain and Palliative Care Unit, Instituto Nacional de Cancerologia, Bogota D.C., Colombia (Forero) Department of Anesthesia, McMaster University, Hamilton, ON, Canada (Contreras) Department of Anesthesia, Clinica Universitaria de la Sabana; Universidad de la Sabana, Chia, Colombia (Mora-Arteaga) Department of Internal Medicine, Intensive Care Unit, Hospital Universitario San Ignacio, Bogota D.C., Colombia (Mora-Arteaga) School of Medicine, Pontificia Universidad Javeriana, Bogota D.C., Colombia Publisher Elsevier Inc. Abstract Background The erector spinae plane block (ESPB) is increasingly used for analgesia in cardiac surgery, but its effectiveness across surgical approaches remains uncertain. We aimed to evaluate the analgesic efficacy, recovery effects, and safety of ESPB in adult cardiac surgery, with analyses stratified by surgical approach (median sternotomy versus minimally invasive cardiac surgery [MICS]). Methods We searched MEDLINE, Embase, CENTRAL, and Scopus (January 2016-June 2025) for randomized controlled trials (RCTs) comparing ultrasound-guided ESPB with standard systemic analgesia in adults undergoing cardiac surgery. This PRISMA-compliant review (PROSPERO: CRD42024570340) used random-effects meta-analyses with Hartung-Knapp adjustment. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. The primary outcome was postoperative pain within 24 h. Secondary outcomes included opioid consumption, time to extubation, ICU and hospital length of stay, and complications. Results Nineteen RCTs (N = 1344; 673 received ESPB) were included. In the median sternotomy subgroup (n = 1092), ESPB was associated with modest improvements in 24-h pain (0-10 VAS/NRS; mean difference [MD] -0.65, 95% CI - 1.14 to -0.16), intraoperative and 24-h opioid consumption (MD - 80.8 and - 45.8 mg OME), time to extubation (MD -1.28 h), and ICU stay (MD -13.1 h). However, heterogeneity was substantial (I2 > 85% for most outcomes), and wide prediction intervals crossed the null, suggesting that effects may vary substantially across clinical settings. In the MICS subgroup (4 RCTs, n = 252), no clear statistically significant or clinically meaningful benefits were detected for most outcomes in pain, opioid use, or recovery outcomes. Conclusion Low- to very-low-certainty evidence suggests that ESPB is associated with modest improvements in early pain and recovery after median sternotomy; however, very high heterogeneity and wide prediction intervals indicate that effects may vary substantially between centers. In contrast, no clear benefit was demonstrated within ERAS-optimized MICS pathways, and findings in this subgroup remain preliminary. Copyright © 2024. Published by Elsevier Inc. <66> 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 <67> Accession Number 2047816509 Title One-Year Outcomes of High-Risk Percutaneous Coronary Interventions With Versus Without Mechanical Circulatory Support: Propensity Score-Matched Analysis. Source Catheterization and Cardiovascular Interventions. (no pagination), 2026. Date of Publication: 2026. Author Gasecka A.; Pietrasik A.; Pawlowski T.; Zimodro J.M.; Ciesla D.; Sacha J.; Grygier M.; Kochman J.; Tajstra M.; Dyrbus K.; Wojakowski W.; Mizia-Stec K.; Swiatkowski A.; Francuz P.; Kalarus Z.; Smolka G.; Gasior M. Institution (Gasecka, Pietrasik, Zimodro, Kochman) 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland (Pawlowski) National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland (Ciesla) Department of Science and New Technologies, Silesian Center for Heart Diseases, Zabrze, Poland (Sacha) Department of Cardiology, University Hospital in Opole, Opole, Poland (Sacha) Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland (Grygier) 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland (Tajstra, Dyrbus, Gasior) 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland (Wojakowski) Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland (Mizia-Stec) 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland (Swiatkowski, Francuz, Kalarus) Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland (Smolka) Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland Publisher John Wiley and Sons Inc Abstract Background: Impella is increasingly used as mechanical circulatory support (MCS) during high-risk percutaneous coronary interventions (HR-PCI). Registry-based data provide insights into the efficacy and safety of Impella-assisted HR-PCI. Aim(s): We aimed to evaluate 1-year outcomes of Impella-assisted HR-PCI compared to HR-PCI without MCS. Method(s): One hundred and thirty-eight patients undergoing Impella-assisted PCI, included in the IMPELLA-PL registry, were propensity score-matched with controls from the retrospective CardioSilesia registry who underwent HR-PCI without MCS. Study endpoints included 1-year post-discharge all-cause mortality, myocardial infarction (MI), stroke, rehospitalization for heart failure (HF), and repeat coronary revascularization. Result(s): Clinical and angiographic characteristics were comparable in both groups, with higher rates of dyslipidemia (78.3% vs. 37.7%, p < 0.001), chronic kidney disease (39.9% vs. 16.7%, p < 0.001), and peripheral artery disease (34.1% vs. 8.0%, p < 0.001) in the IMPELLA-PL cohort. Intravascular ultrasound was more frequently used in the Impella-supported patients (44.2% vs. 25.4%, p = 0.002), while staged revascularization was more common among controls (30.4% vs. 15.9%, p = 0.007). At 1 year, rates of post-discharge all-cause mortality, stroke, and repeat coronary revascularization were similar in both groups. MI was less frequent in the IMPELLA-PL cohort (1.4% vs. 10.9%, p = 0.003), alongside a trend toward lower incidence of rehospitalizations for HF (9.4% vs. 18.1%, p = 0.055). Conclusion(s): Despite an unfavorable cardiovascular risk profile, patients who underwent Impella-assisted HR-PCI had similar 1-year post-discharge survival, with a lower rate of MI, compared to propensity score-matched controls who underwent HR-PCI without MCS. Impella may improve HR-PCI outcomes in selected patients, but further randomized controlled trials are required to confirm this finding. Copyright © 2026 Wiley Periodicals LLC. <68> Accession Number 2047645381 Title Comment on "Prognostic value of AI-enabled quantitative coronary CT angiography for major adverse cardiovascular events: A systematic review and meta-analysis". Source International Journal of Cardiology: Cardiovascular Risk and Prevention. 30 (no pagination), 2026. Article Number: 200675. Date of Publication: 01 Sep 2026. Author Sreenivasulu G.; Nagesh C.; Rajyalakshmi C. Institution (Sreenivasulu) Department of Computer Science & Engineering, Madanapalle Institute of Technology & Science (MITS), Deemed to be University, Andhra Pradesh, Madanapalle, India (Nagesh) Department of Computer Science and Engineering, Srinivasa Ramanujan Institute of Technology, Andhra Pradesh, Anantapur, India (Rajyalakshmi) Department of Computer Science and Engineering, Aditya University, Andhra Pradesh, Surampalem, India Publisher Elsevier B.V. <69> Accession Number 2047832394 Title Pharmacologic Strategies for Intraoperative Hypotension When Ephedrine Is Unavailable: An Evidence-Based Review. Source Journal of Personalized Medicine. 16(7) (no pagination), 2026. Article Number: 384. Date of Publication: 01 Jul 2026. Author Duarte-Medrano G.; Nuno-Lambarri N.; Chavez-Munoz D.; Elguezabal Rodelo R.G.; Gonzalez-Chon O.; La Via L. Institution (Duarte-Medrano, Chavez-Munoz, Elguezabal Rodelo, Gonzalez-Chon) Department of Anesthesia, Hospital Medica Sur, Mexico Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City, Mexico (Nuno-Lambarri) Translational Research Unit, Medica Sur Clinic & Foundation, Puente de Piedra 150, Toriello Guerra, Tlalpan, Mexico City, Mexico (Nuno-Lambarri) Department of Surgery, Faculty of Medicine, The National Autonomous University of Mexico (UNAM), Escolar 411A, Copilco Universidad, Coyoacan, Mexico City, Mexico (La Via) Department of Anesthesia and Intensive Care 1, University Hospital Policlinico "G. Rodolico-San Marco", Catania, Italy Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Intraoperative hypotension (IOHs) affects up to 87% of patients under general anesthesia and is consistently associated with acute kidney injury, myocardial damage, stroke, and mortality. The intermittent unavailability of ephedrine across healthcare systems underscores the need for evidence-based alternatives. This review critically evaluates pharmacological options for IOH when ephedrine is unavailable, focusing on receptor pharmacodynamics, population-specific evidence, and clinical consequences of inadequately managed hypotension. Method(s): A narrative, evidence-based review was conducted examining mechanisms of action, dosing strategies, adverse effect profiles, and clinical applicability of key vasoactive agents: ephedrine, phenylephrine, norepinephrine, and epinephrine. Population-specific evidence across obstetric, pediatric, and elderly cohorts was synthesized from randomized controlled trials, meta-analyses, and observational studies. The clinical impact of IOH on neurological, cardiovascular, and renal outcomes was reviewed. Result(s): Each vasopressor exhibits a distinct receptor-selectivity profile that determines its hemodynamic effect and optimal clinical context. Norepinephrine's favorable alpha1/beta1 balance tends to preserve cardiac output better than pure alpha1-agonists and has emerged as a promising alternative in obstetric and elderly populations, although the optimal agent ultimately depends on the underlying mechanism of hypotension and individual patient characteristics. Epinephrine provides combined vasopressor and inotropic support for hypotension with myocardial depression. IOH is associated with a greater than twofold increase in postoperative AKI and significantly elevated risks of myocardial infarction and stroke, with outcomes driven by cumulative hypotensive exposure rather than isolated pressure nadirs. Conclusion(s): Effective management of IOH requires individualized vasopressor selection guided by underlying pathophysiology, cardiovascular profile, and surgical context. A physiology-based strategy-rather than protocol-driven drug substitution-enables anesthesiologists to achieve precise hemodynamic control and preserve end-organ perfusion even when ephedrine is unavailable. Copyright © 2026 by the authors. <70> Accession Number 2047821452 Title Perioperative Immunonutrition in Patients Undergoing Lung Cancer Surgery: Current Evidence and Future Perspectives. Source Nutrients. 18(14) (no pagination), 2026. Article Number: 2381. Date of Publication: 01 Jul 2026. Author Werblinska A.; Skrzypczak P.J.; Roszak M.; Bryl M.; Piwkowski C.; Gabryel P. Institution (Werblinska, Skrzypczak, Piwkowski, Gabryel) Department of Thoracic Surgery, Poznan University of Medical Sciences, Szamarzewskiego 62 Street, Poznan, Poland (Werblinska) Doctoral School, Poznan University of Medical Sciences, Bukowska 70, Poznan, Poland (Werblinska, Skrzypczak, Bryl, Piwkowski, Gabryel) Greater Poznan Center of Pulmonology and Thoracic Surgery, Szamarzewskiego 62 Street, Poznan, Poland (Roszak) Department of Pathophysiology, Poznan University of Medical Sciences, Poznan, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality worldwide, and surgical resection is the primary curative treatment for patients with early-stage non-small cell lung cancer (NSCLC). Patients undergoing lung cancer surgery are frequently affected by malnutrition, systemic inflammation, sarcopenia, and cancer-related cachexia, which may adversely affect postoperative recovery and clinical outcomes. Perioperative immunonutrition has been proposed as a strategy to support immune and metabolic responses associated with surgical stress. This narrative review summarizes current evidence regarding the role of perioperative immunonutrition in patients undergoing lung cancer surgery. Method(s): This narrative review summarizes current evidence regarding perioperative immunonutrition in patients undergoing lung cancer surgery. Relevant studies evaluating perioperative immunonutrition, including formulations enriched with arginine, omega-3 fatty acids, glutamine, and nucleotides, were analyzed. Particular attention was given to clinical studies in thoracic surgical oncology, perioperative outcomes, inflammatory response, and current nutritional guideline recommendations. Result(s): Available evidence suggests that perioperative immunonutrition may improve nutritional and immunological status in patients undergoing lung cancer surgery. Clinical studies have reported reductions in postoperative complications, shorter chest drainage duration, improved nutritional indices, and decreased inflammatory markers in patients receiving immunonutritional support. Experimental and translational studies also indicate potential beneficial effects on immune cell function and inflammatory regulation. However, current thoracic-specific evidence remains limited because of small study populations, heterogeneity of nutritional protocols, and variability in study design. Conclusion(s): Perioperative immunonutrition appears to be a promising adjunct to comprehensive perioperative care in patients undergoing lung cancer surgery. Although preliminary evidence suggests potential benefits in postoperative recovery and nutritional optimization, its implementation should be individualized according to the patient's nutritional status, disease stage, and overall treatment strategy. As immunonutrition modulates metabolic and immune pathways that may also influence tumor biology, nutritional interventions should be evidence-based, carefully monitored, and integrated within multidisciplinary perioperative care to maximize clinical benefits while minimizing potential unintended effects. Further large, well-designed randomized clinical trials are needed to establish standardized protocols and clarify the role of immunonutrition in thoracic surgical oncology. Copyright © 2026 by the authors. <71> Accession Number 2046302973 Title AI-enabled digital wound monitoring after cardiac surgery: a randomised controlled feasibility, safety, and acceptability trial. Source Journal of Hospital Infection. 174 (pp 428-435), 2026. Date of Publication: 01 Aug 2026. Author Rochon M.; Tanner J.; Cariaga K.; Jurkiewicz J.; Beckhelling J.; Harris R.; Wilson K.; Dhoonmoon L.; Bolton S.; Bouttell J.; Davis D.; Shipolini A.; Magboo R.; Oezalp F.; Chester V. Institution (Rochon, Cariaga) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Tanner) University of Nottingham, Nottingham, United Kingdom (Jurkiewicz) Isla Care Ltd, London, United Kingdom (Beckhelling, Davis, Chester) Derby Clinical Trials Support Unit, Derby, United Kingdom (Harris) NIHR Research Support Service (RSS) Hub Delivered by the University of Leicester and Partners, Nottingham, United Kingdom (Wilson) Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom (Dhoonmoon) London North West University Healthcare, London, United Kingdom (Bolton, Bouttell) Centre for Healthcare Equipment and Technology Adoption (CHEATA), Nottingham, United Kingdom (Shipolini, Magboo) Barts Health NHS Trust, London, United Kingdom (Oezalp) The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom Publisher W.B. Saunders Ltd Abstract Background: Surgical site infection after cardiac surgery is a common cause of morbidity and unplanned healthcare use, with most infections developing after hospital discharge. Remote wound monitoring using smartphone technology and artificial intelligence (AI) may support earlier identification of complications. Aim(s): To evaluate the feasibility, acceptability, and safety of an AI-enabled digital wound monitoring platform plus usual care (Isla-AI) compared with usual care (UC) alone. Design, setting, and participants: This multi-centre, two-arm randomised controlled feasibility trial was conducted at two U.K. hospitals between August 2024 and January 2025. Adults undergoing cardiac surgery were randomised to receive Isla-AI or UC. The study was not powered to assess effectiveness. Result(s): 120 patients were randomised and participated (Isla-AI N = 62; UC N = 58). Feasibility targets were exceeded: 60% of eligible patients approached consented, 95% of Isla-AI participants submitted at least one image, and 92% completed the study. Ninety-eight percent of images were suitable for clinical assessment. Clinician agreement with AI priority flags was 87%. AI prioritisation performance was slightly better for patients with darker skin tones. More than half of participants required assistance to capture or submit wound images. Patient- and staff-acceptability of AI was largely favourable. Adverse and serious adverse event rates were similar across both groups. The proportion of patients accessing National Health Service (NHS) resources for wound-related problems and antibiotics was lower in the Isla-AI group. Conclusion(s): These findings support progression to a large, definitive multi-centre effectiveness trial, with further attention to equity, usability, and workflow integration. Trial registration: IRAS 338141; local project UHDB/2022/024. ISRCTN16900119. Clinicaltrials.gov: NCT06475703. Date registered: 20/06/2024. Copyright © 2026 The Author(s) <72> Accession Number 2047850913 Title Acute kidney injury after heart transplantation: A systematic review and meta-analysis. Source Transplantation Reviews. 40(4) (no pagination), 2026. Article Number: 101045. Date of Publication: 01 Dec 2026. Author Murad C.M.; Freitas A.P.S.; Cavalcanti H.T.G.; Zeferino S.P.; Marcondes-Braga F.G.; Galas F.R.B.G.; Bacal F. Institution (Murad, Zeferino, Marcondes-Braga, Galas, Bacal) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, Sao Paulo, Brazil (Murad, Bacal) Hospital Israelita Albert Einstein, SP, Sao Paulo, Brazil (Freitas, Cavalcanti) Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), SP, Sao Paulo, Brazil Publisher Elsevier Inc. Abstract Background: Acute kidney injury (AKI) after heart transplantation (HT) remains incompletely understood. This systematic review and meta-analysis aimed to estimate the pooled incidence of AKI and AKI requiring renal replacement therapy (RRT) after HT, assess associated mortality risks and identify characteristics associated with AKI requiring RRT. Method(s): A systematic literature search identified original studies reporting the incidence of AKI after HT using standardized definitions or reporting AKI requiring RRT. Meta-analyses were conducted using random-effects models. Result(s): Forty-eight studies covering 14,389 patients were included. The pooled incidence of AKI was 57.05% (95% CI: 49.51-64.28), and AKI requiring RRT occurred in 16.99% (95% CI: 13.58-21.04). Among patients with AKI, 30-day and one-year mortality were of 12.96% (95% CI: 9.80-16.94) and 18.51% (95% CI: 14.56-23.23) respectively. AKI was associated with an approximately threefold increase in 30-day (OR: 2.92; 95% CI: 2.02-4.22) and one-year mortality (OR: 3.07; 95% CI: 1.76-5.34). In patients requiring RRT, 30-day and one-year mortality were 26.47% (95% CI: 18.46-36.41) and 35.13% (95% CI: 28.78-42.06), respectively. AKI requiring RRT was associated with and increased 30-day mortality of more than twelvefold (OR: 12.11; 95% CI: 6.05-24.24) and one-year mortality of more than fivefold (OR: 5.40; 95% CI: 3.88-7.51) Characteristics associated with AKI requiring RRT included higher body mass index, elevated baseline creatinine, chronic kidney disease, perioperative extracorporeal membrane oxygenation support, and longer cardiopulmonary bypass time. Conclusion(s): AKI is highly prevalent after HT and is strongly associated with increased early and late mortality, particularly in patients requiring RRT. Copyright © 2026 Elsevier Inc. <73> Accession Number 2047761127 Title Angiotensin II Type 1 Receptor Expression and Anti-AT1R Antibodies in Heart Transplantation: A Systematic Review of Distinct but Related Non-HLA Immune Pathways. Source Journal of Clinical Medicine. 15(14) (no pagination), 2026. Article Number: 5419. Date of Publication: 01 Jul 2026. Author Gopalan R.; Mohamed M.R.; Mahar J.; Sunkara A.; Kalya A.; Hafez A.; Reinsmoen N.; Arabia F. Institution (Gopalan, Mahar, Sunkara, Kalya, Arabia) Cardiology Department, Banner University Medical Center, Phoenix, AZ, United States (Mohamed) Department of Medicine, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States (Hafez) Mayo Clinic, Department of Cardiovascular Medicine, Phoenix, AZ, United States (Reinsmoen) HLA and Immunogenetics Laboratory, Cedars-Sinai Medical Center, Los Angeles, CA, United States Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Heart transplantation (HT) remains the definitive therapy for end-stage heart failure, yet rejection and cardiac allograft vasculopathy (CAV) continue to limit long-term outcomes. Beyond donor-specific HLA antibodies, non-HLA antibodies, particularly anti-angiotensin II type 1 receptor antibodies (AT1R-Abs), have been implicated in allograft injury, but published findings are heterogeneous. Aim(s): The aim of this study is to systematically evaluate the evidence linking AT1R gene expression and anti-AT1R antibodies with key post-heart transplant outcomes. Method(s): We conducted a systematic review in accordance with PRISMA guidelines. Scopus, PubMed, Web of Science, and the Cochrane Library were searched (December 2025) for cohort and case-control studies evaluating AT1R gene expression and/or AT1R-Ab status in HT recipients and their association with post-transplant outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the NIH Quality Assessment Tool. Result(s): Twelve studies encompassing 951 recipients met the inclusion criteria. Five studies evaluated AT1R mRNA expression, reporting variable patterns: several observed reduced AT1R/AT2R transcription after transplantation without clear clinical correlation, whereas others associated higher donor or recipient AT1R expression with transplant coronary artery disease and recurrent rejection. AT1R-Ab prevalence varied widely and appeared to increase after mechanical circulatory support, with substantial seroconversion reported during LVAD support in initially antibody-negative patients. Associations between AT1R-Ab and acute cellular rejection and antibody-mediated rejection were inconsistent across studies, and survival findings were inconclusive; however, some reports linked elevated AT1R-Abs to poorer long-term freedom from adverse events. Evidence regarding CAV was mixed, with signals of increased vasculopathy risk in some cohorts but not others. Conclusion(s): Current evidence suggests a potential role for AT1R expression and AT1R-Abs in cardiac allograft dysfunction, including rejection phenotypes and vasculopathy. Larger prospective studies with harmonized testing strategies are needed to define clinically meaningful AT1R-Ab cutoffs and clarify their utility in risk stratification and targeted therapeutic trials. Copyright © 2026 by the authors. <74> Accession Number 2046150005 Title Postoperative pericardial effusion on routine echocardiography: A review of incidence, progression, and management: To dissolve or to be resolved. Source Netherlands Heart Journal. 34(7-8) (pp 254-264), 2026. Date of Publication: 01 Aug 2026. Author van Dinter S.; Wollersheim L.; Li W.; Donders R.; van Royen N.; Dieker H.-J.; Verhagen A. Institution (van Dinter, Li, Verhagen) Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, Netherlands (Wollersheim) Department of Cardiothoracic Surgery, Frisius Medical Center, Leeuwarden, Netherlands (Donders) Department for Health Evidence, Section Biostatistics, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands (van Royen, Dieker) Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands Publisher Bohn Stafleu van Loghum Abstract Postoperative pericardial effusion (PPE) is a common finding after cardiac surgery, with reported incidences ranging widely from 2% to 85%. While most effusions resolve spontaneously, a subset progresses to cardiac tamponade requiring urgent intervention. This systematic review evaluated the true incidence of PPE and PPE-related reinterventions based on routine echocardiographic screening, and explored temporal evolution, symptomatology, and perioperative risk factors. A comprehensive search of Embase, PubMed, and Web of Science through May 2025 identified 26 eligible studies including 8,495 patients. Data extraction followed PRISMA guidelines and quality assessment with the JBI checklist. Random-effects meta-analysis demonstrated a pooled PPE incidence of 36% (95% confidence interval (CI) 25-49%), whereas only 3% (95% CI 2-4%) required reintervention, ranging from 2% after CABG to 6% after aortic surgery. Large effusions (>2cm) were associated with a substantially higher likelihood of intervention (54% [14-90%]), although spontaneous resolution remained common. Preventive strategies such as posterior pericardiotomy and posterior chest tube placement significantly reduced both PPE incidence and reintervention rates. Despite these findings, interpretation is limited by substantial heterogeneity in study design, definitions, and follow-up protocols. Standardized definitions, structured echocardiographic follow-up, and prospective studies are needed to improve risk stratification and guide clinical decision-making. Copyright © The Author(s) 2026. <75> Accession Number 651904662 Title Coronary artery bypass grafting in women: optimizing operative outcomes. Source Current opinion in cardiology. (no pagination), 2026. Date of Publication: 06 Aug 2026. Author Constantakis S.; Lamarche-Silmser K.; Reed E.; Clarizia N.A.; Ruel M.; Sozzi F.B. Institution (Constantakis) Faculty of Medicine, University of Ottawa (Constantakis, Lamarche-Silmser) Division of Cardiac Surgery, Ottawa Heart Institute Research Corporation (Reed, Clarizia, Ruel) Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada (Sozzi) Department of Cardio-Thoracic-Vascular Diseases, IRCCS Ca 'Granda Foundation Maggiore Policlinico Hospital, Milan, Italy Abstract PURPOSE OF REVIEW: Women undergoing coronary artery bypass grafting (CABG) continue to experience worse perioperative and long-term outcomes than men despite advances in surgical techniques and perioperative care. This review summarizes contemporary evidence on sex-related differences in coronary artery disease (CAD), surgical outcomes, and secondary prevention. Gaps in the current evidence are identified and priorities for optimizing outcomes and informing sex-specific clinical practice are highlighted. RECENT FINDINGS: Women present with distinct patterns of CAD, including higher prevalence of microvascular dysfunction and nonobstructive disease, contributing to delayed diagnosis and referral for surgical revascularization. Women are less likely to receive guideline-recommended revascularization strategies, including multiple arterial grafting. Women also experience higher rates of graft failure, mortality, and stroke after CABG. Emerging observational evidence suggests that off-pump and minimally invasive CABG approaches may reduce the disparities in female patients, although randomized sex-specific data remains limited. Secondary prevention remains suboptimal, with persistent gaps in implementation of guideline-directed therapies. SUMMARY: Significant disparities persist across the continuum of care for women undergoing CABG, from diagnosis through long-term secondary prevention. Improving equitable implementation of evidence-based surgical strategies, increasing representation of women in randomized clinical trials, and developing sex-specific evidence are essential to optimize outcomes and inform future clinical guidelines. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <76> [Use Link to view the full text] Accession Number 651909119 Title Effect of Pre-operative Intravenous Crystalloid Bolus on Post-Induction Blood Pressure - a randomized blinded intervention trial. Source Anesthesiology. (no pagination), 2026. Date of Publication: 07 Aug 2026. Author Eichinger M.; Reiterer C.; Eichlseder M.; Pichler A.; Taschner A.; Horvath K.; Essber H.; Freidorfer D.; Adamowitsch N.; Hantakova N.; Heri A.; Heuschneider L.; Graf A.; Fraunschiel M.; Bornemann-Cimenti H.; Kabon B.; Fleischmann E.; Bayer A.; Hodl M.; Wild G.; Eckhardt A.; Reisinger A.C.; Kurz A. Institution (Eichinger, Eichlseder, Pichler, Essber, Freidorfer, Heri, Heuschneider, Bornemann-Cimenti, Bayer, Hodl, Wild, Eckhardt, Kurz) Division of Anesthesiology and Intensive Care Medicine 1, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria (Eichinger, Reiterer, Eichlseder, Pichler, Essber, Freidorfer, Kabon, Fleischmann, Kurz) Outcomes Research, TX, United States (Reiterer, Taschner, Horvath, Adamowitsch, Hantakova, Kabon, Fleischmann) Medical University of Vienna, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Vienna, Austria (Graf) Medical University of Vienna, Institute of Medical Statistics, Centre for Medical Data Science, Vienna, Austria (Fraunschiel) Medical University of Vienna, IT Services and Strategic Information Management, Vienna, Austria (Reisinger) Division of Intensive Care Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria Abstract BACKGROUND: Post-induction hypotension in major non-cardiac surgery is common and a modifiable risk factor for adverse outcomes. There is an ongoing debate whether pre-operative crystalloid fluid administration can reduce the incidence or severity of post-induction hypotension. This study aims to assess whether a pre-operative intravenous crystalloid bolus reduces post-induction hypotension in high-risk patients under general anesthesia. METHOD(S): This was a prospective, randomized, single-blind clinical trial conducted at two centers in Austria (Medical University of Graz, Medical University of Vienna). Adult patients aged 45 years and older with cardiovascular risk factors undergoing major surgery were enrolled and randomly assigned to receive a pre-operative crystalloid bolus within 60 +/- 15 minutes before anesthetic induction, or to receive standard care. The primary outcome was the time-weighted average mean arterial pressure of <65 mmHg within the first 20 minutes after induction or until surgical incision. RESULT(S): Of the 504 patients analyzed (247 in the intervention group and 257 in the control group), no statistically significant difference in median time-weighted average of the mean arterial pressure <65 mmHg was observed (Intervention group: 0.0 mmHg (IQR 0.0-0.56); Standard of Care group: 0.0 mmHg (IQR 0.0-0.84, p=0.368). CONCLUSION(S): In this blinded randomized clinical trial, administering a crystalloid fluid bolus within 60 minutes before surgery did not significantly reduce the time-weighted average of a mean arterial pressure less than 65 mmHg compared to standard care in patients with cardiovascular risk factors undergoing major non-cardiac surgery. Our study suggests that administering crystalloids before surgery does not prevent post-induction hypotension. <77> Accession Number 651911249 Title De-escalation of antiplatelet therapy to evaluate platelet reactivity and clinical outcomes after coronary stenting in patients at high bleeding risk and recent acute coronary syndrome: Rationale and design of the DESC-HBR trial. Source Cardiovascular revascularization medicine : including molecular interventions. (no pagination), 2026. Date of Publication: 04 Aug 2026. Author Costa F.; Vizzari G.; Zecchino S.; Galli M.; Montalto C.; Carciotto G.; Quadri G.; Vergallo R.; Castriota F.; Soraci E.; Magliarditi A.; Giudice S.L.; Iuvara G.; Munafo A.; Giannino F.; Pallante F.; Franzino M.; Teresi L.; Piccolo R.; Varbella F.; Musumeci G.; Di Bella G.; Ortega-Paz L.; Angiolillo D.J.; Micari A. Institution (Costa) Cardiology Department, University Hospital Virgen de la Victoria, Instituto de Investigacion Biomedica de Malaga (IBIMA), 29010 Malaga, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28220, Madrid, Spain; Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, 98122, Messina, Italy (Vizzari, Carciotto, Giudice, Iuvara, Giannino, Pallante, Di Bella, Micari) Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Messina, Italy (Zecchino, Varbella) Division of Cardiology, Interventional Unit-Infermi Rivoli Hospital, Turin, Italy; San Luigi Gonzaga University Hospital, Turin, Italy (Galli) Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, 04100, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola 48033, Italy (Montalto, Munafo) De Gasperis Cardio Center, Interventional Cardiology Unit, Niguarda Hospital, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (Quadri, Musumeci) Interventional Cardiology Unit, A.O. Ordine Mauriziano, Turin, Italy (Vergallo) Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Azienda Ospedaliera Metropolitana, Largo R. Benzi, 10, Genoa, 16132, Italy; Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa 16132, Italy (Castriota) Maria Cecilia Hospital, GVM Care & Research, Italy (Soraci, Magliarditi) U.O.S. Emodinamica, Department of Medicine, Ospedale Barone Romeo di Patti, Messina, Italy (Franzino) Cardiology Department, Sant'Andrea Hospital, Vercelli, Italy (Teresi) Cardiovascular Department, ARNAS Ospedale Civico Di Cristina Benfratelli, Palermo, Italy (Piccolo) Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy (Ortega-Paz, Angiolillo) Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, United States Abstract BACKGROUND: Patients at high bleeding risk (HBR) presenting with acute coronary syndrome (ACS) and treated with percutaneous coronary intervention (PCI) have competing hazards of ischemic and bleeding events. In unselected ACS populations, trials of unguided de-escalation of P2Y12 inhibition reduce bleeding without excess ischemia; however, HBR patients were largely underrepresented in these studies. Comparative evidence across multiple de-escalation regimens in this vulnerable cohort is currently lacking. STUDY DESIGN: DESC-HBR is a prospective, multicenter, randomized, open-label trial with blinded endpoint adjudication enrolling 200 HBR patients (PRECISE-DAPT >=25 or ARC-HBR criteria) at 30 +/- 7 days after ACS-PCI. Following one month of dual antiplatelet therapy (DAPT) with prasugrel 10 mg once daily or ticagrelor 90 mg twice daily, on a background of aspirin 100 mg, patients are randomized (1: 1:1:1) to clopidogrel 75 mg once daily, prasugrel 5 mg once daily, ticagrelor 60 mg twice daily, or continuation of full-dose potent therapy. The primary endpoint is the proportion of patients achieving optimal platelet reactivity (VerifyNow PRU 85-208) at 14 +/- 2 days post-randomization, 2-h after maintenance dose. Key secondary outcomes include BARC bleeding, net adverse clinical events, quality of life and adherence. Pharmacodynamic profiling incorporates VerifyNow and Total Thrombus Formation Analysis (T-TAS). A total sample of 200 patients allows >80% power to detect superiority of each de-escalation arm versus control (alpha = 0.017). CONCLUSION(S): DESC-HBR is the first randomized trial directly comparing multiple P2Y12 inhibitor de-escalation strategies in HBR patients post-ACS. By integrating pharmacodynamic, clinical, and patient-reported outcomes, it will provide information to guide individualized antiplatelet strategies balancing ischemic protection and bleeding mitigation in HBR patients. CLINICAL TRIAL REGISTRATION UNIQUE IDENTIFIER: NCT05903976, EudraCT 2023-000029-10. Copyright © 2026. Published by Elsevier Inc. <78> Accession Number 651913164 Title A Systematic Review and Meta-Analysis of the Evidence for Overuse of Vascular Diagnostic Imaging Tests and Procedures in High-Income Countries. Source Annals of vascular surgery. (no pagination), 2026. Date of Publication: 07 Aug 2026. Author Kirkham A.M.; Sypes E.E.; Xu C.C.; Nagpal S.K.; Niven D.J.; Mamas M.A.; McIsaac D.I.; Shorr R.; Graham I.D.; Stelfox H.T.; Grimshaw J.M.; Roberts D.J. Institution (Kirkham) Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Methodological and Implementation Research Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada (Sypes, Xu) Department of Medicine, University of Ottawa, Ottawa, ON, Canada (Nagpal) Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada (Niven) Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada (Mamas) Keele Cardiovascular Research Group, School of Medicine, Keele University, Keele, United Kingdom (McIsaac) School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Methodological and Implementation Research Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada (Shorr) Learning Services, Ottawa Hospital, Ottawa, ON, Canada (Graham) School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Methodological and Implementation Research Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada (Stelfox) Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Grimshaw) School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Methodological and Implementation Research Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (Roberts) Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Methodological and Implementation Research Program, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Clinical Science and Translational Medicine Graduate Program, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Abstract BACKGROUND: We sought to synthesize and evaluate evidence for the overuse of vascular diagnostic imaging tests and procedures in high-income countries as they may be overused in asymptomatic, minimally symptomatic, and/or high-risk patients with limited life expectancy. METHOD(S): After protocol registration (CRD42021257490), we searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1st, 2010-May 14th, 2025) for English-language studies that reported the incidence/prevalence of overuse of vascular diagnostic imaging tests and/or procedures in high-income countries; adjusted predictors of overuse; or adjusted associations between overuse and outcomes. Three investigators independently reviewed titles/abstracts and full-texts, extracted data, and assessed risk of bias. Data were pooled using random-effects models. GRADE was used to assess estimate certainty. RESULT(S): Among 11,748 citations, we included 14 studies (n=16,706,904 patients) that examined two unique vascular diagnostic imaging tests and eight unique procedures. The most frequently overused vascular imaging tests included carotid (pooled-cumulative incidence=19%; 95% confidence interval [CI]=10-30%; moderate-certainty) and venous duplex (cumulative incidence=46%; 95% CI=43-48%; moderate-certainty). The most frequently overused vascular procedures included renal artery angioplasty (pooled-cumulative incidence=92%; 95% CI=85-97%; low-certainty) and inferior vena cava filter placement (pooled-cumulative incidence=72%; 95% CI=0-100%; low-certainty). Adjusted-risk factors for carotid duplex overuse included increasing age and higher median neighborhood income quartile. Adjusted risk factors for overuse of endovascular intervention for claudication included ever smoking and end-stage renal disease. Overuse was associated with increased healthcare costs in all studies examining this outcome. CONCLUSION(S): Overuse of vascular diagnostic imaging tests and procedures may be common in high-income countries and associated with increased healthcare costs. However, because the included studies had important limitations, our findings should be confirmed before methods to reduce the above overuse are developed. Copyright © 2026 Elsevier Inc. All rights reserved. <79> Accession Number 651908460 Title Direct oral anticoagulant dose vs dual antiplatelet therapy after left atrial appendage closure in patients with nonvalvular atrial fibrillation: a systematic review and meta-analysis. Source Journal of thrombosis and thrombolysis. (no pagination), 2026. Date of Publication: 07 Aug 2026. Author Alam U.; Ahmed A.U.; Javed J.; Khan A.; Ansab M.; Khan I.; Rafi S.; Mushahid Z.; Nawaz B.; Asif M.A.; Lohana R.; Khan S.N.; Moiz A.; Bibi F.; Aslam B. Institution (Alam) Khyber Medical College, Peshawar, Pakistan (Ahmed, Rafi) Punjab Medical College, Faisalabad Medical University, Faisalabad, Pakistan (Javed) Jinnah Sindh Medical University, Karachi, Pakistan (Khan) Lady Reading Hospital, Peshawar/Nowshera Medical College, Pakistan (Ansab) Services Institute of Medical Sciences, Lahore, Pakistan (Khan) FMH College of Medicine and Dentistry, Lahore, Pakistan (Mushahid, Lohana) Dow University of Health Sciences, Karachi, Sindh, Pakistan (Nawaz) Islamic International Medical College, Rawalpindi, Pakistan (Asif) University of Western Ontario, London, Canada (Khan) Azad Jammu and Kashmir Medical College, Muzaffarabad, Pakistan (Moiz) Bacha Khan Medical College, Mardan, Pakistan (Bibi) Jinnah Medical and Dental College, Karachi, Pakistan (Aslam) University of Lahore, Lahore, Pakistan Abstract Left atrial appendage closure (LAAC) is increasingly used in patients with non-valvular atrial fibrillation (NVAF) who are at high risk of bleeding. However, the optimal post-procedural antithrombotic strategy remains uncertain. This meta-analysis compares the efficacy and safety of direct oral anticoagulants (DOACs) versus dual antiplatelet therapy (DAPT) following LAAC. A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. PubMed, Embase, and Cochrane were searched from inception to November 2025 for randomized controlled trials and cohort studies comparing DOACs with DAPT after LAAC in NVAF patients. Outcomes included all-cause mortality, cardiac mortality, stroke, major bleeding, device-related thrombosis (DRT), and thromboembolic events. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models as appropriate. Seven studies (3 RCTs and 4 observational studies) comprising 2,103 patients (1,003 DOAC; 1,096 DAPT) were included. DOAC therapy significantly reduced all-cause mortality (RR = 0.55, 95% CI 0.34-0.89), major bleeding (RR = 0.55, 95% CI 0.37-0.81), and device-related thrombosis (RR = 0.46, 95% CI 0.24-0.91) compared with DAPT. No statistically significant differences were observed for stroke, cardiac mortality, or overall thromboembolic events, although effect estimates consistently favored DOACs. Thromboembolic events associated with major bleeding were markedly lower with DOACs (RR = 0.14, 95% CI 0.05-0.36). However, sensitivity analyses restricted to randomized controlled trials did not demonstrate statistically significant benefits for all-cause mortality, major bleeding, or device-related thrombosis. Therefore, the observed overall benefit appeared to be mainly driven by observational studies, and these findings should be interpreted cautiously. DOAC therapy after LAAC may be associated with a favorable clinical profile compared with DAPT, with significant reductions in all-cause mortality, major bleeding, and device-related thrombosis in the overall pooled analysis. However, these benefits were not confirmed in sensitivity analyses restricted to randomized controlled trials and appeared to be primarily driven by observational studies. Therefore, these findings should be interpreted cautiously and should not be used to support a definitive preference for DOACs over DAPT without further adequately powered randomized evidence. Copyright © 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. <80> Accession Number 651910534 Title Early versus delayed percutaneous coronary revascularization in patients with concomitant sepsis and non-ST elevation myocardial infarction. Source Cardiovascular revascularization medicine : including molecular interventions. (no pagination), 2026. Date of Publication: 04 Aug 2026. Author Golzarian H.; Tabares D.; Kalidas A.; Hamideh M.; Shah A.; Janjua A.; Tatapudi S.; Elbey M.; Khan Z.; Niknam N.; Patel D.; Almahmoud M.; Mgbemena O.N. Institution (Golzarian, Elbey, Khan, Niknam, Almahmoud) Department of Cardiovascular Disease, HCA Houston Healthcare - Kingwood/University of Houston College of Medicine, Houston, TX, United States (Tabares, Kalidas, Hamideh, Janjua, Tatapudi, Patel) Department of Internal Medicine, HCA Houston Healthcare - Kingwood/University of Houston College of Medicine, Houston, TX, United States (Shah) Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX, United States (Mgbemena) Department of Cardiovascular Disease, HCA Houston Healthcare - Kingwood/University of Houston College of Medicine, Houston, TX, United States Abstract BACKGROUND: The prognosis of patients with concomitant sepsis and severe coronary artery disease (CAD) who develop acute myocardial infarction (AMI) is poor. While percutaneous coronary intervention (PCI) can improve survival in AMI during and post sepsis, the decision is complex due to high mortality rates and increased risk of complications. The optimal timing of intervention for these patients, once clinically indicated, remains controversial, with specific recommendations for revascularization lacking in current guidelines. This retrospective analysis investigates and compares clinical outcomes of early PCI strategy (<72 h from diagnosis of MI) versus delayed PCI strategy (>=72 h) in patients who were hospitalized with sepsis and concomitantly developed AMI. METHOD(S): This multicenter retrospective study included 217 hospitalized patients with sepsis and AMI who underwent PCI after sepsis treatment, from January 2016 to May 2024. Patients with ST-elevation myocardial infarctions and non-obstructive CAD were excluded. Of these, 75 patients received early PCI, and 142 underwent delayed PCI. We analyzed in-hospital all-cause mortality, major cardiovascular events, progression to shock, length of stay, and readmission rates at 45 days and 1 year. RESULT(S): The mean peak serum troponin I level in the early revascularization cohort was higher (13.1 ng/mL vs. 7.8 ng/mL; P < 0.01). Baseline characteristics were otherwise similar. There was significantly higher all-cause mortality (16% vs. 3.5%; P < 0.01) associated with early PCI in patients with concomitant sepsis. However, a delayed invasive strategy was associated with a 28% longer length of stay (14.6 days vs. 11.4 days) and a greater likelihood of progression to shock (RR 1.41). There were no major differences in 45-day and 1-year readmission rates between the cohorts. CONCLUSION(S): In patients with non-ST elevation myocardial infarction in the context of sepsis, early PCI was associated with higher all-cause mortality compared to delayed PCI. The delayed PCI cohort had longer lengths of stay; however, these findings may be attributable to the lower mortality in this group. This study suggests that in select patients with concomitant MI and sepsis, it may not be unreasonable to prioritize treating the sepsis prior to attempting revascularization. However, major limitations exist in the study and a randomized controlled trial is warranted to further investigate these findings. Copyright © 2026 Elsevier Inc. All rights reserved. <81> Accession Number 651908845 Title Effect of a Nurse Practitioner-Led Bundled Care on Postoperative Recovery in Cardiac Surgery Patients: A Randomized Controlled Trial. Source Research in nursing & health. (no pagination), 2026. Date of Publication: 07 Aug 2026. Author Paul D.; Kanagaraj P.; Pappaiya P. Institution (Paul) Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India (Kanagaraj) Department of Nursing, College of Applied Medical Sciences, University of Bisha, Saudi Arabia (Pappaiya) Narayana Hrudayalaya College of Nursing, Narayana Health City, Bangalore, Karnataka, India Abstract Postoperative delirium, pain, and sleep disturbances prolong recovery after cardiac surgery. Evidence for multicomponent, nurse practitioner-led interventions is limited, especially in resource-constrained settings. This study evaluated their effect on delirium, pain, sleep quality, and hospital stay. In a single-blinded, post-test only RCT at a tertiary cardiac hospital in India, 100 adults undergoing elective coronary artery bypass graft, mitral valve replacement, or aortic valve replacement were randomized to nurse practitioner-led bundled care (n = 50) or routine care (n = 50). The intervention included preoperative orientation, early mobilization, cognitive reorientation, family engagement, relaxation, and sleep promotion. Outcomes-delirium (CAM-ICU), pain (VAS), and sleep quality (RCSQ) and length of stay were analyzed using chi-square/Fisher's exact tests, repeated-measures ANOVA, GLM, and Mann-Whitney U tests. All 100 participants completed the study (n = 50 per group) with comparable baseline demographics and clinical profiles. The intervention group showed significantly lower postoperative delirium (Day 2: 6% vs. 32%, p = 0.001; GLM group x time interaction p = 0.009), reduced pain scores across Days 1-3 (F1,98 = 72.18, p < 0.001), and improved sleep quality across Days 2-4 (F1,98 = 233.35, p < 0.001; group x time interaction p < 0.001) compared with controls. Recovery was faster, with shorter ICU stay (median 3 vs. 3-4 days, p = 0.006), ward stay (5 vs. 6 days, p = 0.002), and total hospital stay (8 vs. 10 days, p < 0.001). Nurse practitioner-led bundled care reduces delirium, improves pain and sleep, and shortens recovery, providing a feasible, low-cost approach for cardiac surgery patients. Trial Registration: CTRI/2023/06/054180 Dated 6/19/2023. Copyright © 2026 Wiley Periodicals LLC. <82> Accession Number 2048024980 Title Comparison of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with prior chest radiation: a systematic review and meta-analysis of 11,572 patients. Source Future Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Ntoumaziou A.; Xenos D.; Sagris M.; Chatziioannou A.; Krokidis M.; Tzoumas A. Institution (Ntoumaziou) Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States (Xenos) Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States (Sagris) 1st Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Chatziioannou, Krokidis) 1st Department of Radiology, School of Medicine, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece (Tzoumas) Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, United States Publisher Taylor and Francis Ltd. Abstract Background: Cardiac complications from prior oncologic therapies and radiation are being increasingly recognized and patients with symptomatic severe aortic valve disease and a history of prior chest radiation represent a high-risk group in which the best management approach has not yet been established. Method(s): A systematic search of PubMed, Scopus, and Cochrane identified studies comparing outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients with a history of prior chest radiation. Result(s): Nine studies comprising 11,572 patients were included in this meta-analysis. There were no significant differences between TAVR and SAVR in postoperative mortality (OR: 0.70; 95% CI 0.44-1.13, p = 0.147) or 1-year mortality (OR: 1.04; 95% CI 0.71-1.53, p = 0.84). TAVR was associated with significantly lower rate of postoperative major bleeding (OR: 0.38; 95%CI: 0.25-0.57, p < 0.01), acute kidney injury (AKI) (OR: 0.51; 95%CI: 0.27-0.97, p: 0.04), postoperative atrial fibrillation (OR: 0.20 95%CI: 0.16-0.24, p: <0.01) and respiratory complications (OR: 0.39; 95%CI: 0.24-0.63, p < 0.01) compared to SAVR. The incidence of postoperative permanent pacemaker insertion (OR: 2.27; 95%CI: 1.79-2.87, p < 0.01) and at least moderate aortic regurgitation (OR: 4.44 (95%CI: 2.93-6.73), p < 0.01) were higher among the patients undergoing TAVR. Conclusion(s): TAVR in patients with a history of prior radiation was associated with a lower risk for postoperative complications albeit at an increased risk for pacemaker insertion in the postoperative period compared to SAVR. Copyright © 2026 Informa UK Limited, trading as Taylor & Francis Group. <83> Accession Number 651913212 Title HPS-4/TIMI 65/ORION-4: A double-blind randomized placebo-controlled trial assessing the effects of inclisiran on clinical outcomes among people with atherosclerotic cardiovascular disease: Trial design, recruitment, and baseline characteristics. Source American heart journal. (pp 107546), 2026. Date of Publication: 07 Aug 2026. Author Mafham M.; Zayed M.; Collins R.; Sabatine M.; Armitage J.; Brittain D.; da Costa B.; Chen F.; Goonasekera M.; Hill M.; Hopewell J.C.; Landray M.; Lay M.; Lesogor A.; Maggioni A.; Morrow D.; Nunn M.; O'Donoghue M.; Ray K.K.; Rizkala A.; Schwartz G.; Stevens W.; Wallendszus K.; Wright R.S.; Wijesurendra R.; Wincott E.; Preiss D.; Bowman L. Institution (Mafham, Zayed, Collins, Armitage, da Costa, Chen, Goonasekera, Hill, Hopewell, Landray, Lay, Nunn, Stevens, Wallendszus, Wijesurendra, Wincott, Preiss, Bowman) Clinical Trial Service Unit and Epidemiological Studies Unit, Oxford Population Health, University of Oxford, Oxford, United Kingdom (Sabatine, Morrow, O'Donoghue) Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, United States (Brittain, Lesogor) Novartis Pharma AG, Basel, Switzerland (Maggioni) National Association of Hospital Cardiologists Research Center, Florence, United States (Ray) Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, United Kingdom (Rizkala) Novartis, East Hanover, NJ, United States (Schwartz) Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States (Wright) Division of Preventive Cardiology and the Department of Cardiology, Mayo Clinic, Rochester, MN, United States Abstract BACKGROUND: Despite widespread statin use, atherosclerotic cardiovascular disease remains a leading cause of morbidity and mortality worldwide. Monoclonal antibodies targeting circulating proprotein convertase subtilisin-kexin type 9 (PCSK9) substantially reduce low-density lipoprotein cholesterol (LDL-C) levels and cardiovascular events. However, the requirement for self-administration every 2-4 weeks may limit adherence to treatment. Inclisiran, a first-in-class small interfering ribonucleic acid (siRNA) therapy targeting hepatic PCSK9 production, has several potential advantages over the anti-PCSK9 monoclonal antibodies, principally longer duration of action. To date, however, the efficacy and safety of inclisiran have not been proven in a cardiovascular outcomes trial. METHOD(S): The ORION-4 study is the first large-scale clinical outcomes trial of an siRNA therapy, aiming to assess the efficacy and safety of inclisiran among participants with pre-existing atherosclerotic cardiovascular disease. The primary assessment is an intention-to-treat comparison of the effect of inclisiran sodium 300 mg (equivalent to 284 mg inclisiran), given by subcutaneous injection at randomization, at approximately 3 months and then approximately every 6 months thereafter, on major adverse cardiovascular events (MACE), defined as the composite of coronary death, myocardial infarction, fatal or non-fatal ischaemic stroke, or urgent coronary revascularization. Participants will be followed until the median time since randomization is at least 5 years and at least 1700 participants have a recorded adjudicated MACE. With a planned sample size of ~15,000 participants, ORION-4 was designed to have >99% power to detect a relative reduction in the primary outcome of about one quarter, while also providing an opportunity to assess efficacy in different subgroups as well as on secondary outcomes of interest. RESULT(S): Between 2019 and 2023 a total of 16,124 participants were randomized in the UK and the US. The mean (SD) age was 70 (8.1) years and 30% were female. At baseline, 78% had a history of coronary heart disease, 22% of ischaemic stroke, 15% of revascularization for peripheral arterial disease, and 23% had diabetes mellitus. 85% were on statin therapy (53% high intensity statin, 29% moderate and 3% low intensity statins). Overall, baseline mean (SD) LDL-C was 96 (32) mg/dL, and was similar among participants on high- and moderate/low-intensity statin regimens (87 (27) mg/dL and 93 (26) mg/dL respectively), with higher levels in those receiving no statin therapy (133 (33) mg/dL). Follow-up will complete during 2026 and results will be available in early 2027. INTERPRETATION: Inclisiran potentially offers a scalable lipid-lowering treatment, either alone or in combination with other agents. ORION-4 will evaluate the clinical efficacy of inclisiran, and provide a robust assessment of the safety of prolonged use of an siRNA therapeutic. Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved. <84> Accession Number 651907285 Title The long-term impact of a teleprehabilitation program on modifiable risk factors and quality of life after cardiac surgery. Source European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. (no pagination), 2026. Date of Publication: 06 Aug 2026. Author van Susante L.; Janssen L.; Bidar E.; Slooter G.; Sardari Nia P. Institution (van Susante, Bidar, Sardari Nia) Department of Cardiothoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, Netherlands (van Susante, Janssen, Slooter) Department of Surgery, Maxima Medical Center, De Run 4600, Veldhoven, Netherlands (Bidar, Sardari Nia) Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands Abstract OBJECTIVES: To assess the long-term effects of teleprehabilitation on modifiable risk factors and quality of life up to one year following elective cardiac surgery. METHOD(S): This secondary analysis of the Digital Cardiac Counselling trial, a randomized controlled trial, compared multimodal teleprehabilitation with standard care in patients undergoing elective cardiac surgery. The teleprehabilitation program targeted physical fitness, inspiratory muscle training, psychological support, nutritional optimization, and smoking cessation. Outcomes included trajectories of modifiable risk factors and quality of life measured preoperatively and at 3, 6, and 12 months postoperatively. Generalized linear mixed models assessed differences over time between groups, with exploratory post hoc analyses for individual time points. RESULT(S): Both groups showed postoperative reductions in all assessed modifiable risk factors and improvements in quality of life over time (p < 0.001), except for nutritional optimization (p = 0.173). Teleprehabilitation was associated with more favorable trajectories for smoking behavior (p = 0.045) and nutritional risk (p = 0.011), with consistently lower incidences throughout follow-up. Smoking prevalence remained significantly lower in the teleprehabilitation group at all-time points (p < 0.05), while malnutrition prevalence was lower at three months postoperatively (p = 0.012). Quality-of-life scores were consistently higher in the teleprehabilitation group throughout follow-up (p = 0.002). CONCLUSION(S): Teleprehabilitation in cardiac surgery patients not only reduces postoperative complications, but may also provide additional long-term benefits, particularly in smoking cessation, nutritional optimization, and quality of life. These findings support teleprehabilitation as a valuable addition to standard preoperative care, with possible sustained benefits on long-term lifestyle and quality of life. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. <85> Accession Number 2038475369 Title Heterotopic Caval Valve Implantation for Severe Tricuspid Regurgitation: A Systematic Review and Recommendations for Implantation and Futility. Source Reviews in Cardiovascular Medicine. 27(7) (no pagination), 2026. Article Number: 51423. Date of Publication: 01 Jul 2026. Author Corrado D.; Nenna A.; Jawabra M.; Ferraresi B.; Dominici C.; Casali G.; Toriello F.; Carugo S.; Chello M.; Lusini M. Institution (Corrado, Jawabra, Ferraresi, Chello, Lusini) Cardiac Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy (Nenna, Dominici, Toriello, Carugo) Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Casali) Cardiac Surgery, Azienda Ospedaliero Universitaria Maggiore della Carita di Novara, Novara, Italy (Carugo) Department of Clinical Sciences and Community Health, Universita degli Studi di Milano, Milan, Italy Publisher IMR Press Limited Abstract Background: Heterotopic transcatheter caval valve implantation (CAVI) has emerged as a palliative yet promising therapeutic strategy for treating severe tricuspid regurgitation (TR), which aims to reduce systemic venous congestion by implanting bioprosthetic valves in the venae cavae rather than in the native tricuspid annulus. However, despite encouraging procedural success, clinical improvement and survival remain highly variable. Method(s): A systematic review of published registries and case series was performed, focusing on the outcomes, procedural success, mortality, and safety of CAVI. Data were extracted from multicenter registries and observational series describing the use of transcatheter stented bioprosthesis or bioprosthesis alone. Result(s): Across published cohorts and registries, procedural success rates ranged from 90% to 100%, with 30-day mortality ranging from 5% to 25%. The TRICUS EURO study, which included 35 patients across 12 European centers, demonstrated significant improvements in New York Heart Association (NYHA) functional class and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at 6 months, with minimal device-related complications and adverse events. The ongoing TRICAV-II pivotal trial (NCT06458907) and EuroTR registry (NCT06307262) are expected to provide larger real-world datasets. Smaller case series and individual reports, typically involving <=10 patients, confirmed feasibility and symptomatic benefits, particularly reductions in peripheral edema and ascites. However, long-term outcome data remain limited. This study highlights right ventricle (RV) dysfunction, severe pulmonary hypertension, advanced end-organ failure, and clinical frailty as major determinants of unfavorable outcomes. Conclusion(s): Heterotopic CAVI represents a viable alternative for high-risk patients with severe TR, offering symptomatic improvement and reduced venous congestion when conventional surgery or orthotopic repair is not feasible. However, current evidence is derived primarily from non-randomized studies and limited registries. Ongoing prospective registries and pivotal trials are crucial for defining patient selection, procedural optimization, and long-term survival benefit. Early intervention and multidisciplinary patient selection appear crucial for avoiding futile procedures and identifying patients who may derive true symptomatic and prognostic benefit from CAVI. Copyright © 2026 The Author(s). <86> Accession Number 651897504 Title Intracardiac versus Transesophageal Echocardiography in patients undergoing Ablation for Atrial fibrillation: A systematic review and meta-analysis. Source European heart journal. Cardiovascular Imaging. (no pagination), 2026. Date of Publication: 05 Aug 2026. Author Dandamudi M.; Hakkeem B.; Pinilla J.; Samad N.S.; de Lucena L.A.; Humayun Z.; Khairallah T.T.; Stabile F. Institution (Dandamudi) Charleston Area Medical Center (CAMC), Charleston, WV, United States (Hakkeem) Government Medical College Kozhikode, Kerala, India (Pinilla) CES University School of Medicine. Medellin, Colombia (Samad) New York University CAS XUSOM, Woodbury, NY, United States (de Lucena) Federal University of Rio Grande do Norte, Natal, RN, Brazil (Humayun) University of Missouri - Kansas City, MO, United States (Khairallah) University of Georgia, Tbilisi, Georgia (Stabile) Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy Abstract BACKGROUND: Intracardiac echocardiography (ICE) is a valuable, real-time imaging tool in structural cardiology and electrophysiology, performed without general anesthesia. However, its safety compared to transesophageal echocardiography (TEE) remains unclear. OBJECTIVE(S): To conduct a meta-analysis evaluating outcomes of catheter ablation for atrial fibrillation (AF) with or without left atrial appendage closure (LAAC) guided by TEE versus ICE. METHOD(S): Databases were searched for studies comparing ICE with TEE guidance during AF ablation +/- LAAC. Outcomes were pooled using the Inverse-Variance (IV) random-effects model in R, with risk ratios (RRs) for dichotomous variables and mean or standardized mean differences (MD or SMD) for continuous variables, and 95% confidence intervals (CIs) reported. RESULT(S): We included 8 studies involving 7,671 patients, of whom 3,903 (50.9%) underwent procedures with ICE guidance. There were no significant differences between groups in cardiac tamponade risk (RR 0.86; 95% CI 0.44-1.66; p = 0.39), stroke or TIA (RR 1.00; 95% CI 0.39-2.55; p = 0.57), vascular complications (RR 0.80; 95% CI 0.51-1.25; p = 0.37). ICE was associated with lower pre-procedure LAA thrombus detection (RR 0.32; 95% CI 0.11-0.94; p = 0.04), radiation dose (SMD -0.47; 95% CI -0.90 to -0.04; p = 0.03), and fluoroscopy time (-4.25 mins; 95% CI -6.01 to -2.49; p < 0.01) but the procedure duration was significantly lower only in combined AF ablation + LAAC (MD -19.56 mins; 95% CI -24.15 to -14.97; p < 0.01). CONCLUSION(S): This meta-analysis indicates that ICE is a safe, effective, and non-inferior alternative to TEE for patients undergoing AF ablation +/- LAAC. However, TEE remains an effective tool for detecting LAA thrombus. 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 <87> Accession Number 2038464461 Title Systematic Review When Time Matters in Aortic Stenosis: Can Transcatheter Aortic Valve Replacement Make a Difference in Non-Elective Cases?. Source Reviews in Cardiovascular Medicine. 27(7) (no pagination), 2026. Article Number: 49738. Date of Publication: 01 Jul 2026. Author Etchegoyen C.V.; Chollet L.; Ahmed M.; Bilauca C.; Farina J.M.; Pereyra M.; Scalia I.G.; Razaghi M.; Abdelfattah F.E.; Awad K.; Hafez A.; Ahmed S.; Ayoub C.; Alsidawi S.; Sweeney J.P.; Lester S.J.; Lee K.S.; Fortuin D.; Sell-Dottin K.A.; Arsanjani R. Institution (Etchegoyen, Ahmed, Bilauca, Farina, Sell-Dottin) Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, AZ, United States (Chollet, Farina, Pereyra, Scalia, Razaghi, Abdelfattah, Awad, Hafez, Ahmed, Ayoub, Alsidawi, Sweeney, Lester, Lee, Fortuin, Arsanjani) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States Publisher IMR Press Limited Abstract Background: The development of symptoms or left ventricular dysfunction in severe aortic stenosis (AS) is associated with high morbidity and mortality. While elective transcatheter aortic valve replacement (TAVR) is supported by robust randomized evidence, data on TAVR performed in non-elective settings (urgent, emergent, or salvage) remain limited and heterogeneous. In these settings, outcomes may be influenced more by baseline clinical severity than by procedural factors. This study aimed to systematically evaluate the safety and effectiveness of non-elective TAVR and to compare the associated outcomes with those of elective TAVR. Method(s): This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and registered with PROSPERO. The PubMed, Embase, and Scopus databases were searched for studies published after 2002 evaluating urgent, emergent, or salvage TAVR in adult patients with severe AS. Eligible studies were required to include elective TAVR as a comparator. Outcomes included mortality and major procedural complications. Prespecified era-based analyses and sensitivity analyses excluding studies at critical risk of bias were performed. Risk of bias was assessed using the ROBINS-I tool. Result(s): A total of 17 observational studies published between 2015 and 2025 were included, comprising 215,141 patients. Compared with elective patients, those undergoing non-elective TAVR had more advanced heart failure, higher NYHA class, greater comorbidity burden, and higher surgical risk scores, whereas baseline echocardiographic severity of AS was similar. Pooled outcomes for non-elective TAVR showed in-hospital, 30-day, and 1-year mortality rates of 5.1%, 12.4%, and 26.7%, respectively. Non-elective TAVR was associated with higher mortality at all time points compared with elective procedures; meanwhile, rates of stroke, vascular complications, and permanent pacemaker implantation were similar, while major bleeding and acute kidney injury were more frequent. Era-based analyses showed a stable relative mortality risk over time. Conclusion(s): Although non-elective TAVR is associated with worse outcomes than elective procedures, these differences appear to be largely driven by baseline clinical severity rather than by the transcatheter intervention. In unstable patients with severe AS, non-elective TAVR remains the most effective definitive treatment option compared with balloon aortic valvuloplasty or conservative management. The PROSPERO Registration: CRD420251239620, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251239620. Copyright © 2026 The Author(s). <88> Accession Number 651902430 Title Machine-Learning Versus Traditional Scores for Predicting Outcomes After Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-Analysis. Source Surgical innovation. (pp 15533506261468192), 2026. Date of Publication: 05 Aug 2026. Author Gupta A.K.; Zaka A.; Tyagi D.; Mutahar D.; Parvez R.; Muston B.; Farag M.; Lombardo A.; Eranki A.; Wilson-Smith A.; Song G.; Stretton B.; Kovoor J.G.; Bacchi S.; Ramponi F.; Chan J.C.Y.; Zaman S.; Chow C.; Kovoor P.; Bennetts J.S.; Maddern G.J. Institution (Gupta, Stretton, Kovoor, Bacchi, Maddern) Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia (Zaka, Mutahar) Department of Medicine, Gold Coast University Hospital, Southport, QLD, Australia (Tyagi) School of Medicine, University of Newcastle, Callaghan, NSW, Australia (Parvez) School of Medicine, Bond University, QLD, Australia (Muston, Wilson-Smith) Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, NSW, Australia (Farag, Lombardo) Department of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia (Eranki) Department of Cardiothoracic Surgery, Royal Hobart Hospital, TAS, Australia (Song) School of Medicine, Deakin University, Burwood, VIC, Australia (Ramponi) Yale University, New Haven, CT, Australia (Chan) New York University, NY, United States (Zaman, Chow) Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (Zaman, Chow, Kovoor) Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia (Bennetts) School of Medicine, Monash University, Melbourne, VIC, Australia (Bennetts) Department of Cardiothoracic Surgery, Victorian Heart Hospital, Melbourne, VIC, Australia (Maddern) Australian Safety and Efficacy Register of New Interventional Procedures - Surgical, Royal Australasian College of Surgeons, Adelaide, SA, Australia (Maddern) Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, SA, Australia Abstract BackgroundCoronary artery bypass grafting (CABG) is associated with significant morbidity and mortality. Traditional risk scores, such as the Society of Thoracic Surgery (STS) and EuroSCORE II, have limitations in predicting outcomes, particularly in high-risk patients. Machine learning (ML) models may address these issues by detecting nuanced data patterns not captured by conventional methods. This systematic review and meta-analysis compared the efficacy of ML models with traditional risk scores in predicting outcomes after CABG.MethodsA comprehensive literature search of records up to August 14th 2025, was conducted using PubMed, Embase, Web of Science, and the Cochrane Library. Studies included used ML algorithms and traditional risk scores to predict all-cause mortality (in-hospital, 30-day, or longer term as reported by each study) following CABG. Data extraction and quality assessment were independently performed by two reviewers. Meta-analyses were conducted using a linear mixed-effects model, with C-statistics as the primary measure of discrimination.ResultsTwenty-six studies, comprising 565 063 participants, met the inclusion criteria. The pooled C-statistic for ML models was 0.82 (95% CI 0.79-0.85), significantly higher than the 0.73 (95% CI 0.71-0.76) for traditional risk scores (P < 0.0001). The top-performing ML model achieved a C-statistic of 0.98 (CI 0.95-1.00). Calibration was reported inconsistently across studies and was synthesised narratively rather than quantitatively. Where reported, ML calibration was generally adequate but a robust head-to-head comparison with traditional risk scores was not possible. Subgroup analyses revealed consistent superior performance of ML models across various algorithms and covariate sets.ConclusionsIn this meta-analysis of predominantly internally-validated models, ML approaches showed higher pooled discrimination than traditional risk scores for mortality after CABG. However, given the small number of pooled studies, very high between-study heterogeneity (I2 = 98%), the predominance of high risk-of-bias studies, and the scarcity of external validation, these findings should be interpreted as supporting the promise of ML rather than establishing proof of clinical superiority. Confirmatory prospective, externally validated studies are required before ML can be recommended for routine pre-operative risk stratification. <89> Accession Number 2047932874 Title Rhythm vs. rate control for treatment of postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1820175. Date of Publication: 01 Jul 2026. Author Dairi M.S.; Tarabzoni M.; Tarola C.; Sehmbi H.; Alwafi H.; Alghamdi S.M.; Khan S.; Alotaibi W.T.; Hegazy A.F. Institution (Dairi) Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Tarabzoni) Cardiovascular and Thoracic Surgery Department, King Salman Heart Centre, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia (Tarola) Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Sehmbi) Department of Anesthesia, Waterloo Regional Health Network, McMaster University, Hamilton, ON, Canada (Alwafi) Department of Pharmacology and Toxicology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Alghamdi) Clinical Technology Department, Respiratory Care Program, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia (Khan) General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia (Alotaibi) Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia (Hegazy) Division of Critical Care Medicine, Department of Medicine, University of Western Ontario, London, Ontario, ON, Canada (Hegazy) Cardiac Surgery Intensive Care Unit, Department of Critical Care Medicine, Madinah Cardiac Centre, Madinah, Saudi Arabia Publisher Frontiers Media SA Abstract Background - We aimed to compare the clinical impact of treatment with a rhythm control strategy to a rate control strategy in postcardiac surgery atrial fibrillation patients. Methods - A comprehensive search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Scopus, ProQuest Dissertations, and ClinicalTrials.gov was conducted from inception to October 2025. Our meta-analysis included randomized controlled trials (RCTs) comparing therapeutic rhythm control interventions with rate control interventions. We used the Cochrane risk-of-bias tool to appraise the quality of included RCTs, the GRADE framework to evaluate the strength of the evidence, and adhered to the PRISMA guidelines for reporting. Results - Eight RCTs (n = 894 patients) met the inclusion criteria. There was no difference in hospital length of stay (4 RCTs) between rhythm control and rate control [MD: -0.41 days (95% CI: -3.23, 2.42)]. An aggressive rhythm control strategy (ibutilide, procainamide, propafenone, or electric cardioversion) was associated with higher odds of in-hospital conversion to sinus rhythm [OR: 4.01 (95% CI: 1.30, 12.39)] and a higher risk of medication-related adverse events (hypotension, bradycardia, and syncope) [RR: 3.05 (95% CI: 1.05, 8.89)]. Conclusion - Among postcardiac surgery patients with new-onset atrial fibrillation, there was no evidence that a rhythm control treatment strategy resulted in better outcomes than a rate control strategy. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD42019128559, identifier CRD42019128559. Copyright © 2026 Dairi, Tarabzoni, Tarola, Sehmbi, Alwafi, Alghamdi, Khan, Alotaibi and Hegazy. <90> Accession Number 2038475372 Title Intraoperative Atrial Fibrillation in Non-Cardiac Surgery: A Narrative Review of Risk Factors and Management Strategies. Source Reviews in Cardiovascular Medicine. 27(7) (no pagination), 2026. Article Number: 51310. Date of Publication: 01 Jul 2026. Author Hasheminia A.; Gupta K.; Kaminska M.; Garagiola M.L.; Meghdadi A.; Bornancini N.; Botbol A.L.; Rodriguez J.E.L.; Zhou Z.; Villacreses F.H.; Baranchuk A. Institution (Hasheminia) Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada (Gupta, Meghdadi) Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada (Kaminska) Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada (Garagiola) Division of Cardiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada (Bornancini, Botbol, Baranchuk) Faculty of Medicine, Universidad Abierta Interamericana (UAI), Buenos Aires, Argentina (Rodriguez) Universidad De Especialidades Espiritu Santo, Guayaquil, Ecuador (Zhou) Faculty of Medicine, Queen's University, Kingston, ON, Canada (Villacreses) Servicio de Medicina Intensiva, Servicio de Cardiologia, Hospital Clinica San Francisco, Guayaquil, Ecuador Publisher IMR Press Limited Abstract Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia. A less studied presentation of AF is intraoperative atrial fibrillation (IOAF), which is defined as AF occurring during surgery. IOAF has important clinical implications, as this condition is associated with increased morbidity and mortality, even in non-cardiac surgical procedures. A narrative review of studies published between 1990 and 2025 was conducted using PubMed, ScienceDirect, and the Cochrane Library to evaluate the risk factors and management of IOAF in non-cardiac surgery. Reported IOAF prevalence varies by procedure type, ranging from 1% to 5% in most non-cardiac surgeries. Across non-cardiac surgical procedures, three IOAF risk domains emerge: patient profile, including age, prior AF, and structural heart disease; the invasiveness of the procedure; acute triggers, including hypotension and electrolyte imbalance. Management of IOAF begins with rapid assessment of hemodynamic stability and identification of surgical triggers. In hemodynamically unstable patients, particularly those with myocardial ischemia or pulmonary edema, immediate synchronized direct-current cardioversion (DCCV) is indicated. Conversely, in hemodynamically stable patients, the "3As" management framework is usually followed: first, acute triggers are addressed; then, the AF rate or rhythm is controlled; finally, anticoagulation is considered using the CHA<inf>2</inf>DS<inf>2</inf>-VASc score. Across the spectrum of surgical procedures, IOAF is best documented in cardiac surgery, where guidelines for the associated management and prevention are readily available. To further investigate IOAF in non-cardiac surgery, adopting standardized definitions is critical to advancing research and improving management. Copyright © 2026 The Author(s). <91> Accession Number 651897012 Title Comparison of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with prior chest radiation: a systematic review and meta-analysis of 11,572 patients. Source Future cardiology. (pp 1-10), 2026. Date of Publication: 05 Aug 2026. Author Ntoumaziou A.; Xenos D.; Sagris M.; Chatziioannou A.; Krokidis M.; Tzoumas A. Institution (Ntoumaziou) Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States (Xenos) Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA (Sagris) 1st Department of Cardiology, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece (Chatziioannou, Krokidis) 1st Department of Radiology, School of Medicine, Areteion Hospital, National and Kapodistrian University of Athens, Athens, Greece (Tzoumas) Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, OH, United States Abstract BACKGROUND: Cardiac complications from prior oncologic therapies and radiation are being increasingly recognized and patients with symptomatic severe aortic valve disease and a history of prior chest radiation represent a high-risk group in which the best management approach has not yet been established. METHOD(S): A systematic search of PubMed, Scopus, and Cochrane identified studies comparing outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients with a history of prior chest radiation. RESULT(S): Nine studies comprising 11,572 patients were included in this meta-analysis. There were no significant differences between TAVR and SAVR in postoperative mortality (OR: 0.70; 95% CI 0.44-1.13, p = 0.147) or 1-year mortality (OR: 1.04; 95% CI 0.71-1.53, p = 0.84). TAVR was associated with significantly lower rate of postoperative major bleeding (OR: 0.38; 95%CI: 0.25-0.57, p < 0.01), acute kidney injury (AKI) (OR: 0.51; 95%CI: 0.27-0.97, p: 0.04), postoperative atrial fibrillation (OR: 0.20 95%CI: 0.16-0.24, p: <0.01) and respiratory complications (OR: 0.39; 95%CI: 0.24-0.63, p < 0.01) compared to SAVR. The incidence of postoperative permanent pacemaker insertion (OR: 2.27; 95%CI: 1.79-2.87, p < 0.01) and at least moderate aortic regurgitation (OR: 4.44 (95%CI: 2.93-6.73), p < 0.01) were higher among the patients undergoing TAVR. CONCLUSION(S): TAVR in patients with a history of prior radiation was associated with a lower risk for postoperative complications albeit at an increased risk for pacemaker insertion in the postoperative period compared to SAVR. <92> Accession Number 651903069 Title Non-Pharmacologic Interventions for Hemodynamic Stability During Dental Implant Surgery: A Randomized Controlled Trial. Source Clinical implant dentistry and related research. 28(4) (pp e70177), 2026. Date of Publication: 01 Aug 2026. Author Luo F.; Zhang Z.; Mao Q.; Luo L.; Zhou Y. Institution (Luo) State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu, China (Luo) Department of General Dentistry, West China School of Stomatology, Sichuan University, Chengdu, China (Zhang, Mao, Luo, Zhou) Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu, China Abstract OBJECTIVES: To assess the efficacy of non-pharmacologic interventions, specifically auditory distraction (music or comedy) and haptic distraction (stress-relief device), in maintaining hemodynamic stability during dental implant surgery. MATERIAL AND METHODS: This was a prospective, single-center, randomized trial. We included 150 patients getting single-tooth implants. Patients were split into three groups of 50. The Control group got standard care. The Auditory Distraction group listened to patient-selected Guzheng music or Xiangsheng comedy. The Haptic Distraction group used a stress-relief device. We recorded systolic and diastolic blood pressure and heart rate before and after surgery. We used paired t-tests and one-way ANOVA with Tukey's post hoc tests for analysis. RESULT(S): Surgery increased blood pressure in all groups (p < 0.0001). The heart rate response was different between groups. The Control group had a significant increase in heart rate (p < 0.05). Both the Auditory and Haptic Distraction groups had lower heart rates after surgery (p < 0.05). There was no significant difference between the two interventions. CONCLUSION(S): Non-pharmacologic interventions may not fully prevent the rise in blood pressure from procedure-related BP elevation. However, these methods help stop the heart rate from rising due to physiological stress. Listening to familiar music or comedy, or using a simple stress-relief device, can help steady the heart during dental implant surgery. CLINICAL RELEVANCE: Auditory and haptic distractions are low-cost, non-invasive, and effective adjuncts for managing procedure-related physiological stress. By stabilizing heart rate, these interventions enhance patient safety and comfort, offering a viable alternative or supplement to pharmacological sedation in implant dentistry. Copyright © 2026 Wiley Periodicals LLC. <93> Accession Number 2047980112 Title Impact for Treatment Decision-Making and Clinical Outcome of Angiography-Derived Fractional Flow Reserve. Source JACC: Cardiovascular Interventions. 19(15) (pp 2116-2126), 2026. Date of Publication: 10 Aug 2026. Author Tanigaki T.; Mizukami T.; Arai T.; Hagiya K.; Kikuta Y.; Yoshida T.; Yamamoto H.; Takahara M.; Isodono K.; Kawase Y.; Okubo M.; Zen K.; Hikichi Y.; Kinoshita N.; Kitamura R.; Ogawa T.; Kozuma K.; Nanasato M.; Ako J.; Otake H.; Yokoi H.; Matsuo H. Institution (Tanigaki, Kawase, Okubo, Matsuo) Department of Cardiovascular Medicine, Gifu Heart Center, Japan (Mizukami) Division of Clinical Pharmacology, Department of Pharmacology, Showa University School of Medicine, Japan (Arai) Department of Medicine, Division of Cardiology, Showa University School of Medicine, Japan (Hagiya, Nanasato) Department of Cardiology, Sakakibara Heart Institute, Japan (Kikuta) Department of Cardiology, Fukuyama Cardiovascular Hospital, Japan (Yoshida) Department of Cardiology, Saga-Ken Medical Centre Koseikan, Japan (Yamamoto, Kozuma) Division of Cardiology, Department of Internal Medicine, Teikyo University, Japan (Takahara, Zen) Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan (Isodono, Kitamura) Department of Cardiology, Ijinkai Takeda General Hospital, Japan (Hikichi) Department of Cardiology, Fukuoka Kieikai Hospital, Japan (Kinoshita) Department of Cardiology, Koseikai Takeda Hospital, Japan (Ogawa) Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan (Ako) Department of Cardiovascular Medicine, Kitasato University, Japan (Otake) Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan (Yokoi) Department of Cardiology, Fukuoka Sanno Hospital, Japan Publisher Elsevier Inc. Abstract Background Pressure wire-based fractional flow reserve (FFR) is the reference standard for physiologic lesion assessment but remains underutilized owing to the need for hyperemia, procedural complexity, and wire-related risks. Angiography-derived FFR provides a wire- and hyperemia-free assessment derived from routine angiography; however, its clinical impact in guiding treatment remains uncertain. Objectives This study aimed to determine whether angiography-derived FFR is noninferior to pressure wire-based FFR in guiding revascularization decisions among patients with stable coronary artery disease. Methods PROVISION (Prospective randomized trial of clinical outcomes of angiography-based fractional flow reserve guidance versus wire-based fractional flow reserve guidance) was a prospective, multicenter, randomized study. Participants were randomized 1:1 to angiography-derived FFR-guided or pressure wire-based FFR-guided revascularization. The primary endpoint was the noninferiority of angiography-derived FFR in terms of revascularization rate, defined as the proportion of patients undergoing percutaneous coronary intervention or coronary artery bypass grafting based on physiologic assessment. Secondary endpoints included the 1-year incidence of major adverse cardiac events (cardiac death, any myocardial infarction, or ischemia-driven target vessel revascularization). Results Overall, 401 patients (483 vessels) were enrolled at 13 Japanese centers. Revascularization was performed in 41.4% of patients in the angiography-derived FFR group and 37.9% in the pressure wire-based FFR group (absolute difference: 3.5%; 95% CI: -6.0 to 13.1; P for noninferiority = 0.049). At 1 year, major adverse cardiovascular events occurred in 8.4% and 10.1% of patients, respectively (HR: 0.84; 95% CI: 0.44-1.60; P = 0.591). Conclusions Angiography-derived FFR-guided revascularization was noninferior to pressure wire-based FFR-guided strategy for determining revascularization in patients with stable coronary artery disease. This finding suggests that angiography-derived FFR may serve as a practical, wire-free alternative for physiologic guidance of coronary revascularization, warranting confirmation in larger outcome-driven trials. (PROVISION; UMIN000049230) Copyright © 2026 American College of Cardiology Foundation. <94> Accession Number 2048094968 Title Efficacy and safety of different antithrombotic treatment regimens in patients undergoing transcatheter mitral valve repair and atrial fibrillation; A meta-analysis and systematic review. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1743097. Date of Publication: 2026. Author Zhu F.; Yu Z.; He Z. Institution (Zhu, He) Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China (Yu) Department of Clinical Medicine, Chengde Medical University, Chengde City, Hebei, China Publisher Frontiers Media SA Abstract Background - Optimal antithrombotic therapy following transcatheter mitral valve repair (TMVR/TEER) in patients with atrial fibrillation remains uncertain, with substantial practice variation and reliance on nonrandomized data. Methods - We performed a systematic review and network meta-analysis of observational studies evaluating antithrombotic strategies after TMVR/TEER with atrial fibrillation. Antithrombotic regimens were harmonized into two main categories: oral anticoagulation [OAC; including vitamin K antagonists [VKAs] and direct oral anticoagulants [DOACs]] and antiplatelet therapy (APT; including aspirin or clopidogrel, alone or in combination). Outcomes of interest were ischemic stroke, major bleeding, and all-cause mortality. Pairwise and network random-effects models were applied to derive odds ratios (ORs) with 95% confidence intervals (CIs). Results - Four multicenter observational cohorts (n = 2, 098) were included. Across comparisons, OAC strategies demonstrated a favorable profile compared with APT for bleeding risk reduction, while DOACs showed heterogeneous results depending on comparator drug and study region (phenprocoumon in Europe vs. warfarin in the U.S.). Mortality findings consistently favored OAC (particularly DOACs) potential benefits over APT. For stroke, OAC (phenprocoumon) showed better ischemic prevention, indicating more effectiveness in minimizing stroke risk compared with APT. Network geometry was limited, with most contrasts informed by only one or two studies. Conclusions - In patients undergoing TMVR/TEER with atrial fibrillation, OAC strategies appeared to be associated with lower bleeding risk and potentially favorable mortality outcomes compared with antiplatelet therapy. However, conclusions regarding comparative efficacy, particularly for stroke prevention, should be interpreted cautiously due to the limited number of studies and the observational nature of the available evidence. Thus, the evidence base remains limited by observational design, heterogeneous comparators, and inconsistent outcome definitions. Randomized trials are urgently needed to guide antithrombotic management in this high-risk population. Copyright © 2026 Zhu, Yu and He. <95> Accession Number 2048110355 Title von Willebrand disease: an illustrated review. Source Research and Practice in Thrombosis and Haemostasis. 10(5) (no pagination), 2026. Article Number: 106838. Date of Publication: 01 Jul 2026. Author Abou-Ismail M.Y.; Kouides P.A.; James P.D.; Connell N.T. Institution (Abou-Ismail) Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States (Kouides) Department of Hematology, Rochester General Hospital, Rochester, NY, United States (James) Queen's University, Department of Medicine, Kingston, ON, Canada (Connell) Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States Publisher Elsevier B.V. Abstract First described 100 years ago, von Willebrand disease (VWD) is the most common inherited bleeding disorder, characterized by a quantitative or qualitative deficiency of von Willebrand factor (VWF), a large multimeric glycoprotein central to hemostasis. Despite its prevalence, VWD remains globally underdiagnosed. Accurate diagnosis requires thorough clinical assessment and specialized laboratory evaluation. Although international evidence-based guidelines have advanced care, significant diagnostic and management challenges remain. Management focuses on treating and preventing bleeding, ensuring periprocedural safety, and improving quality of life through individualized strategies and the use of various hemostatic agents and therapeutic strategies. Optimal management approaches in complex clinical scenarios remain challenging. In this comprehensive illustrated review, we cover the biology and physiology of VWF, along with the pathophysiology, diagnosis, and management of VWD. We review current clinical practice recommendations and provide practical guidance for challenging scenarios such as surgery, pregnancy, cardiovascular disease, aging, and acquired von Willebrand syndrome. We also highlight emerging therapeutics and models of care in VWD. Copyright © 2026 The Authors. Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/ <96> Accession Number 2048114033 Title Outcomes of Video-Assisted Thoracic Surgery Compared to Open Thoracic Surgery for Pulmonary Hydatid Disease: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. (no pagination), 2026. Date of Publication: 2026. Author Hussein A.M.; Hammadeh B.M.; Aldalati A.Y.; Albliwi M.; Odat R.M.; Shabaneh A. Institution (Hussein, Hammadeh) Faculty of Medicine, Al- Balqa' Applied University, Salt, Jordan (Aldalati, Odat) Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Albliwi) Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States (Shabaneh) Department of General Surgery, Mayo Clinic, Rochester, MN, United States Publisher Elsevier Ltd Abstract Background & Aim: Pulmonary echinococcosis, or pulmonary hydatid disease, caused by Echinococcus larvae, presents a significant health challenge, particularly in endemic areas. While surgery is the primary treatment for viable cysts, the optimal approach for this remains under debate. There is a lack of comparative evidence comparing traditional open thoracic surgery (OTS) with minimally invasive video-assisted thoracic surgery (VATS). This systematic review and meta-analysis aims to comprehensively compare the efficacy and safety of VATS versus OTS for pulmonary hydatid disease; it will expand on prior research by including patients of all ages and conducting detailed subgroup analyses, sensitivity analyses, and publication bias assessments. Method(s): Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and International Prospective Register of Systematic Reviews registration (CRD420251012764), major databases (PubMed, Scopus, Cochrane Library, Web of Science) were searched up to 5 March 2025, without language or date restrictions. Comparative studies (randomised controlled trials and observational studies) reporting perioperative, postoperative, and recovery outcomes for VATS versus OTS were included. Data were synthesised using random-effects models (calculating mean differences [MDs] or risk ratios with 95% confidence intervals). Heterogeneity (I2), risk of bias (Risk Of Bias In Non-randomised Studies of Interventions) and publication bias (Doi plots, Luis Furuya-Kanamori index) were assessed. Result(s): Nine retrospective cohort studies met the inclusion criteria. Compared with OTS, VATS was associated with significantly shorter operation times (MD -38.08 min; p<0.001; I2=92%), lower perioperative blood loss (MD -64.02 mL; p=0.006; I2=98%), reduced postoperative drainage volume (MD -124.46 mL; p=0.003; I2=85%), earlier chest drain removal (MD -2.27 days; p<0.001; I2=92%), and shorter hospital stays (MD -3.68 days; p<0.001; I2=98%). Although VATS showed a trend towards fewer postoperative complications, the difference was not statistically significant (risk ratio 0.72; p=0.13; I2=0%). Significant heterogeneity (I2>85%) was present for most continuous outcomes, and risk of bias assessment indicated high risks in confounding and reporting domains for several studies. Potential publication bias favouring VATS was detected for multiple outcomes. Conclusion(s): VATS appears to offer significant perioperative and recovery advantages over OTS for the surgical management of pulmonary hydatid disease. However, these findings must be interpreted with caution. While this review incorporates recently available randomised evidence, the majority of the data remains retrospective, and the pooled results are affected by significant heterogeneity and a high risk of bias in several domains. Copyright © 2026 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ) <97> Accession Number 2048076983 Title Diuretic therapy for critically ill patients: a systematic review and network meta-analysis. Source Annals of Intensive Care. 16 (no pagination), 2026. Article Number: 100120. Date of Publication: 01 Jan 2026. Author Kuriyama A.; Polok K.; Malhotra N.; Kuse N.; Pitre T.; Lakhanpal D.; Sun R.; Soni K.D.; Campbell K.; Burry L.D.; Clark E.G.; Lewis K.; Moller M.H.; Gershengorn H.B.; Rochwerg B. Institution (Kuriyama, Lewis, Rochwerg) Department of Health Research Methods, Evidence, and Impact, McMaster University, Ontario, Canada (Polok) Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland (Malhotra) Department of Medicine, Division of Cardiology, McMaster University, Hamilton, ON, Canada (Malhotra) Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada (Kuse) Firestone Institute for Respiratory Health at St. Joseph's Healthcare, Hamilton, ON, Canada (Pitre) University Health Network, University of Toronto, Toronto, ON, Canada (Lakhanpal) Department of Chemical and Physical Sciences, University of Toronto, Toronto, ON, Canada (Sun) Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Soni) Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India (Campbell) Campbell Information Consulting, Inc., Petawawa, ON, Canada (Burry) Departments of Pharmacy, Medicine, Sinai Health Research, Sinai Health, Toronto, ON, Canada (Burry) Leslie Dan Faculty of Pharmacy and Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada (Clark) Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada (Clark) Kidney Research Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada (Lewis, Rochwerg) Department of Medicine, McMaster University, Hamilton, ON, Canada (Moller) Department Of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (Moller) Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark (Gershengorn) Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, United States (Gershengorn) Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, United States Publisher Societe de Reanimation de Langue Francaise Abstract Background Fluid overload is common in critically ill patients and is associated with worse outcomes. Diuretics are the mainstay of active fluid removal in patients with preserved renal function. The optimal diuretic strategy for fluid removal remains uncertain. Methods We conducted a systematic review and Bayesian random-effects network meta-analysis of randomized controlled trials comparing two or more diuretic strategies for fluid removal in critically ill adults. We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials via Ovid, as well as trial registries, from inception to November 20, 2025. Two reviewers independently extracted data and assessed risk of bias using ROBUST-RCT. Certainty of evidence was evaluated using the GRADE approach for network meta-analysis. Treatment effects were summarized as odds ratios (ORs) or mean differences (MDs) with 95% credible intervals (CrIs). Results Twenty-six randomized controlled trials involving 1,652 participants were included. Evaluated interventions included bolus loop diuretics (19 studies), continuous loop infusion (15 studies), oral loop diuretics (5 studies), and loop diuretics combined with tolvaptan (8 studies), spironolactone (3 studies), thiazides (2 studies), acetazolamide (1 study), or triamterene (1 study). Compared with bolus loop diuretics, continuous loop infusion had an uncertain effect on mortality (OR 1.26; 95% CrI 0.62 to 2.55; very low certainty) and may increase ICU length of stay (MD 1.56 days; 95% CrI -0.02 to 3.16; low certainty). Tolvaptan monotherapy may reduce acute kidney injury compared with bolus or continuous loop diuretics (OR 0.12; 95% CrI 0.01 to 0.87; low certainty), although no studies evaluated its effect on the need for renal replacement therapy. For most other comparisons and outcomes, the certainty of evidence was low or very low. Conclusions Available evidence comparing diuretic strategies for fluid removal during ICU-level care is limited, clinically heterogeneous, and derived largely from heart failure and post-cardiovascular surgery populations. Bolus loop diuretics were at least comparable to alternate diuretic strategies for patient important outcomes in critically ill adults, but this was based mostly on low or very low certainty evidence. Tolvaptan monotherapy may decrease acute kidney injury, but its effect on subsequent need for RRT and mortality remains uncertain. Copyright © 2026 The Authors. <98> Accession Number 2048012474 Title The internal mammary artery in autologous breast reconstruction and coronary artery bypass grafting. Source European Journal of Plastic Surgery. 49(1) (no pagination), 2026. Article Number: 148. Date of Publication: 01 Dec 2026. Author Ozturk M.; Niederegger T.; Schaschinger T.; Brandt J.; Didzun O.; Panayi A.C.; Haug V.; Gazyakan E.; Bigdeli A.; Kneser U.; Hundeshagen G. Institution (Haug, Gazyakan, Kneser, Hundeshagen) Department of Hand, Plastic, and Reconstructive Surgery, Burn Center at Heidelberg University, BG Klinik Ludwigshafen, Ludwigshafen, Germany (Niederegger, Schaschinger, Brandt) Medical Faculty, Heidelberg University, Heidelberg, Germany (Didzun, Bigdeli) Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Klinikum Kassel, Kassel, Germany (Panayi) Department of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, Ramistrasse 100, Zurich, Switzerland (Ozturk) Institute for Molecular and Cellular Anatomy, University of Regensburg, Universitatsstrase 31, Regensburg, Germany (Ozturk) Institute for Medical Science & Engineering (IMSE), Deggendorf Institute of Technology, Deggendorf, Germany (Ozturk) Department of Plastic Surgery, Kliniken am Goldenen Steig, Freyung, Germany Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: The internal mammary artery (IMA) is a critical vessel for both autologous breast reconstruction (ABR) and coronary artery bypass grafting (CABG), creating potential conflict when both procedures are needed. This review evaluates evidence on the feasibility, safety, and vascular consequences of using the IMA in ABR while preserving future CABG options. Method(s): A PRISMA-2020 aligned systematic review assessed IMA use in ABR and implications for future CABG. PubMed, EMBASE, and Web of Science were searched through March 10, 2025, using terms related to ABR and CABG. Result(s): Ten studies (2004-2025) met inclusion criteria, involving female patients aged 24-77 years. Most studies used the deep inferior epigastric perforator flap for ABR, with the IMA as the predominant recipient vessel. Notably, end-to-side arterial anastomosis and dissection at or below the fourth intercostal space were frequently applied to preserve IMA length and integrity for future CABG. Myocardial complication rates after ABR were comparable to flap loss rates, and one patient subsequently underwent CABG using an alternative graft due to prior IMA harvest. Importantly, one cohort study introduced the Breast Reconstruction and Internal Mammary Artery Assessment (BRIMA) score, a cardiovascular risk-stratification tool designed to guide IMA selection in reconstructive planning. Conclusion(s): The IMA may be used in selected ABR cases without significantly limiting future CABG if end-to-side anastomoses or internal mammary artery perforators preserve conduit integrity. Because the IMA is the primary CABG graft, careful surgical planning and cardiovascular risk assessment are crucial. Further prospective data are needed to guide long-term management as the population ages. Level of Evidence: no gradable. Copyright © The Author(s) 2026. <99> Accession Number 2048195305 Title Feasibility and Preliminary Effectiveness of a Transitional Care Program on Cardiac Self-Efficacy and Transitional-Care Knowledge Among Patients Awaiting Elective Coronary Artery Bypass Graft: A Pilot Randomized Controlled Trial. Source International Journal of Drug Delivery Technology. 16(74 Supplement) (pp 725-733), 2026. Date of Publication: 2026. Author Rani R.; Bhupali P.R. Institution (Rani, Bhupali) KLE's institute of nursing sciences, Karnataka, Belagavi, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Background: Patient who are going to undergo CABG surgery face stressful situations that affect their cardiac self-efficacy and recovery. TCPs that link hospital and home environments can make a difference in their self-management and psychological functioning. Aim(s): Feasibility and preliminary effects of a nurse-led TCP in improving transitional care knowledge, cardiac self-efficacy, depression, anxiety, and stress of patients undergoing CABG surgery in India. Method(s): This parallel-group pilot randomized controlled study included 20 adults who needed a CABG procedure. Participants were assigned randomly to receive either TCP intervention along with usual care (10 subjects) or usual care alone (10 subjects). The TCP comprised educational activities regarding lifestyle modification, stress management (through yoga and breathing techniques), and drug compliance. Measurements were taken before and after the intervention through a transitional-care knowledge scale that consisted of 40 items, Cardiac Self-Efficacy Scale of 13 items, and Depression, Anxiety, and Stress Scale (DASS-21). Result(s): All 20 subjects who had been randomized successfully went through both the pre- and post-test measures within a span of 7 weeks, thus establishing high feasibility of this research project. After conducting the intervention session, the experimental group showed improvement with respect to their transitional care knowledge (decrease in poor knowledge from 6 to 1 member). The participants in the experimental group had shown a marked increase in their cardiac self-efficacy scores (pre-test 17-29 and post-test 20-41), while the control group had low-to-moderate scores (pre-test 15-31 and post-test 15-34). Furthermore, the experimental group showed favorable shifts toward milder depression and reduced severe stress and anxiety, outperforming the control group. Conclusion(s): The nurse-led TCP was highly feasible and demonstrated positive trends towards improvement in transitional care knowledge, cardiac self-efficacy, and psychological well-being. A fully powered randomized control trial is needed. Copyright © 2026, Dr. Yashwant Research Labs Pvt. Ltd. All rights reserved. <100> Accession Number 2048065557 Title Perioperative dexmedetomidine is associated with improved respiratory outcomes in patients undergoing cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 465. Date of Publication: 01 Dec 2026. Author Guo Y.; Wei Y.; Yu S. Institution (Guo) Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China (Wei) Department of Anesthesiology, Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, China (Yu) Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, The Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China Publisher BioMed Central Ltd Abstract Background: Over 2 million cardiac surgeries are performed annually, with significant risks such as systemic inflammation and postoperative pulmonary complications (PPCs). Dexmedetomidine has shown promise in reducing PPCs in thoracic surgeries. This review evaluates its effects on PPCs and respiratory outcomes in cardiac surgery. Method(s): A systematic search of the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to include randomized controlled trials comparing intravenous dexmedetomidine and other drugs in terms of respiratory outcomes in adult patients undergoing cardiac surgery. Primary Outcome: PPC incidence. Secondary Outcomes: PaO<inf>2</inf>, PaCO<inf>2</inf>, SpO<inf>2</inf>, oxygenation index, respiratory index, time to extubation, length of ICU stay, and adverse events. Risk ratios (RRs) and mean differences (MDs) were calculated using random-effects models. Result(s): Sixteen studies comprising 1,668 patients were included in this meta-analysis. The perioperative use of dexmedetomidine was associated with a reduced incidence of overall postoperative pulmonary complications (RR = 0.57; 95% CI: 0.38 to 0.87; P = 0.0078). Additionally, participants who received intravenous dexmedetomidine had a shorter ICU stay (MD = -0.56 h; 95% CI: -1.12 to -0.00; P = 0.0480). Furthermore, perioperative dexmedetomidine significantly improved postoperative SpO<inf>2</inf> (MD = 0.46% points; 95% CI: 0.17 to 0.74; P = 0.0018) and respiratory index (MD = -0.16; 95% CI: -0.27 to -0.05; P = 0.0057). Conclusion(s): Perioperative dexmedetomidine may be associated with improved respiratory outcomes in cardiac surgery patients. However, the evidence for reduction in overall PPCs remains limited, and dexmedetomidine may increase the risk of bradycardia. Larger, high-quality RCTs are needed to confirm its safety and benefits. Copyright © The Author(s) 2026. <101> Accession Number 2048128114 Title Gabapentin for Postoperative Analgesia in Cardiac Surgery via Sternotomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Nhuch F.; Gonzalez G.L.; Wegner G.R.M.; Wegner B.F.M.; Barreto L.A.L.; Marinho Miranda A.; Li R.; do Nascimento T.S. Institution (Nhuch) Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States (Gonzalez) Federal University of the State of Rio de Janeiro - UNIRIO, Rio de Janeiro, Brazil (Wegner) Federal University of Fronteira Sul, Rio Grande do Sul, Brazil (Wegner) Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil (Barreto) Federal University of Ceara, Ceara, Brazil (Marinho Miranda) Federal University of Sao Paulo, UNIFESP, Sao Paulo, Brazil (Li) Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, United States (do Nascimento) Department of Anesthesiology, University of Iowa, IA, United States Publisher W.B. Saunders Abstract Background: Opioids remain the mainstay for moderate-to-severe postoperative pain after cardiac surgery but are associated with frequent adverse effects. Gabapentin has been proposed as part of multimodal analgesia to reduce opioid use and related complications. However, existing evidence in cardiac surgery is limited and heterogeneous. This systematic review and meta-analysis aimed to evaluate the latest evidence on the efficacy and safety of perioperative gabapentin for postoperative analgesia in adults undergoing cardiac surgery. Method(s): PubMed, Embase, and the Cochrane Library were searched through October 1, 2025, for randomized controlled trials (RCTs) comparing perioperative gabapentin with placebo in adults undergoing cardiac surgery via sternotomy. The primary outcome was postoperative pain at 24 hours. Secondary outcomes included pain at other time points, opioid consumption, and adverse events (nausea, vomiting, sedation, atrial fibrillation). Pooled analyses used random-effects models with mean differences for pain outcomes, standardized mean differences for opioid consumption, and risk ratios for dichotomous outcomes, with 95% confidence intervals. The certainty of evidence across outcomes was assessed using the GRADE framework. Result(s): Six RCTs, including 751 patients, were analyzed. Mean age ranged from 50 to 69.9 years, and 82.9% were male. Gabapentin was not associated with a statistically significant reduction in rest pain (MD -0.69; 95% CI -1.38 to 0.00; p = 0.0507) or cough-elicited pain at 24 hours (MD -0.34; 95% CI -0.71 to 0.04; p = 0.079). However, a modest but statistically significant reduction in cough-elicited pain was observed at 6 hours (MD -1.24; 95% CI -2.45 to -0.03; p = 0.0439). Gabapentin was associated with lower opioid consumption at 24 hours when analyzed using standardized mean difference (SMD -1.06; 95% CI -2.02 to -0.11; p = 0.0295). No significant differences were observed for pain outcomes at other time points or for adverse events, including sedation, nausea, vomiting, or atrial fibrillation. According to the GRADE framework, the certainty of evidence for these outcomes ranged from low to very low. Conclusion(s): Gabapentin provided a small, isolated reduction in early cough-elicited pain but not a clinically meaningful reduction in opioid consumption or overall analgesic benefit after cardiac surgery via sternotomy. Routine use as part of multimodal analgesia is not supported. Copyright © 2026 Elsevier Inc. <102> Accession Number 2048114799 Title Surgical approaches, techniques and knowledge gaps in the management of osteoporotic vertebral fractures in the thoracic and lumbar spine: A Narrative review. Source Journal of Clinical Orthopaedics and Trauma. 82 (no pagination), 2026. Article Number: 103576. Date of Publication: 01 Nov 2026. Author Holas M.; Camino-Willhuber G.; Scherer J.; Kumar V.; Sadiqi S.; Takahata M.; Vialle E.; Yurac R.; Popescu C.; Pumberger M.; Bigdon S.; El-Skarkawi M.; Bransford R.J.; Joaquim A.F.; Schnake K.; Spiegl U.; Schroeder G. Institution (Holas) Department of Orthopaedics and Trauma Surgery Slovak Medical University, F.D.Roosevelt University Hospital, Banska Bystrica, Slovakia (Camino-Willhuber) Department of Orthopedics, Policlinica Gipuzkoa, San Sebastian, Spain (Scherer) Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa (Scherer) Department of Traumatology, University Hospital of Zurich, Zurich, Switzerland (Kumar) Additional Professor of Orthopaedics, PGIMER, Chandigarh, India (Sadiqi) Department of Orthopaedics, University Medical Center Utrecht, Utrecht, Netherlands (Sadiqi) Department of Orthopaedics, St. Antonius Hospital, Utrecht, Netherlands (Takahata) Department of Orthopaedic Surgery Dokkyo Medical University, Japan (Vialle) Spine Surgery Group, Department of Orthopaedics, Cajuru University Hospital, Catholic University of Parana, Curitaba, Brazil (Yurac) University del Desarrollo, Clinica Alemana de Santiago, Chile (Popescu) Emergency Hospital, Iasi, Romania (Pumberger) Center for Musculoskeletal Surgery, Charite - Universitatsmedizin Berlin, Germany (Bigdon) Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Bern, Switzerland (El-Skarkawi) Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt (Bransford) Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, United States (Joaquim) Neurosurgery Division, Department of Neurology, State University of Campinas, Campinas, Sao Paulo, Brazil (Schnake) Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St, Marien Erlangen, Erlangen, Germany (Schnake) Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany (Spiegl) Klinik fur Unfallchirurgie und Orthopadie, Klinik Munchen Harlaching, Munchen, Germany (Schroeder) Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, United States Publisher Delhi Orthopedic Association Abstract Osteoporotic vertebral fractures (OVF) represent a growing clinical challenge due to population aging and the increasing prevalence of osteoporosis. Surgical management of OVF differs substantially from that of traumatic vertebral fractures in younger patients and requires careful consideration of fracture morphology, stability, and patient-related factors. A wide range of surgical techniques is currently available, yet clear treatment algorithms remain limited.A non-systematic narrative review of the literature was performed using PubMed, Scopus, and Google Scholar, supplemented by manual reference screening. The review focuses on contemporary surgical strategies for thoracic and lumbar OVF, with particular emphasis on fracture morphology as defined by the AO Spine-DGOU Osteoporotic Fracture (OF) classification and its implications for treatment selection.Minimally invasive cement augmentation techniques, including vertebroplasty and kyphoplasty, are primarily indicated for stable fracture patterns and provide effective pain relief and early mobilization. Posterior fixation strategies range from short-to long-segment constructs, with stability increasing as construct length increases, particularly in osteoporotic bone. Cement augmentation of pedicle screws significantly improves implant anchorage and reduces mechanical complications. Hybrid stabilization, combining posterior instrumentation with vertebral body augmentation, offers circumferential stabilization with favourable mid-term outcomes and reduced invasiveness compared with combined anterior-posterior surgery. Combined anterior-posterior reconstruction remains the most biomechanically robust option for selected patients with severe instability, neurological deficits, or structural collapse, although its use is limited by patient frailty and surgical morbidity.Surgical treatment of osteoporotic vertebral fractures encompasses a spectrum of techniques tailored to fracture morphology, biomechanical demands, and patient condition. Cement augmentation is suitable for less unstable fractures, whereas posterior fixation-often augmented or combined with hybrid strategies-is preferred in more complex patterns. Individualized treatment selection based on fracture classification and patient factors remains essential to optimize outcomes while minimizing complications. Copyright © 2026 Delhi Orthopedic Association. All rights are reserved, including those for text and data mining, AI training, and similar technologies. <103> Accession Number 2048203658 Title Intravenous amino acids to prevent acute kidney injury in cardiac surgery with cardiopulmonary bypass: a meta-analysis of randomized controlled trials. Source IJC Heart and Vasculature. 66 (no pagination), 2026. Article Number: 101986. Date of Publication: 01 Oct 2026. Author Pantaleao A.N.; Mutarelli A.; Kang J.; Braga M.A.P.; Passos F.S.; Caldonazo T.; Kirov H.; Doenst T.; Bagchi A.; Melnitchouk S. Institution (Pantaleao, Mutarelli) School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil (Kang, Melnitchouk) Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States (Braga) Department of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Passos) Department of Thoracic Surgery, Hospital MaterDei, Salvador, Brazil (Caldonazo, Kirov, Doenst) Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany (Bagchi) Department of Anesthesia and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Publisher Elsevier Ireland Ltd Abstract Background: The efficacy of intravenous amino acids (AA) in preventing cardiac surgery-associated acute kidney injury (CSA-AKI) remains uncertain. Method(s): Three libraries were searched for randomized controlled trials (RCTs) comparing intravenous AA versus placebo or standard care to reduce the risk of CSA-AKI after cardiac surgery with cardiopulmonary bypass (CPB). The primary endpoint was the incidence of CSA-AKI, overall and stratified by KDIGO stage. Secondary endpoints were need for renal replacement therapy (RRT), 30-day mortality, and 90-day mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Result(s): Five studies were included, comprising 4499 patients, of whom 2247 (50%) were randomized to intravenous AA infusion. Compared with placebo or standard care, intravenous AA administration significantly reduced the risk of CSA-AKI (RR 0.81, 95% CI 0.70-0.94; p = 0.005), predominantly driven by one trial. The relative risk reduction was more important for stage 2 or 3 AKI (RR 0.69, 95% CI 0.48-0.99; p = 0.046). No significant differences were observed in the need for RRT (p = 0.223), 30-day mortality (p = 0.893), or 90-day mortality (p = 0.581). Conclusion(s): Intravenous AA administration is associated with a reduced risk of CSA-AKI across the spectrum of AKI severity, without showing an association with other major clinical outcomes. Copyright © 2026 The Author(s) <104> Accession Number 2048126316 Title Uncovering the evidence frontier beyond the lipid-lowering effects of PCSK9 inhibitors in heart transplantation. Source American Journal of the Medical Sciences. (no pagination), 2026. Date of Publication: 2026. Author Yazdanpanah F.; Ramirez G. Institution (Yazdanpanah) Department of General Preventive Medicine and Public Health, The University of Texas Health Science Center at Tyler, TX, United States (Ramirez) Division of Population Health Leadership and Analytics, The University of Texas Health Science Center at Tyler, TX, United States Publisher Elsevier B.V. Abstract Cardiac allograft vasculopathy (CAV) is a major cause of long-term complications in heart transplant (HTx) recipients, with dyslipidemia playing a key role in its development. While statins are the standard therapy, their effectiveness can be limited by side effects, insufficient lipid-lowering response, or drug interactions. This scoping review examines the emerging role of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) as an alternative strategy, emphasizing their positive effects on lipid profiles, especially low-density lipoprotein cholesterol (LDL-c), in slowing CAV progression. Recent preclinical studies using a heterotopic murine heart transplant model have identified a novel finding: the PCSK9i "alirocumab" may protect against transplant rejection through mechanisms independent of lipid-lowering, possibly by modulating hepatic immune responses. These findings reveal a significant evidence frontier and highlight the need for clinical research to further explore the immunomodulatory properties of PCSK9i in the context of heart transplantation. Copyright © 2026 Southern Society for Clinical Investigation <105> Accession Number 2048096305 Title Association of pectoral nerve (PECS) and Serratus Anterior Plane (SAP) blocks with intraoperative left internal mammary artery free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting: a randomized controlled trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 470. Date of Publication: 01 Dec 2026. Author Tekeli A.E.; Eker E.; Sahinalp S.; Yuzkat N.; Caliskan R.; Catulay D.; Uzlas M.; Elkassabany N. Institution (Tekeli, Yuzkat, Catulay, Uzlas) Department of Anesthesiology and Reanimation, Van Yuzuncu Yil University School of Medicine, Van, Turkey (Eker) Department of Anesthesiology and Reanimation, Memorial Bodrum Hospital, Mugla, Turkey (Sahinalp) Department of Cardiovascular Surgery, Van Yuzuncu Yil University School of Medicine, Van, Turkey (Caliskan) Department of Cardiovascular Surgery, Health Sciences University Dr. Siyami Ersek Chest, Heart, and Vascular Surgery Training and Research Hospital, Istanbul, Turkey (Elkassabany) Department of Anesthesiology and Perioperative Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States Publisher BioMed Central Ltd Abstract Background: Ultrasound-guided pectoral nerve (PECS) and serratus anterior plane (SAP) blocks are increasingly used for perioperative analgesia in cardiac surgery. However, their effect on intraoperative physiological parameters, such as left internal mammary artery (LIMA) blood flow, remains unclear. This study aimed to evaluate the association of PECS and SAP blocks with intraoperative LIMA free blood flow and hemodynamic responses in patients undergoing coronary artery bypass grafting (CABG). Method(s): In this prospective, randomized controlled trial, 150 adult patients undergoing elective, isolated, on-pump CABG were allocated to three groups: control (no block), PECS block, or SAP block (n = 50 per group). Blocks were performed preoperatively under ultrasound guidance. LIMA free blood flow was measured intraoperatively after harvesting under standardized hemodynamic conditions and expressed as mL/min. Hemodynamic responses to surgical incision, intraoperative opioid requirements, and vasoactive drug use were also recorded. Result(s): Baseline characteristics were comparable among groups. LIMA free blood flow was higher in the PECS and SAP groups compared with the control group (mean +/- SD: 83.1 +/- 23.8 and 92.5 +/- 21.0 vs. 60.6 +/- 20.0 mL/min, respectively; p < 0.001), with higher values observed in the SAP group compared with the PECS group (p < 0.01). Both block groups demonstrated significantly attenuated increases in mean arterial pressure and heart rate in response to surgical incision (p < 0.001 for all comparisons) and reduced rescue opioid requirements. Vasoactive drug use prior to LIMA flow measurement was comparable among groups. Conclusion(s): PECS and SAP blocks were associated with attenuated hemodynamic responses to surgical incision and higher measured LIMA free blood flow under standardized conditions in patients undergoing CABG. These findings suggest that chest wall regional anesthesia techniques may influence intraoperative physiological parameters beyond their established analgesic effects. However, this study does not demonstrate improved graft patency, myocardial perfusion, or clinical outcomes. Further studies are warranted to determine whether these intraoperative differences translate into clinically meaningful benefits. Trial registration: ClinicalTrials.gov NCT05907798. Registered on 23 May 2023, before the initiation of patient recruitment at our institution. Copyright © The Author(s) 2026. <106> Accession Number 2048115961 Title Central and Mixed Venous Oxygen Saturation in Cardiac Surgery: A Systematic Review and Meta-analysis. Source Journal of Cardiothoracic and Vascular Anesthesia. (no pagination), 2026. Date of Publication: 2026. Author Guarnieri M.; Baggio L.; Amendolagine L.; Mincolelli A.; De Caria D.; Nonini S.; Battistelli E.Z.; Mulazzani F.; Fumagalli M.; Mondino M.G.; Pedrazzini G.; Belletti A. Institution (Guarnieri, Pedrazzini) Department of Anesthesia and Intensive Care, Centro Cardiologico Monzino IRCCS, Milan, Italy (Baggio, Amendolagine, Battistelli, Mulazzani, Fumagalli) Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy (Amendolagine, Mincolelli, De Caria, Nonini, Mondino) Cardiothoracic and Vascular Anaesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Publisher W.B. Saunders Abstract Central venous oxygen saturation (ScvO<inf>2</inf>) and mixed venous oxygen saturation (SvO<inf>2</inf>) are widely used markers of tissue perfusion. Their role in cardiac surgery remains uncertain. This study conducted a systematic review and meta-analysis to evaluate the prognostic significance of ScvO<inf>2</inf> or SvO<inf>2</inf> in this setting. PubMed, Embase, and the Cochrane Library were searched from inception to March 31, 2025. Included studies enrolled adult or pediatric cardiac surgery patients reporting associations between ScvO<inf>2</inf> and/or SvO<inf>2</inf> values and clinical outcomes. Exclusion criteria were noncardiac surgery populations, case reports, editorials, and studies without outcome data. Quantitative synthesis was performed for studies reporting mortality data across different ScvO<inf>2</inf> or SvO<inf>2</inf> strata. Of 11,037 records screened, 29 studies (38,217 patients) were included in the qualitative synthesis and 9 studies in the meta-analysis. Most were observational, with heterogeneous measurement timing and thresholds. In particular, most studies performed measurement at a single time point. Low ScvO<inf>2</inf> or SvO<inf>2</inf> (<60%-65%) was significantly associated with increased mortality compared with normal values (risk ratio, 5.23; 95% confidence interval, 2.82-9.69; p < 0.00001; I2 = 79%). No significant difference was observed between normal and supranormal (>77.4%-80%) values. Risk of bias was generally low to moderate, with confounding the main concern. Low ScvO<inf>2</inf> or SvO<inf>2</inf> identified patients at higher risk after cardiac surgery. However, most data were derived from single-time-point observational studies, and evidence regarding trends, repeated measurements, or study-defined high or supranormal values is limited. Copyright © 2026 The Author(s) <107> Accession Number 2048168842 Title The Effectiveness of Perioperative Respiratory Muscle Exercise in Elderly Cardiac Surgery Patients: A Randomized Controlled Trial. Source Archives of Physical Medicine and Rehabilitation. (no pagination), 2026. Date of Publication: 2026. Author Wang Q.; Shao J.; Peng Y.; Li S.; Chen L.; Lin Y. Institution (Wang, Shao, Peng, Lin) Department of Nursing, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Wang, Li, Chen, Lin) Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Wang) School of Nursing, Fujian Medical University, Fujian, Fuzhou, China Publisher W.B. Saunders Abstract Objective: This study aimed to evaluate the impact of perioperative respiratory muscle training on respiratory muscle strength, pulmonary function, functional capacity, and prognostic outcomes in patients undergoing surgery. Design(s): A randomized controlled trial. Setting(s): Cardiac surgery ward and cardiac surgery intensive care unit of a tertiary Grade A hospital in Fuzhou, China. Participant(s): Eighty-two participants. Intervention(s): Perioperative respiratory muscle exercise. Main Outcome Measure(s): Eighty-two patients were randomly assigned to either the intervention group (n=42), who performed perioperative respiratory muscle training, or the control group (n=40). The intervention group completed respiratory muscle exercise from admission to discharge (except during mechanical ventilation). Respiratory muscle strength was assessed upon admission, the day before surgery, on the third day postintensive care unit transfer, and at discharge. Each patient underwent a lung function test, a 6-minute walk test, a self-efficacy for exercise scale, an anxiety and depression test, and a quality of life questionnaire, before and after intervention. Result(s): Compared to the control group, the intervention group showed significantly greater improvements in maximal inspiratory pressure (57.69+/-10.85 cmH<inf>2</inf>O vs 48.28+/-10.30 cmH<inf>2</inf>O), pulmonary function, functional capacity, postoperative pulmonary complications (38.1% vs 65.0%), inspiratory muscle weakness (42.9% vs 85.0%), duration of mechanical ventilation and intensive care unit stay, level of anxiety and depression, quality of life, and length of postoperative hospitalization. In addition, the incidence of postoperative pulmonary (9.5% vs 22.5%) and rehospitalization within 6 months (9.5% vs 17.5%) was reduced, though not statistically significant. Conclusion(s): Perioperative respiratory muscle training could contribute to improved respiratory muscle strength, pulmonary function, functional capacity, prognostic outcomes, and quality of life in elderly cardiac surgery patients. Continuous activation of the respiratory muscles could provide multiple benefits for these individuals. Copyright © 2026 American Congress of Rehabilitation Medicine <108> Accession Number 651882070 Title Delay and Attrition in Severe Aortic Stenosis: A Four-Checkpoint Systematic Review of Pathway Bottlenecks and Interventions. Source European heart journal. Quality of care & clinical outcomes. (no pagination), 2026. Date of Publication: 01 Aug 2026. Author Fanous N.; Zubrzycki N.; Weir L.; Mohammed F.; Pomeroy A.; Meredith T.; Roy D.; Roy A.; Kovacic J.; Muller D.; Feneley M.; Elmariah S.; Namasivayam M. Institution (Fanous, Zubrzycki, Weir, Mohammed, Pomeroy, Meredith, Roy, Roy, Kovacic, Muller, Feneley, Namasivayam) St Vincent's Hospital Sydney, Sydney, NSW, Australia (Fanous, Zubrzycki, Weir, Mohammed, Pomeroy, Meredith, Kovacic, Feneley, Namasivayam) Victor Chang Cardiac Research Institute, Sydney, NSW, Australia (Fanous, Zubrzycki, Weir, Feneley, Namasivayam) Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia (Elmariah) Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Abstract The care pathway for severe aortic stenosis (AS) remains vulnerable to diagnostic delay, referral inertia, undertreatment, and procedural waiting times despite the availability of definitive intervention with surgical or transcatheter aortic valve replacement. This systematic review with narrative synthesis aimed to identify where delay and attrition occur across the contemporary severe AS pathway and to summarise evidence for digital, organisational, and workflow interventions designed to improve timely care. Randomised and non-randomised studies examining diagnostic, referral, treatment-decision, or procedural-access delays in adults with severe AS were eligible. Findings were mapped onto a four-checkpoint framework: pre-echocardiographic recognition, echocardiographic detection, post-diagnostic referral and decision-making, and procedural access. Nineteen studies met inclusion criteria. After de-duplication of overlapping registries and exclusion of studies without a verifiable unique severe-AS or severe-AS pathway denominator, the synthesis represented approximately 52,000 patients. Evidence was unevenly distributed, with no included study providing severe-AS-specific data before echocardiography. At echocardiographic detection, missed or delayed recognition was concentrated in low-gradient phenotypes and women; an artificial-intelligence-assisted alert system increased severe-AS detection from 2.4% to 4.1%. After diagnosis, undertreatment persisted despite guideline indications, and non-cardiology ordering of the diagnostic echocardiogram was associated with lower early follow-up or AVR and higher mortality. Electronic provider notification increased one-year AVR rates from 37.2% to 48.2%, with the largest observed effects in women, patients older than 80 years, and inpatient echocardiography. At procedural access, wait-list mortality was approximately 4.5%-5.8%, with deaths occurring early after referral. Risk-based triage reduced modelled wait-list mortality, while decentralised pre-procedural work-up shortened referral-to-TAVI time from 126 to 32 days. Severe AS care is characterised by measurable delay and attrition across multiple post-diagnostic transitions, while pre-echocardiographic recognition remains an important evidence gap. A four-checkpoint framework may support benchmarking and targeted pathway improvement through structured reporting, electronic referral prompts, risk-based triage, and decentralised workflows. 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 <109> Accession Number 651877271 Title Effect of Buerger-Allen Exercises on Lower Extremity Perfusion in Diabetes Mellitus Patients Undergoing Coronary Artery Bypass Grafting With Saphenous Vein Harvesting: A Randomized Controlled Trial. Source Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 31(4) (pp e70308), 2026. Date of Publication: 01 Oct 2026. Author Thakare N.; Shukla M.P.; Kapre V. Institution (Thakare, Kapre) Department of Cardiovascular & Respiratory Physiotherapy, MGM Institute of Physiotherapy, Maharashtra, India (Shukla) Department of Cardiovascular & Respiratory Physiotherapy, Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India Abstract BACKGROUND & PURPOSE: Patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with saphenous vein harvesting are at increased risk of impaired lower extremity perfusion and wound-related complications. Buerger-Allen exercises have been proposed to improve peripheral circulation; however, evidence supporting their effectiveness following CABG remains limited. This study evaluated the effect of Buerger-Allen exercises as an adjunct to phase I cardiac rehabilitation on lower extremity perfusion and wound healing in diabetic patients undergoing CABG. METHOD(S): A randomized controlled trial was conducted involving 60 diabetic patients undergoing CABG with saphenous vein harvesting. Participants were randomly allocated to an intervention group receiving standard phase I cardiac rehabilitation plus Buerger-Allen exercises (n = 30) or a control group receiving standard rehabilitation alone (n = 30). The primary outcome was ankle-brachial index (ABI). Secondary outcomes included wound healing disturbances and peripheral ankle swelling. Postoperative ABI was analyzed using two-way repeated-measures ANOVA, whereas categorical outcomes were analyzed using Fisher's exact test or the Chi-squared test. RESULT(S): A significant effect of time on ABI was observed (p = 0.004), whereas neither the group effect (p = 0.754) nor the group x time interaction (p = 0.711) was statistically significant. An earlier resolution of mild wound-related pain was observed on postoperative day 3 in the intervention group (p = 0.038); however, no between-group differences were present on postoperative day 5. No intervention-related adverse events were reported. DISCUSSION(S): Buerger-Allen exercises were safe and feasible during early postoperative rehabilitation but did not provide additional improvement in lower extremity perfusion beyond standard rehabilitation during the 5-day postoperative period. The isolated improvement in wound-related pain should be interpreted cautiously. CONCLUSION(S): Buerger-Allen exercises did not significantly improve the primary outcome of lower extremity perfusion following CABG. Although they appeared safe and were associated with transient improvement in wound-related pain, further adequately powered studies with longer follow-up are required to determine whether clinically meaningful benefits exist. TRIAL REGISTRATION: This study was prospectively registered in the Clinical Trial Registry India (CTRI/2023/10/058535). Copyright © 2026 John Wiley & Sons Ltd. All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies. <110> Accession Number 651883938 Title Exploring patient and NHS staff acceptability of artificial intelligence-supported surgical wound monitoring within the WISDOM feasibility study: a multi-centre qualitative interview study. Source BMJ open. 16(7) (pp e116323), 2026. Date of Publication: 31 Jul 2026. Author Tanner J.; Rochon M.; Cariaga K.; Harris R.; Beckhelling J.; Bouttell J.; Bolton S.; Wilson K.; Jurkiewicz J.; Dhoonmoon L.; Mostafa N.; Dummer J.; Basilio K.; Magboo R.; Procter K.; McMillan C. Institution (Tanner) School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Rochon) Infection Prevention and Control, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Cariaga) Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Harris) Research Support Service, University of Nottingham, Nottingham, United Kingdom (Beckhelling) University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom (Bouttell, Bolton) Centre for Healthcare Equipment and Technology, Nottingham, United Kingdom (Wilson) Research, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom (Jurkiewicz) Isla Health, London, United Kingdom (Dhoonmoon) Central and North West London NHS Foundation Trust, London, United Kingdom (Mostafa, Dummer) Health Innovation East Midlands, Nottingham, United Kingdom (Basilio) Barts Health NHS Trust, London, United Kingdom (Magboo) Saint Bartholomew's Hospital Barts Heart Centre, London, United Kingdom (Procter, McMillan) Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom Abstract OBJECTIVE: Artificial intelligence (AI) is beginning to be used within digital surgical wound monitoring to facilitate implementation at scale. AI acceptability is essential to its success. This study aimed to explore patient and staff acceptability of an AI-based digital surgical wound monitoring platform. DESIGN: Qualitative interviews SETTING: Two hospitals performing cardiac surgery in England. PARTICIPANTS: 20 patients undergoing cardiac surgery and 10 clinical staff participating in a randomised feasibility trial of surgical wound monitoring with AI. INTERVENTIONS: Semi-structured interviews were conducted focusing on participants' experiences or perceptions of AI-based digital surgical wound monitoring. Data were analysed, guided by the theoretical framework of acceptability. PRIMARY MEASURE: Patient and staff acceptability of AI within surgical wound monitoring. RESULT(S): Patients and staff were supportive of the use of AI within surgical wound monitoring and felt safety was improved, access was increased and efficiency was improved. AI monitoring was perceived to allow the early detection and treatment of surgical wound complications and facilitate the implementation of monitoring at scale for all patients. Some participants were concerned about data security risks, staff over-reliance on AI and the loss of human interaction. CONCLUSION(S): AI-supported digital surgical wound monitoring appeared acceptable to participants within this feasibility study. Further research is needed to evaluate implementation in broader settings. TRIAL REGISTRATION NUMBER: ISRCTN16900119 and NCT06475703. Copyright © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group. <111> Accession Number 651877658 Title Association between preoperative sleep disturbance and postoperative delirium in older adults: a systematic review and meta-analysis. Source Psychology, health & medicine. (pp 1-18), 2026. Date of Publication: 31 Jul 2026. Author Zhao B.; Li J.; Wang M.; Xiao Z. Institution (Zhao) Dalian Medical University, Dalian, China (Zhao) Department of Anesthesiology, Central Hospital of Dalian University of Technology, Dalian, China (Li) Department of Anesthesiology, Yantai Yuhuangding Hospital of Qingdao University Yantai, Yantai, China (Wang) Department of Anesthesiology, Ningde MunicipaI Hospital of Ningde Normal University, Ningde, China (Xiao) Department of Anesthesiology, Second Hospital of Dalian Medical University, Dalian, China Abstract This systematic review and meta-analysis aimed to investigate the association between preoperative sleep disturbance and postoperative delirium (POD) in older surgical patients. A comprehensive search encompassing PubMed, Embase, Cochrane Library, and Web of Science was conducted from inception to December 30, 2024. Subgroup and sensitivity analyses were performed to explore heterogeneity. Seventeen studies involving 49 758 patients were included. The findings indicated a significant association between preoperative sleep disturbance, variously defined across studies, and POD (OR: 2.84; 95% CI: 1.63-4.93; p = 0.002). Subgroup analyses revealed a higher incidence of POD in patients undergoing cardiac (OR: 3.03; 95% CI: 1.78 - 5.15, p < 0.0001), orthopedic (OR: 4.48; 95% CI: 2.83-7.10, p < 0.00001), or other non-cardiac surgeries (OR: 2.36; 95% CI: 1.55-3.60, p < 0.0001). Additionally, an association was found in moderate to-high complexity surgery (OR: 0.79; 95% CI: 0.71-0.88, p < 0.0001). Obstructive sleep apnea (OSA) (OR: 2.18; 95% CI: 1.10-4.29, p = 0.02) and unspecified sleep disturbance (OR: 3.92; 95% CI: 2.66-5.79, p < 0.00001) were also significantly associated with POD. This systematic review and meta-analysis identifies a significant association between preoperative sleep disturbance and a higher incidence of postoperative delirium in older surgical patients. These findings underscore the importance of sleep quality assessment in preoperative care. Further research is warranted to elucidate the underlying mechanisms and enhance interventions. <112> Accession Number 651876065 Title Gabapentin for Postoperative Analgesia in Cardiac Surgery via Sternotomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 01 Jul 2026. Author Nhuch F.; Gonzalez G.L.; Wegner G.R.M.; Wegner B.F.M.; Barreto L.A.L.; Marinho Miranda A.; Li R.; do Nascimento T.S. Institution (Nhuch) Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States (Gonzalez) Federal University of the State of Rio de Janeiro - UNIRIO, Rio de Janeiro, Brazil (Wegner) Federal University of Fronteira Sul, Rio Grande do Sul, Brazil (Wegner) Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil (Barreto) Federal University of Ceara, Ceara, Brazil (Marinho Miranda) Federal University of Sao Paulo, UNIFESP, Sao Paulo, Brazil (Li) Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, United States (do Nascimento) Department of Anesthesiology, University of Iowa, IA, United States Abstract BACKGROUND: Opioids remain the mainstay for moderate-to-severe postoperative pain after cardiac surgery but are associated with frequent adverse effects. Gabapentin has been proposed as part of multimodal analgesia to reduce opioid use and related complications. However, existing evidence in cardiac surgery is limited and heterogeneous. This systematic review and meta-analysis aimed to evaluate the latest evidence on the efficacy and safety of perioperative gabapentin for postoperative analgesia in adults undergoing cardiac surgery. METHOD(S): PubMed, Embase, and the Cochrane Library were searched through October 1, 2025, for randomized controlled trials (RCTs) comparing perioperative gabapentin with placebo in adults undergoing cardiac surgery via sternotomy. The primary outcome was postoperative pain at 24 hours. Secondary outcomes included pain at other time points, opioid consumption, and adverse events (nausea, vomiting, sedation, atrial fibrillation). Pooled analyses used random-effects models with mean differences for pain outcomes, standardized mean differences for opioid consumption, and risk ratios for dichotomous outcomes, with 95% confidence intervals. The certainty of evidence across outcomes was assessed using the GRADE framework. RESULT(S): Six RCTs, including 751 patients, were analyzed. Mean age ranged from 50 to 69.9 years, and 82.9% were male. Gabapentin was not associated with a statistically significant reduction in rest pain (MD -0.69; 95% CI -1.38 to 0.00; p = 0.0507) or cough-elicited pain at 24 hours (MD -0.34; 95% CI -0.71 to 0.04; p = 0.079). However, a modest but statistically significant reduction in cough-elicited pain was observed at 6 hours (MD -1.24; 95% CI -2.45 to -0.03; p = 0.0439). Gabapentin was associated with lower opioid consumption at 24 hours when analyzed using standardized mean difference (SMD -1.06; 95% CI -2.02 to -0.11; p = 0.0295). No significant differences were observed for pain outcomes at other time points or for adverse events, including sedation, nausea, vomiting, or atrial fibrillation. According to the GRADE framework, the certainty of evidence for these outcomes ranged from low to very low. CONCLUSION(S): Gabapentin provided a small, isolated reduction in early cough-elicited pain but not a clinically meaningful reduction in opioid consumption or overall analgesic benefit after cardiac surgery via sternotomy. Routine use as part of multimodal analgesia is not supported. Copyright © 2026 Elsevier Inc. All rights reserved. <113> Accession Number 2047966965 Title Chimney Stenting Versus BASILICA for Prevention of Coronary Obstruction in High-Risk Transcatheter Aortic Valve Implantation. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S660-S661), 2026. Date of Publication: 01 Aug 2026. Author Zaka A.; Mutahar D. Institution (Zaka, Mutahar) Gold Coast University Hospital, Ormeau, QLD, Australia Publisher Elsevier Ltd Abstract Aim: We aimed to compare clinical and safety outcomes between BASILICA and chimney stenting in high-risk TAVI. Method(s): PubMed, EMBASE, Web of Science, and Cochrane databases were searched until February 20, 2026 for all studies enrolling TAVI patients undergoing preventive BASILICA or chimney stenting. The primary endpoint was early all-cause mortality (in-hospital and at 30 days). The secondary outcome was the composite 1-year major adverse cardiovascular events (MACE). Odds ratios (OR) were pooled using a random-effects model. Result(s): A total of 13 studies were included (424 patients undergoing BASILICA and 389 chimney stenting). Technical success was 97.4% and 87.9% in chimney and BASILICA groups, respectively (p<0.001). Planned BASILICA was converted to bailout coronary stenting in 20/424 (4.7%) of cases. There was no statistically significant difference in MACE at 1 year between the chimney and BASILICA strategies (OR 0.92, 95% CI 0.42-2.01), despite a trend towards increased early all-cause mortality (8.3% vs 4.8%, p=0.07) (Figure). Conclusion(s): Chimney stenting and BASILICA demonstrate comparable 1-year efficacy in preventing clinically significant CO in high-risk TAVI. Despite trend towards increased mortality, AKI and paravalvular leak in the chimney stenting group, there was insufficient evidence to demonstrate superiority of either strategy. [Formula presented] Copyright © 2026 <114> Accession Number 651870275 Title CEREBRAL EMBOLIC PROTECTION DEVICES (CEPDS) DURING TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI): A META-ANALYSIS OF 11,589 PATIENTS FROM RANDOMIZED CONTROLLED TRIALS. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i1035-i1036), 2026. Date of Publication: 01 May 2026. Author Gbreel M.; Badran A.; Hassan M.; Balata M. Institution (Gbreel) Department of Neurology, Ahmed Maher Teaching Hospital, Cairo, Egypt (Badran) Faculty of Medicine, Ain Shams University, Cairo, Egypt (Hassan) Department of Immunology, Theodor Bilharz Research Institute, Giza, Egypt (Balata) Department of Cardiology, University of Rostock, Rostock, Germany Publisher Oxford University Press Abstract Background and aims: Transcatheter aortic valve implantation (TAVI) is associated with procedure-related stroke. Cerebral embolic protection devices (CEPDs) are designed to reduce the risk of embolic debris reaching the brain; however, the evidence supporting their efficacy remains controversial. In this study, we aim to evaluate the efficacy and safety of CEPDs in patients undergoing TAVI. Method(s): Six databases (PubMed, Scopus, Web of Science, Cochrane, Embase, and Ovid) were systematically searched up to April 4, 2025. Only randomized controlled trials (RCTs) were included and critically appraised using the Cochrane Risk of Bias 2 (ROB-2) tool. Statistical analyses were performed using R software to calculate risk ratios (RRs) with 95% confidence intervals. Result(s): We retrieved 1609 records. Eight RCTs (11,589 patients) were analyzed. No significant difference was observed in overall stroke incidence between CEPD and control groups (RR 0.93; 95% CI: 0.74-1.16; P=0.49), including disabling and non-disabling strokes. Device-specific analyses showed a non-significant trend toward reduced disabling stroke with the Sentinel device, while the Triguard device was associated with increased major vascular complications (RR 2.18; 95% CI: 1.04-4.59). All-cause mortality, transient ischemic attacks, bleeding, acute kidney injury, delirium, and pacemaker implantation rates were similar between groups. Notably, CEPD use was linked to a transient improvement in cognitive function (MoCA scores) at 2-5 days post-TAVI, but this effect was not sustained at later follow-ups. Conclusion(s): CEPDs show no significant reduction in overall, disabling, or non-disabling stroke, nor in all-cause mortality post-TAVI. <115> Accession Number 2047977864 Title Prognostic Significance of Atherosclerotic Plaque Detected by CT Coronary Angiography in Asymptomatic Adults: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S644), 2026. Date of Publication: 01 Aug 2026. Author Machado R.; Khanna S.; Vasanthakumar S.; Paleri S.; Boktor J.; Hood H.; Lin A.; Nerlekar N. Institution (Machado, Nerlekar) Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (Khanna) The George Institute for Global Health, Sydney, NSW, Australia (Vasanthakumar, Paleri, Boktor, Hood, Lin, Nerlekar) Victorian Heart Institute, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Aim: Current cardiovascular risk assessment may fail to identify patients with subclinical atherosclerosis. The prognostic significance of plaque detected by CT Coronary Angiography (CTCA) in asymptomatic patients remains uncertain. This systematic review and meta-analysis aimed to evaluate the association between CTCA-detected coronary plaque and major adverse cardiovascular events (MACE) in asymptomatic adults. Method(s): PubMed, Embase and CENTRAL were systematically searched for studies reporting MACE (defined as myocardial infarction, unstable angina, all-cause or cardiovascular mortality, or coronary revascularisation) in asymptomatic adults undergoing CTCA. Multivariable hazard ratios (HRs) for MACE associated with CTCA-detected coronary artery disease (CAD) were log-transformed and pooled using random-effects meta-analysis. Result(s): Seven studies including 37,176 asymptomatic adults were analysed. Mean age was 60 years, 49% were male and mean follow-up was 6.5 years. CTCA-detected obstructive CAD was associated with increased MACE risk (pooled HR 2.79, 95% CI 1.55-5.04; p<0.001). Two studies reported outcomes in patients with coronary artery calcium score=0; MACE occurred in 9 patients (17%) with obstructive CAD and 5 (0.08%) without. Individual studies also demonstrated that any plaque (HR 1.59, 95% CI 1.16-2.20) and noncalcified plaque (HR 1.60, 95% CI 1.22-2.10) were associated with MACE. Lesion-level analysis from one study demonstrated that low-attenuation plaque was strongly associated with plaque vulnerability (HR 14.3, 95% CI 1.9-109; p=0.010). Conclusion(s): CTCA-detected coronary atherosclerosis in asymptomatic adults is associated with significantly increased risk of subsequent cardiovascular events and can provide prognostic information beyond calcium scoring. Further investigation into the role of CTCA in primary prevention is warranted. Copyright © 2026 <116> Accession Number 651870314 Title PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE FOR PATIENTS WITH ATRIAL FIBRILLATION-RELATED ISCHEMIC STROKE DESPITE ANTICOAGULATION: AFIDA 1 & 2 STUDIES. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i1082), 2026. Date of Publication: 01 May 2026. Author Koga M.; Tanaka K.; Kusano K. Institution (Koga) Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (Tanaka) Stroke Center, Kinki University Hospital, Sakai, Japan (Kusano) Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan Publisher Oxford University Press Abstract Background and aims: Anticoagulation effectively prevents recurrent ischemic events. However, AF-related ischemic stroke despite anticoagulation (AFIDA) carries an approximately 1.5-fold higher risk of recurrent ischemic stroke than strokes occurring without oral anticoagulants, highlighting the urgent need for novel preventive strategies. Percutaneous left atrial appendage closure (LAAC) is reimbursed in Japan for patients at high bleeding risk (e.g., HAS-BLED >=3) with planned discontinuation of antithrombotic therapy, and meta-analyses of the PROTECT AF and PREVAIL trials demonstrated that LAAC significantly reduces disabling or fatal stroke (mRS >=2) compared with warfarin with non-significant increase of ischemic stroke or systemic embolism. Method(s): To evaluate the efficacy and safety of LAAC in AFIDA. Result(s): A multicenter, prospective, single-arm interventional trial in which cardiologists and stroke specialists collaboratively perform LAAC in 180 AFIDA patients (AFIDA2) is ongoing. Continuation of oral anticoagulation during follow-up will be individualized according to ischemic and bleeding risk profiles. In parallel, we will establish a multicenter prospective cohort of 520 AFIDA patients (AFIDA1), enabling integrated analysis of the interventional and observational arms. Conclusion(s): The primary composite endpoint is 1-year incidence of ischemic stroke or systemic embolism. <117> Accession Number 651888746 Title Central and Mixed Venous Oxygen Saturation in Cardiac Surgery: A Systematic Review and Meta-analysis. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 05 Jul 2026. Author Guarnieri M.; Baggio L.; Amendolagine L.; Mincolelli A.; De Caria D.; Nonini S.; Battistelli E.Z.; Mulazzani F.; Fumagalli M.; Mondino M.G.; Pedrazzini G.; Belletti A. Institution (Guarnieri, Pedrazzini) Department of Anesthesia and Intensive Care, Centro Cardiologico Monzino IRCCS, Milan, Italy (Baggio, Battistelli, Mulazzani, Fumagalli) Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy (Amendolagine) Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy; Cardiothoracic and Vascular Anaesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (Mincolelli, De Caria, Nonini, Mondino) Cardiothoracic and Vascular Anaesthesia and Intensive Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (Belletti) Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy Abstract Central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation (SvO2) are widely used markers of tissue perfusion. Their role in cardiac surgery remains uncertain. This study conducted a systematic review and meta-analysis to evaluate the prognostic significance of ScvO2 or SvO2 in this setting. PubMed, Embase, and the Cochrane Library were searched from inception to March 31, 2025. Included studies enrolled adult or pediatric cardiac surgery patients reporting associations between ScvO2 and/or SvO2 values and clinical outcomes. Exclusion criteria were noncardiac surgery populations, case reports, editorials, and studies without outcome data. Quantitative synthesis was performed for studies reporting mortality data across different ScvO2 or SvO2 strata. Of 11,037 records screened, 29 studies (38,217 patients) were included in the qualitative synthesis and 9 studies in the meta-analysis. Most were observational, with heterogeneous measurement timing and thresholds. In particular, most studies performed measurement at a single time point. Low ScvO2 or SvO2 (<60%-65%) was significantly associated with increased mortality compared with normal values (risk ratio, 5.23; 95% confidence interval, 2.82-9.69; p < 0.00001; I2 = 79%). No significant difference was observed between normal and supranormal (>77.4%-80%) values. Risk of bias was generally low to moderate, with confounding the main concern. Low ScvO2 or SvO2 identified patients at higher risk after cardiac surgery. However, most data were derived from single-time-point observational studies, and evidence regarding trends, repeated measurements, or study-defined high or supranormal values is limited. Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved. <118> Accession Number 651881717 Title Mechanical vs. sutureless aortic valve replacement: clinical outcomes and the contribution of preoperative multislice CT. Source Cardiovascular journal of Africa. 37(3) (pp 289-293), 2026. Date of Publication: 31 Jul 2026. Author Coban O.; Ozsoyler I. Institution (Coban) Adana City Training and Research Hospital, Department of Cardiovascular Surgery, Adana, Turkey (Ozsoyler) Adana City Training and Research Hospital, Department of Cardiovascular Surgery, Adana, Turkey Abstract INTRODUCTION: Heart valve disease is a significant cause of morbidity and mortality, and aortic valve replacement (AVR) is a common treatment option. Recently, sutureless biological valves have gained increasing use. This study aimed to evaluate the concordance between preoperative computed tomography-derived annulus measurements and valve sizes implanted during surgery rather than the direct clinical impact of imaging on prosthesis selection. METHOD(S): A total of 40 patients with aortic valve stenosis who underwent elective open-heart surgery and preoperative multislice computed tomography between February 20 and May 20, 2024, were included and were randomly allocated into two groups: sutureless biological valve (n = 20) and mechanical valve (n = 20). Data were obtained from patient records and the hospital's data system and analysed statistically. RESULT(S): A total of 40 patients were included in the study: 20 received sutureless, rapidly implantable biological valves, and 20 underwent mechanical AVR. The mean age of the cohort was 61.5 +/- 9.1 years, with 45% females and 55% males. Compared with the sutureless group, the mechanical valve group had significantly longer cross-clamp (73.5 vs. 53.0 minutes, p < 0.001) and cardiopulmonary bypass times (102 vs. 92 minutes, p = 0.011), as well as smaller sinotubular junction diameters (30.2 vs. 32.3 mm, p = 0.025). In contrast, the sutureless group demonstrated a significantly greater optimal effective orifice area index (1.58 vs. 0.77, p < 0.001). CONCLUSION(S): Preoperative computed tomography is a reliable tool for planning AVR. Sutureless biological valves provide shorter cross-clamp and bypass times and favourable haemodynamic performance, whereas mechanical valves are more often associated with smaller valve sizes and longer procedures. Early postoperative outcomes were comparable between groups. <119> Accession Number 651887618 Title Outcomes of Video-Assisted Thoracic Surgery Compared to Open Thoracic Surgery for Pulmonary Hydatid Disease: A Systematic Review and Meta-Analysis. Source Heart, lung & circulation. (no pagination), 2026. Date of Publication: 03 Aug 2026. Author Hussein A.M.; Hammadeh B.M.; Aldalati A.Y.; Albliwi M.; Odat R.M.; Shabaneh A. Institution (Hussein, Hammadeh) Faculty of Medicine, Al- Balqa' Applied University, Salt, Jordan (Aldalati, Odat) Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Albliwi) Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States (Shabaneh) Department of General Surgery, Mayo Clinic, Rochester, MN, United States Abstract BACKGROUND & AIM: Pulmonary echinococcosis, or pulmonary hydatid disease, caused by Echinococcus larvae, presents a significant health challenge, particularly in endemic areas. While surgery is the primary treatment for viable cysts, the optimal approach for this remains under debate. There is a lack of comparative evidence comparing traditional open thoracic surgery (OTS) with minimally invasive video-assisted thoracic surgery (VATS). This systematic review and meta-analysis aims to comprehensively compare the efficacy and safety of VATS versus OTS for pulmonary hydatid disease; it will expand on prior research by including patients of all ages and conducting detailed subgroup analyses, sensitivity analyses, and publication bias assessments. METHOD(S): Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and International Prospective Register of Systematic Reviews registration (CRD420251012764), major databases (PubMed, Scopus, Cochrane Library, Web of Science) were searched up to 5 March 2025, without language or date restrictions. Comparative studies (randomised controlled trials and observational studies) reporting perioperative, postoperative, and recovery outcomes for VATS versus OTS were included. Data were synthesised using random-effects models (calculating mean differences [MDs] or risk ratios with 95% confidence intervals). Heterogeneity (I2), risk of bias (Risk Of Bias In Non-randomised Studies of Interventions) and publication bias (Doi plots, Luis Furuya-Kanamori index) were assessed. RESULT(S): Nine retrospective cohort studies met the inclusion criteria. Compared with OTS, VATS was associated with significantly shorter operation times (MD -38.08 min; p<0.001; I2=92%), lower perioperative blood loss (MD -64.02 mL; p=0.006; I2=98%), reduced postoperative drainage volume (MD -124.46 mL; p=0.003; I2=85%), earlier chest drain removal (MD -2.27 days; p<0.001; I2=92%), and shorter hospital stays (MD -3.68 days; p<0.001; I2=98%). Although VATS showed a trend towards fewer postoperative complications, the difference was not statistically significant (risk ratio 0.72; p=0.13; I2=0%). Significant heterogeneity (I2>85%) was present for most continuous outcomes, and risk of bias assessment indicated high risks in confounding and reporting domains for several studies. Potential publication bias favouring VATS was detected for multiple outcomes. CONCLUSION(S): VATS appears to offer significant perioperative and recovery advantages over OTS for the surgical management of pulmonary hydatid disease. However, these findings must be interpreted with caution. While this review incorporates recently available randomised evidence, the majority of the data remains retrospective, and the pooled results are affected by significant heterogeneity and a high risk of bias in several domains. Copyright © 2026 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved. <120> Accession Number 651871031 Title SEX-SPECIFIC DIFFERENCES IN STROKE INCIDENCE AFTER TRANSCATHETER VERSUS SURGICAL AORTIC VALVE REPLACEMENT: A META-ANALYSIS. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i426-i427), 2026. Date of Publication: 01 May 2026. Author Hammad N. Institution (Hammad) Faculty of Medicine, Port-Said University, Port Said, Egypt Publisher Oxford University Press Abstract Background and aims: Stroke remains a major complication following aortic valve replacement, yet sex-specific differences in stroke incidence and mortality after transcatheter versus surgical approaches are not well established. Method(s): We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of patients with severe aortic stenosis undergoing TAVR or SAVR. We searched PubMed, Scopus, CENTRAL, and Web of Science from inception to December 2025. Outcomes were analyzed in women and men, with sex-specific pooling performed for stroke and all-cause mortality. Effect estimates were reported as risk ratios (RRs) with 95% confidence intervals (CIs). Result(s): Stroke data were available for 2,401 women from five randomized trials and 2,519 men from four trials. In women, stroke incidence did not differ significantly between TAVR and SAVR (4.4% vs. 5.4%; OR = 0.73, 95% CI: 0.50-1.09). TAVR was associated with a significant reduction in all-cause mortality or disabling stroke compared with SAVR (OR = 0.73, 95% CI: 0.56-0.96), driven primarily by benefit in high surgical risk women (OR = 0.64, 95% CI: 0.42-0.98), while outcomes were comparable in low- or intermediate-risk women. In men, stroke incidence was similarly comparable between TAVR and SAVR across all surgical risk categories, with stroke rates of 5.2% and 6.6%, respectively (OR = 0.75, 95% CI: 0.53-1.04). Conclusion(s): TAVR reduced death or disabling stroke in high-risk women, with no similar benefit observed in men.(Figure Presented) <121> Accession Number 651883439 Title Multivessel coronary artery bypass grafting via small thoracotomy versus sternotomy (MIST): an investigator-initiated, international, open-label, randomised controlled trial. Source Lancet (London, England). (no pagination), 2026. Date of Publication: 31 Jul 2026. Author Ruel M.; Nambala S.; Guo M.H.; Verevkin A.; Rabindranauth P.; Kikuchi K.; Davierwala P.M.; Lemma M.; Ponnambalam M.; Sheikh A.; Black A.; Borger M.A.; Whitlock R.P.; Zhang Y.; Wells G.A. Institution (Ruel, Guo, Sheikh, Black, Zhang) Department of Surgery, University of Ottawa, Ottawa, ON, Canada (Nambala) Department of Surgery, Apollo Hospitals, Bengaluru, India (Verevkin, Borger) University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany (Rabindranauth) Department of Cardiothoracic Surgery, Gundersen Health System, La Crosse, WI, United States (Kikuchi) Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan (Davierwala) Department of Surgery, University of Toronto, Toronto, ON, Canada (Lemma) Department of Surgery, Jilin Heart Hospital, Changchun, China (Ponnambalam) Department of Surgery, University of British Columbia, Vancouver, BC, Canada (Whitlock) Department of Surgery, McMaster University, Hamilton, ON, Canada (Wells) School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Abstract BACKGROUND: Coronary artery bypass grafting (CABG) is a common but invasive operation traditionally performed through a median sternotomy. Minimally invasive cardiac surgery (MICS) CABG via small thoracotomy might improve postoperative recovery, but randomised evidence has been scarce. We aimed to compare patient-reported recovery after MICS CABG versus sternotomy CABG in patients with multivessel coronary artery disease and to describe clinical and safety outcomes. METHOD(S): MIST was an investigator-initiated, international, open-label, randomised controlled trial done at seven centres (four academic hospitals and three community hospitals) in Canada, India, China, Germany, the USA, and Japan. Patients referred to participating surgeons for CABG were eligible if they were aged 18 years or older; had angiographically confirmed multivessel coronary artery disease, defined as lesions of at least 70% stenosis in at least two major epicardial vessels and at least two separate coronary artery territories (left anterior descending artery, left circumflex artery, or right coronary artery) or left main coronary stenosis of 50% or more; and were suitable for coronary surgery both with sternotomy CABG and MICS CABG. Patients who were haemodynamically compromised, had contraindications to either approach, had had previous cardiac surgery, or required concomitant procedures were excluded. Eligible patients were randomly assigned (1:1) to MICS CABG or sternotomy CABG by a central, web-based system, stratified by centre, with block sizes of four and six. The primary endpoint was patient-reported physical recovery at 1 month, assessed by the 36-item Short Form Health Survey Physical Component Summary (SF-36 PCS) score. The primary analysis was by intention to treat; safety analyses were done according to treatment received. Missing 1-month questionnaire data were handled by multiple imputation. The trial was registered with ClinicalTrials.gov (NCT03447938), and is closed to recruitment. FINDINGS: Between Aug 24, 2018, and Nov 26, 2024, 176 patients were enrolled, 170 of whom were randomly assigned to MICS CABG (n=86) or sternotomy CABG (n=84). The median age of patients was 67.0 years (IQR 61.0-72.0), 154 (91%) patients were male, and 16 (9%) were female. At 1 month after surgery, SF-36 PCS scores were significantly higher in the MICS CABG group than in the sternotomy CABG group (mean 45.1 [SD 8.0] vs 42.2 [9.1]; mean difference 2.9 [95% CI 0.3-5.5]; p=0.031). Clinical and safety follow-up at 1 month was complete in all patients; 12-month clinical and safety follow-up was complete in all except three patients in the sternotomy CABG group. Up to 12 months after surgery, there were no deaths or strokes in either group; one major adverse cardiac or cerebrovascular event occurred in the MICS CABG group before 1 month and none in the sternotomy CABG group. INTERPRETATION: For selected patients with multivessel coronary artery disease, MICS CABG performed by experienced teams improved patient-reported physical recovery at 1 month compared with sternotomy CABG, with no apparent safety penalty through to 12 months. These findings support consideration of MICS CABG in appropriately selected patients treated by experienced teams, and further studies of implementation, recovery pathways, and long-term outcomes. FUNDING: Medtronic. Copyright © 2026 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies. <122> Accession Number 651870121 Title CAN DIRECT ORAL ANTICOAGULANTS REPLACE WARFARIN FOR STROKE PREVENTION IN NEW-ONSET POST-OPERATIVE ATRIAL FIBRILLATION? A META-ANALYSIS AND TRIAL SEQUENTIAL ANALYSIS. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i555-i556), 2026. Date of Publication: 01 May 2026. Author Yassin M.N.; Bady Z.; Talkhan A.; Al Diab Al Azzawi M.; Lasheen M.M.; Youssef M.; Kamel B.; Ayoub B.; Refaey M.; Mohamed M.; Omar Y.M.; Nasreldein A. Institution (Yassin, Ayoub) Cairo University, Faculty of Medicine, Cairo, Egypt (Bady) Assiut University, Faculty of Medicine, Assiut, Egypt (Talkhan, Kamel, Omar) Mansoura University, Faculty of Medicine, Mansoura, Egypt (Al Diab Al Azzawi) Faculty of Medicine, The National Ribat University, Khartoum, Sudan (Lasheen, Youssef) Faculty of Medicine, Tanta University, Tanta, Egypt (Refaey) Sohag University, Faculty of Medicine, Sohag, Egypt (Mohamed) Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University, Ohio, United States (Nasreldein) Neurology Department, Assiut University Hospitals, Assiut, Egypt Publisher Oxford University Press Abstract Background and aims: New-onset postoperative atrial fibrillation (POAF) complicates up to 50% of post-cardiac surgery patients. Despite POAF's high incidence, there are no clear guidelines regarding optimal anticoagulation and stroke prophylaxis regimen. Despite warfarin being the standard of care, its narrow therapeutic window and monitoring burdens are significant drawbacks. We investigated whether Direct Oral Anticoagulants (DOACs) provide a safe and effective alternative in this high-risk population. Method(s): A systematic search of major databases was conducted up to December 2025. Analysis was performed using the Mantel-Haenszel method with a random-effects model on RevMan. Result(s): The analysis incorporated 36,825 patients from 13 studies (2 randomized-controlled trials + 11 observational studies). Analysis revealed no significant difference in stroke risk between Warfarin and DOACs [Relative Risk (RR) for warfarin: 1.22; 95% Confidence interval (CI): 0.96, 1.55; I^2 = 0%]. Trial sequential analysis (TSA) confirmed that the cumulative Z-curve remained within the non-significance zone, approaching the required information size and establishing the futility of further superiority testing. Furthermore, no significant differences were observed in the risk of all-cause mortality, readmission, systemic embolism, transient ischemic attack, major bleeding, gastrointestinal bleeding, or minor bleeding between warfarin and DOACs. Besides, there was no significant difference in post-operative length of stay between the two arms. Conclusion(s): DOACs demonstrated an efficacy and safety profile comparable to warfarin for POAF. Reinforced by Trial Sequential Analysis and low heterogeneity despite mixed study designs, these results support DOACs as a non-inferior standard of care, allowing for simplified postoperative anticoagulation without compromising clinical outcomes. <123> Accession Number 651883966 Title A meta-analysis of randomized controlled trials on atenolol's impact on postoperative atrial fibrillation in adults undergoing cardiac surgery. Source Medicine. 105(31) (pp e50029), 2026. Date of Publication: 31 Jul 2026. Author Deng J.-H.; He F.-R.; Yao Y.-T. Institution (Deng) Department of Anesthesiology, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China (He) Department of Obstetrics and Gynecology, Air Force Hospital of Southern Theater Command, Guangzhou, China (Yao) Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (Yao) Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing, China (Yao) Center of Outcomes Research, Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Houston, TX, United States (Yao) Outcomes Research Consortium, Houston, TX, United States Abstract Prior research has conducted a limited number of studies on the efficacy of atenolol in preventing atrial fibrillation following cardiac surgery (CS). Consequently, a comprehensive evaluation and meta-analysis were undertaken to assess the effectiveness and safety of atenolol in patients undergoing CS for the prevention of postoperative atrial fibrillation (POAF). A meta-analysis of randomized controlled trials was performed. Searches were conducted across multiple databases up to December 1, 2024. The primary focus was the incidence of POAF. Risk ratios (RRs) for treatment effects on dichotomous variables were calculated. The data analysis encompassed 6 randomized controlled trials involving a total of 870 patients. The meta-analysis revealed that atenolol significantly reduces the incidence of POAF in adult patients undergoing CS (RR, 0.55; 95% confidence interval [CI]: 0.32-0.93; P = .03) with moderate heterogeneity (I2 = 57%; P = .10). Atenolol did not demonstrate superiority over sotalol in reducing POAF (RR, 2.39; 95% CI: 1.41-4.04; P = .001) with moderate heterogeneity (I2 = 40%; P = .19). Furthermore, no significant difference was observed between atenolol and the control group (comprising propafenone, metoprolol, nebivolol, and digoxin) in the prevention of POAF (RR, 1.28; 95% CI: 0.76-2.16; P = .35) with moderate heterogeneity (I2 = 43%; P = .15). Recent studies suggest that atenolol could be a safe and effective intervention for the prevention of POAF in adult patients undergoing CS. Copyright © 2026 the Author(s). Published by Wolters Kluwer Health, LLC. <124> Accession Number 651871012 Title LEFT ATRIAL APPENDAGE OCCLUSION FOR STROKE PREVENTION IN PATIENTS WITH ATRIAL FIBRILLATION AND MALIGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 177,896 PATIENTS. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i298), 2026. Date of Publication: 01 May 2026. Author Elkoumi O.; Elkoumi A.; Elbairy M.K.; Beddor A.; Rashed M.A.; Nashwan A.J. Institution (Elkoumi, Elbairy) Faculty of Medicine, Suez University, Suez, Egypt (Elkoumi) Health Affairs Directorate of El Sharqeya, The Ministry of Health and Population, El Sharqeya, Egypt (Beddor) Faculty of Medicine, Yarmouk University, Irbid, Jordan (Rashed) Faculty of Medicine, Al-Azhar University, Cairo, Egypt (Nashwan) Department of Nursing, Hamad Medical Corporation (HMC), Doha, Qatar Publisher Oxford University Press Abstract Background and aims: Atrial fibrillation (AF) is highly prevalent in cancer patients, creating a "competing risk" scenario where prothrombotic states increase stroke risk while malignancy-related factors (thrombocytopenia, mucosal fragility) amplify bleeding risks with oral anticoagulation. Percutaneous left atrial appendage occlusion (LAAO) is a non-pharmacological alternative, yet its safety and efficacy in this high-risk population are not fully established. We aimed to synthesize global evidence on LAAO outcomes in the cardio-oncology population. Method(s): We searched PubMed, Scopus, and Web of Science through August 2025 for studies comparing LAAO outcomes in AF patients with and without cancer. Quantitative synthesis was performed using random-effects models. Result(s): Seven studies (n=177,896) were included, with five (n=61,632) contributing to the meta-analysis. LAAO demonstrated comparable stroke prevention in cancer versus non-cancer cohorts (OR 0.74; 95% CI, 0.41-1.34; p=0.32). While overall bleeding risk appeared similar (p=0.08), sensitivity analysis excluding a single large dataset revealed an increased risk in cancer patients (OR 1.62; 95% CI, 1.02-2.56; p=0.04). Cancer patients faced significantly higher risks of pericardial complications (OR 2.22; p<0.00001) and all-cause mortality (HR 1.57; p=0.002). Mortality likely reflects underlying oncological prognosis rather than procedural failure. Conclusion(s): LAAO provides effective stroke prevention for cancer patients with AF, achieving ischemic outcomes comparable to the general population. However, the increased risk of procedural complications and mortality necessitates meticulous patient selection and specialized periprocedural care in this complex cardio-oncology population. <125> Accession Number 651869570 Title STROKE PREVENTION WITH CEREBRAL EMBOLIC PROTECTION DEVICES DURING TRANSCATHETER AORTIC VALVE REPLACEMENT: SYSTEMATIC REVIEW AND META-ANALYSIS. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i668-i669), 2026. Date of Publication: 01 May 2026. Author Hammad N. Institution (Hammad) Faculty of Medicine, Port-Said University, Port Said, Egypt Publisher Oxford University Press Abstract Background and aims: Transcatheter aortic valve replacement (TAVR) is an established therapy for severe aortic stenosis; however, periprocedural stroke remains a serious complication. Cerebral embolic protection devices (CEPDs) have been introduced to reduce cerebral embolization during TAVR, but their clinical effectiveness is uncertain. We evaluated the efficacy and safety of CEPDs using trial sequential analysis (TSA) and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Method(s): We performed a systematic review and meta-analysis of randomized controlled trials comparing TAVR with versus without CEPD. Four electronic databases were searched from inception to April 2025. Primary outcomes were all-cause mortality, major adverse cardiovascular and cerebrovascular events (MACCE), all-cause stroke, and disabling stroke. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using random-effects models. TSA assessed information size, statistical significance, and futility (alpha=5%, power=80%). Result(s): Nine trials including 11,876 patients (CEPD 6,140; control 5,736) were analyzed. CEPD use was not associated with significant reductions in mortality (RR 1.04, 95% CI 0.68-1.58), MACCE (RR 1.13, 95% CI 0.69-1.86), all-cause stroke (RR 0.93, 95% CI 0.74-1.16), or disabling stroke (RR 0.77, 95% CI 0.47-1.26). Secondary neurological and imaging outcomes showed no meaningful benefit. TSA and subgroup analyses confirmed the absence of statistically robust or clinically relevant effects. Current evidence does not support routine CEPD use during TAVR, as no significant reduction in stroke or major clinical outcomes was demonstrated.(Figure Presented) <126> Accession Number 651871548 Title IS LEFT ATRIAL APPENDAGE OCCLUSION SUPERIOR TO ORAL ANTICOAGULATION FOR STROKE PREVENTION IN PATIENTS WITH ATRIAL FIBRILLATION AND END-STAGE RENAL DISEASE? A META-ANALYSIS. Source European Stroke Journal. Conference: 12th European Stroke Organisation Conference, ESOC 2026. Maastricht Netherlands. 11(Supplement 1) (pp i437), 2026. Date of Publication: 01 May 2026. Author Bady Z.; Refaey M.; Talkhan A.; Al Kahil A.; Nasreldein A. Institution (Bady) Assiut University, Faculty of Medicine, Assiut, Egypt (Refaey) Sohag University, Faculty of Medicine, Sohag, Egypt (Talkhan) Mansoura University, Faculty of Medicine, Mansoura, Egypt (Al Kahil) University Hospitals Parma Medical Center, Ohio, United States (Nasreldein) Assiut University, Neurology Department, Assiut, Egypt Publisher Oxford University Press Abstract Background and aims: Atrial fibrillation is common in patients with end-stage renal disease (ESRD), however, the optimal stroke prevention modality is unclear. This meta-analysis compares left atrial appendage occlusion (LAAO) to oral anticoagulation (OAC) in stroke prevention and associated bleeding and mortality rates in ESRD adults. Method(s): A systematic search of major databases was conducted up to December 2025. Analysis was performed using the generic inverse variance method with a random-effects model on RevMan software. Result(s): The analysis incorporated 22,512 patients. LAAO displayed a significantly lower risk of stroke/systemic embolism [Relative Risk (RR): 0.74; 95% Confidence interval (CI): 0.64, 0.86; I^2 = 0%; p= 0.0001], and study-defined Major bleeding [RR: 0.73, 95% CI: 0.57, 0.93; I^2 = 80%; p= 0.01]. Notably, subgroup analysis revealed significantly higher reduction in major bleeding in studies with patients predominantly on warfarin [RR: 0.59, 95% CI: 0.52, 0.67; I^2 = 0%; p<0.00001] compared to studies with patients predominantly on direct oral anticoagulants [RR: 0.88, 95% CI: 0.77, 0.99; I^2 = 0%; p= 0.04] (p-value for subgroup differences <0.0001). However, there was no significant difference between the interventions in all-cause mortality [RR: 0.8, 95% CI: 0.59, 1.07] or cardiovascular deaths [RR: 0.95, 95% CI: 0.82, 1.11]. Conclusion(s): LAAO is associated with superior stroke prevention compared to OAC in patients with ESRD. While LAAO reduces bleeding risk compared to both warfarin and DOACs, the benefit is most pronounced against warfarin. Future randomized controlled trials comparing LAAO to DOACs and warfarin are recommended. <127> Accession Number 651877242 Title Catheter ablation in end-stage heart failure with atrial fibrillation: an hierarchical endpoint analysis of the CASTLE-HTx trial. Source European journal of heart failure. (no pagination), 2026. Date of Publication: 30 Jul 2026. Author Moersdorf M.; Verbeeck J.; Marrouche N.F.; Costard-Jaeckle A.; Crijns H.J.G.M.; Bergau L.; Fox H.; Hindricks G.; Dagres N.; Sossalla S.; Schramm R.; Fink T.; Meynen F.; Sciacca V.; Didenko M.; Konietschke F.; Rudolph V.; Gummert J.; Tijssen J.G.P.; Sommer P.; Sohns C. Institution (Moersdorf, Bergau, Fink, Sciacca, Didenko, Sommer, Sohns) Department of Electrophysiology, Herz- und Diabeteszentrum NRW, Med. Fakultat OWL (Universitat Bielefeld), Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Verbeeck, Meynen) Data Science Institute, Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-Biostat), University of Hasselt, Hasselt, Belgium (Marrouche) Cardiology Department, Tulane University School of Medicine, New Orleans, LA, United States (Costard-Jaeckle, Fox, Schramm, Gummert) Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Med. Fakultat OWL (Universitat Bielefeld), Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Costard-Jaeckle, Fox, Schramm) Heart Failure Department, Herz- und Diabeteszentrum NRW, Med. Fakultat OWL (Universitat Bielefeld), Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Crijns) Department of Cardiology and CARIM, Maastricht University, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands (Hindricks, Dagres) Department of Cardiology, Angiology and Intensive Care Medicine, German Heart Center of the Charite-University Medicine Berlin, Charite Campus Mitte, Berlin, Germany (Sossalla) Department of Cardiology and Angiology, University of Giessen & Kerckhoff Heart Center, Germany (Konietschke) Institute of Biometry and Clinical Epidemiology, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Charite-Universitatsmedizin Berlin, Berlin, Germany (Rudolph) Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universitat Bochum, Bad Oeynhausen, Germany (Tijssen) Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands Abstract BACKGROUND: The CASTLE-HTx trial (NCT04649801) showed that the combination of catheter ablation and guideline-directed medical therapy (GDMT) was associated with a lower likelihood of a composite of death from any cause, implantation of a left-ventricular assist device (LVAD), or heart transplantation (HTx) in patients with end-stage heart failure (HF) and atrial fibrillation (AF). AIMS: This is an ancillary analysis with the generalized pairwise comparison methodology of the main outcomes of CASTLE-HTx. METHOD(S): In CASTLE-HTX, 194 patients were randomized to catheter ablation and GDMT (n = 97) or medical therapy alone (n = 97). The first hierarchical outcome was a composite of (1) death from any cause, (2) urgent HTx, (3) implantation of an LVAD, and (4) frequency of hospitalizations for worsening HF. Secondary analysis also included AF burden and left-ventricular ejection fraction improvement. Treatment effects are reported as net treatment benefit (NTB) and win odds, with corresponding confidence intervals (CIs). RESULT(S): Patients randomized to ablation had more wins with respect to death from any cause (28.4%/12.4%), HTx (4.3%/2.1%), LVAD implantation (4.2%/0.6%), and hospitalizations for worsening HF (24.8%/11.3%). 61.6% of pairs favoured ablation, 26.4% medical therapy, and 12.0% were tied. This resulted in a restricted NTB at 3 years of 35.3% (95% CI, 19.8-49.0, P < .001) favouring ablation (win odds: 2.09; 95% CI, 1.49-2.92). In the secondary analysis, 67.0% of pairs favoured ablation against 28.6% of pairs favouring medical therapy. The restricted NTB was 38.4% (95% CI, 22.8-52.0, P < .001) in favour of ablation (win odds: 2.25; 95% CI, 1.59-3.17). CONCLUSION(S): This pairwise analysis of CASTLE-HTx confirms the clinical benefits of early catheter ablation in addition to GDMT among AF patients in end-stage HF. The treatment benefit was primarily driven by mortality and HF hospitalizations. 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 <128> Accession Number 2048101324 Title Permanent pacemaker rate following Commando and Hemi-Commando procedures: a systematic review and meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1854238. Date of Publication: 23 Jun 2026. Author Zhang Y.; Zhu R.; Yu G.; Hu L.; Cao Y. Institution (Zhang, Zhu, Yu, Hu, Cao) Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Maoming, China Publisher Frontiers Media SA Abstract Objective - The Commando procedure (double-valve replacement with intervalvular fibrous body reconstruction) is associated with a high risk of postoperative atrioventricular block requiring permanent pacemaker implantation. However, precise estimates vary widely. This systematic review and meta-analysis aimed to determine the pooled permanent pacemaker rate after Commando and Hemi-Commando procedures. Methods - PubMed, Embase, Web of Science, and Cochrane CENTRAL were searched from inception to April 2, 2026. Studies reporting permanent pacemaker rates after Commando or Hemi-Commando surgery (sample size >= 5) were included. A random-effects model was used to pool proportions, with logit transformation. Subgroup analyses were performed by procedure type. Sensitivity analyses and publication bias assessment (Egger's test) were conducted. Results - Twelve studies with 13 data points (797 patients) were included. The pooled permanent pacemaker rate was 22.3% (95% confidence interval: 16.1%-30.0%), with substantial heterogeneity (I2 = 73.7%). Subgroup analysis showed that the Chimney Commando modification had a significantly lower rate (6.3%, 95% CI: 3.2%-12.1%) compared with the traditional Commando procedure (28.3%, 95% CI: 21.2%-36.7%; p for subgroup difference < 0.001). Sensitivity analyses confirmed the robustness of the findings. Egger's test indicated potential small-study effects (p = 0.0041). Conclusions - One in five patients undergoing Commando surgery requires a permanent pacemaker. Preliminary evidence suggests that the Chimney Commando modification may be associated with a substantially lower risk (6.3% vs. 28.3%). Based on these preliminary findings, the Chimney technique might be a reasonable option in carefully selected patients with small annuli or those undergoing redo surgery, where conduction injury risk is inherently high. However, given the limited evidence, this recommendation should be considered hypothesis-generating. Future prospective comparative studies are needed to validate these hypothesis-generating findings. Systematic Review Registration - https://osf.io/sgd2e/. Copyright © 2026 Zhang, Zhu, Yu, Hu and Cao. <129> Accession Number 2047814744 Title Contemporary evidence for multiarterial grafting in coronary artery bypass surgery. Source Current Opinion in Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Sun C.; Lee G.S.; Fremes S.E. Institution (Sun) Temerty Faculty of Medicine, Canada (Lee, Fremes) Division of Cardiac Surgery, University of Toronto, Canada (Fremes) Sunnybrook Research Institute and Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Observational data suggests that multiarterial grafting (MAG) is associated with improved long-term outcomes for coronary artery bypass grafting (CABG), yet adoption remains low due to limited randomized evidence. This review synthesizes contemporary evidence comparing MAG with single arterial grafting (SAG), highlighting recent observational studies and ongoing randomized trials. Recent findings - Large registry-based analyses consistently demonstrate a 15-25% relative reduction in long-term mortality and adverse cardiovascular events with MAG compared with SAG. However, randomized evidence is unclear; the Arterial Revascularization Trial (ART) showed no significant survival difference but possessed important methodological limitations. In contrast, randomized data support radial artery use over saphenous vein grafts as a second conduit. The ongoing randomized comparison of the clinical outcome of single vs. multiple arterial grafts (ROMA) trial is expected to provide definitive evidence. Summary - MAG is supported by observational data, but uncertainty persists due to limited randomized evidence and variability in clinical adoption. The results of ROMA will clarify the role of MAG and help determine whether this should become the default strategy for CABG in select patients. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <130> Accession Number 2047940330 Title Impact of an early, graduated mobilization program on recovery and postoperative outcomes after cardiac revascularization with extracorporeal circulation. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1801971. Date of Publication: 2026. Author Liu J.; Jiang M.; Zhao X.; Liang Y.; Liu Y.; Pan R. Institution (Liu, Jiang, Zhao, Liang, Liu, Pan) Cardiac Surgery Department, The First Hospital of Jilin University, Jilin Province, Changchun, China Publisher Frontiers Media SA Abstract Objective - This randomized controlled trial evaluated the effects of an early, graduated mobilization program on functional recovery (primary endpoint: postoperative day-5 forced vital capacity [FVC]; secondary endpoints: activities of daily living [ADL] scores, handgrip strength, Short Physical Performance Battery [SPPB] scores, postoperative pulmonary complications [PPCs], and postoperative length of stay) in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods - Between March to September 2025, 92 patients underwent on-pump CABG; after screening, 80 consecutive eligible patients (sample size calculated based on PPC incidence, n = 42 per group before attrition adjustment) were randomized 1:1 using a random number table with allocation concealment to a control group (n = 40) or an intervention group (n = 40). Results - On postoperative day 5, the intervention group demonstrated significantly better FVC, ADL scores, handgrip strength, and SPPB scores (all P < 0.05). PPC incidence was markedly lower (10% vs. 62.5%, P < 0.0001), and postoperative length of stay was shorter (7.13 +/- 2.36 vs. 9.18 +/- 2.66 days, P = 0.0006). Conclusion - The early graduated mobilization program was safe, feasible, and associated with improved short-term functional recovery, reduced PPCs, and shorter postoperative hospital stay after on-pump CABG. Larger multicenter studies with longer follow-up are required to confirm long-term safety and effectiveness. Copyright © 2026 Liu, Jiang, Zhao, Liang, Liu and Pan. <131> Accession Number 2038476578 Title Cardiopulmonary Bypass-Related Determinants of Adverse Postoperative Outcomes in Adult Cardiac Surgery: A Comprehensive Narrative Review. Source International Journal of Health Sciences and Research. 16(6) (pp 238-249), 2026. Date of Publication: 01 Jun 2026. Author Jagtap N.P.; Sankannavar S.S.; Shitole A.B.; Patil A.P. Institution (Jagtap, Sankannavar) Department of Perfusion Technology, School of Allied Health Sciences, KLE Academy of Higher education and Research, KAHER (Deemed to be University), Karnataka, Belagavi, India (Shitole) Department of Cardiac Anaesthesia, Jawaharlal Nehru Medical College, KLE Academy of Higher education and Research, KAHER (Deemed to be University), Karnataka, Belagavi, India (Patil) Department of Epidemiology and Biostatistics, School of Allied Health Sciences, KLE Academy of Higher education and Research, KAHER (Deemed to be University), Karnataka, Belagavi, India Publisher Galore Knowledge Publication Pvt. Ltd. Abstract Background: Cardiopulmonary bypass (CPB) remains the cornerstone of modern adult cardiac surgery. However, obligate exposure to the extracorporeal circuit precipitates a systemic inflammatory response syndrome (SIRS), hemodilution, and coagulopathy. These non-physiologic states drive significant multi-organ morbidity and perioperative mortality. Objective(s): To present qualitative evidence on CPB-related determinants of adverse outcomes focusing on extent of extracorporeal exposure, inflammatory activation and systemic inflammatory response syndrome and coagulopathy. The review further aims to discuss postoperative multiorgan dysfunction and its actionable mitigation strategies in perioperative period. Method(s): A comprehensive literature search was conducted across PubMed, Cochrane Library, and Google Scholar up to 2026. Keywords included cardiopulmonary bypass, systemic inflammatory response, coagulopathy, acute kidney injury, transesophageal echocardiography, and perioperative outcomes. Result(s): Prolonged CPB time more than 120 minutes independently increases postoperative mortality by 1.6-fold. The incidence of adverse outcomes including acute kidney injury (AKI), postoperative atrial fibrillation (POAF) and reoperation for bleeding (re-exploration) was 10-30%, 20-40% and 2-7% respectively. Evidence-based mitigation strategies demonstrate substantial efficacy and reduction in post operative adverse outcomes. Lung-protective ventilation reduces pulmonary complications by 25%, routine antifibrinolytic therapy decreases transfusion requirements by up to 30%, and goal-directed viscoelastic monitoring reduces bleeding and transfusion associated adverse outcomes. Furthermore, real-time advanced hemodynamic monitoring facilitates like transesophageal echocardiography aid in early detection and management of hemodynamic compromise and cardiac dysfunction paving way for early action and mitigation. Conclusion(s): The pathophysiological insults of CPB are predictable and highly modifiable. Standardized implementation of evidence-based perioperative bundles, driven by precise pharmacological, mechanical, and intraoperative monitoring strategies, drastically improves clinical outcomes and optimizes resource utilization in adult cardiac surgery. Copyright © 2026, Galore Knowledge Publication Pvt. Ltd.. All rights reserved. <132> Accession Number 2038462303 Title Systematic Review Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Stenosis: A Systematic Review and Meta-Analysis. Source Reviews in Cardiovascular Medicine. 27(7) (no pagination), 2026. Article Number: 49401. Date of Publication: 01 Jul 2026. Author Zhu F.-H.; Peng X.; Zhang Y.-Q.; Chen N.; Zhao X.-H.; Zhang H.-P. Institution (Zhu, Zhang, Chen, Zhao, Zhang) Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China (Peng) Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Publisher IMR Press Limited Abstract Background: Although the bicuspid aortic valve (BAV) is a major cause of aortic stenosis (AS), limited evidence exists regarding the safety and efficacy of transcatheter aortic valve replacement (TAVR) in BAV patients. This study aimed to compare TAVR outcomes between BAV and tricuspid aortic valve (TAV) cohorts. Method(s): We conducted a systematic search of PubMed, Web of Science, Em-base, and the Cochrane Library to identify studies reporting 1-year follow-up outcomes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were derived from a random-effects model. Result(s): The analysis included 31 studies involving 192,691 patients. Patients with BAV were younger than those with TAV (71.2 vs. 73.2 years, p < 0.01) and exhibited lower society of thoracic surgeons (STS) scores (3.5% vs. 4.3%, p < 0.05). Compared with TAV, BAV was associated with a lower likelihood of device success (OR = 0.80; 95% CI 0.65-0.98; p = 0.03) and an increased risk of moderate/severe paravalvular leak (PVL) (OR = 1.39; 95% CI 1.22-1.58; p < 0.01). No significant differences were observed in in-hospital mortality (OR = 1.10, 95% CI 0.86-1.42; p = 0.44), or major peri-procedural complications between the two cohorts. At 30 days, all-cause mortality (OR = 1.19, 95% CI 0.96-1.47, p = 0.11) and cardiovascular mortality (OR = 1.59, 95% CI 0.87-2.90; p = 0.13) were similar between BAV and TAV groups. While 1-year cardiovascular mortality showed no significant difference (OR = 0.70, 95% CI 0.42-1.16; p = 0.17), BAV patients exhibited a significant reduction in 1-year all-cause mortality (OR = 0.84, 95% CI 0.73-0.97; p = 0.01). This survival benefit was consistent in propensity-score matched cohorts (OR = 0.78, 95% CI 0.64-0.95; p = 0.01). Subgroup analysis further identified distinct survival advantages for BAV patients who were younger (OR = 0.82, 95% CI 0.71-0.95, p = 0.01), had lower STS scores (OR = 0.68, 95% CI 0.50-0.92, p = 0.01), or received balloon-expandable valves (OR = 0.76, 95% CI 0.61-0.94, p = 0.01). Notably, 1-year all-cause mortality rates were similar when stratified by aortic diameter or paravalvular leak (PVL) incidence. Conclusion(s): This meta-analysis demonstrated that TAVR had similar safety and efficacy profiles for BAV and TAV patients. Additionally, BAV patients undergoing TAVR exhibited a reduced 1-year all-cause mortality compared to TAV patients. The PROSPERO Registration: CRD42025618185, https://www.crd.york.ac.uk/PROSPERO/view/CRD42025618185. Copyright © 2026 The Author(s). <133> Accession Number 2048100786 Title Early aortic valve intervention versus clinical surveillance in patients with asymptomatic severe aortic stenosis: a systematic review and meta-analysis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1830856. Date of Publication: 2026. Author Adamu U.G.; Makgoro C.; Adamu E.-a.U.; Mashilo D.; Patel A.; Tsabedze N. Institution (Adamu, Makgoro, Mashilo, Patel, Tsabedze) Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (Adamu) Department of Internal Medicine, Federal Teaching Hospital, Birnin Kebbi, Nigeria Publisher Frontiers Media SA Abstract Background - The optimal timing of aortic valve replacement (AVR) in patients with asymptomatic severe aortic stenosis (AS) remains uncertain. The aim of this study was to evaluate the efficacy and safety of early AVR compared to clinical surveillance (CSV) in patients with asymptomatic severe AS. Methods - We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus through August 2025 for studies that compared early AVR with conservative management in asymptomatic patients with severe AS. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Results - Eight studies including four randomized controlled trials and four propensity-matched observational studies, enrolling 3, 086 patients, of whom 1, 539 (49.9%) underwent early AVR were included. Compared with CSV, AVR was associated with significant reduction in MACE (OR: 0.41, 95% CI: 0.29-0.59; P < 0.001), all-cause mortality (OR: 0.59, 95% CI: 0.39-0.88; P = 0.011), cardiovascular mortality (OR: 0.49, 95% CI: 0.35-0.69; P < 0.001), hospitalization for heart failure (OR 0.36, 95% CI 0.20-0.65; P < 0.001), and sudden death (OR: 0.51, 95% CI: 0.29-0.88; P = 0.015). Major vascular bleeding was more frequent in the early AVR group than in the conservative surveillance group (OR: 1.75, 95% CI: 1.05-2.92; P = 0.032). The risk of myocardial infarction, stroke, pacemaker implantation, or infective endocarditis were similar between groups. Conclusion - In patients with asymptomatic severe aortic stenosis, an early AVR strategy was associated with reduced heart failure hospitalization, favorable composite and procedural safety outcomes compared with CSV. Although a survival benefit was observed in pooled analyses, this was not consistently demonstrated in randomized trials. These findings support a more individualized approach to the timing of intervention. Systematic Review Registration - https://www.crd.york.ac.uk/PROSPERO/viewCRD420251135500. Copyright © 2026 Adamu, Makgoro, Adamu, Mashilo, Patel and Tsabedze. <134> Accession Number 2048124529 Title Long-term outcomes after transcatheter aortic valve replacement. Source Trends in Cardiovascular Medicine. (no pagination), 2026. Date of Publication: 2026. Author Braasch M.C.; Bai Y.Z.; Kaneko T. Institution (Braasch, Bai, Kaneko) Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States Publisher Elsevier Inc. Abstract Transcatheter aortic valve replacement (TAVR) is a more prevalent procedure than surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). With increasing TAVR utilization in young and low-risk patients, understanding long-term outcomes of TAVR is critical. Three randomized TAVR vs SAVR trials in patients with severe AS were identified with outcomes reported beyond 5 years: the NOTION (10-year outcomes), PARTNER 3 (7-year outcomes), and Evolut Low-Risk (6 year overall outcomes and 7 year reintervention data) trials. Primary trial outcomes, all of which were composite outcomes including all-cause mortality, stroke, myocardial infarction, and/or valve-, procedure-, or heart failure-related readmission, demonstrated similar outcomes between TAVR and SAVR (NOTION: 65.5% vs 65.5%, P = 0.9; PARTNER 3: 34.6% vs 37.2%, HR 0.87 [95% CI 0.70-1.08]; Evolut Low Risk: 23.3% vs 20.4%, P = 0.43). Amongst secondary outcomes, the cumulative incidence of TAVR reintervention was similar to SAVR reintervention in the NOTION trial (4.3%vs 2.2%, P = 0.3) and the PARTNER 3 trial (6.7%vs 6.0%, HR 1.11 [0.63-1.94]), but TAVR reintervention was higher than SAVR reintervention in the Evolut Low-Risk trial (9.8%vs 6.0%; p = 0.02). Study limitations include small cohort size (145 undergoing TAVR) of older patients undergoing TAVR with early generation self-expanding TAVRs in the NOTION trial and no data yet beyond 7 years in the PARTNER 3 and Evolut Low-Risk trials. Despite limitations, these data highlight the criticality in extremely careful patient selection for TAVR to optimize long term outcomes in the era of lifetime management of AS. Copyright © 2026 The Authors <135> Accession Number 651867675 Title Dapagliflozin and Acute Kidney Injury Following Cardiac Surgery: A Randomized Clinical Trial. Source JAMA. (no pagination), 2026. Date of Publication: 30 Jul 2026. Author Oosterom-Eijmael M.J.P.; Hulst A.H.; de Oliveira N.P.M.; Niesten E.D.; Wietsma N.E.; Gerritse B.M.; Scohy T.V.; Rettig T.C.D.; Snellen F.T.F.; Voogd M.F.; Godfried M.B.; de Boer R.N.; Wink J.; van der Werff L.M.M.; Cobbaert C.M.; Ruhaak L.R.; Eberl S.; Preckel B.; Hollmann M.W.; Schenk J.; Hermanides J.; van Raalte D.H. Institution (Oosterom-Eijmael, Hulst, Eberl, Preckel, Hollmann, Hermanides) Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands (Oosterom-Eijmael, van Raalte) Department of Endocrinology, Amsterdam University Medical Center, Amsterdam, Netherlands (Oosterom-Eijmael, Hulst, Preckel, Hollmann, van Raalte) Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands (Hulst) Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, Netherlands (de Oliveira, Niesten, Wietsma) Department of Anesthesiology, Medisch Spectrum Twente, Enschede, Netherlands (Gerritse, Scohy, Rettig) Department of Anesthesiology and Intensive Care, Amphia Hospital, Breda, Netherlands (Snellen) Department of Anesthesiology and Intensive Care, Isala Clinics, Zwolle, Netherlands (Voogd) Department of Anesthesiology, Medisch Centrum Leeuwarden, Leeuwarden, Netherlands (Godfried, de Boer) Department of Anesthesiology, OLVG, Amsterdam, Netherlands (Wink, van der Werff) Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands (Cobbaert, Ruhaak) Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, Netherlands (Preckel, Hollmann, Hermanides) Amsterdam Public Health Research Institute, Quality of care, Amsterdam, Netherlands (Schenk) Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, Netherlands (Schenk) Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, Netherlands Abstract Importance: Two percent to 50% of patients undergoing elective cardiac surgery experience acute kidney injury (AKI) postoperatively. Medications to prevent AKI after elective cardiac surgery have not been identified. Objective(s): In patients undergoing elective cardiac surgery, to evaluate whether initiating dapagliflozin 1 day prior to surgery reduces the incidence of AKI at 7 days after cardiac surgery, compared with placebo. Design, Setting, and Participant(s): Multicenter, double-blind, placebo-controlled randomized clinical trial conducted at 2 academic medical centers and 5 nonacademic hospitals in the Netherlands. Eligible participants were adults undergoing elective cardiac surgery. Enrollment occurred between June 8, 2023, and January 27, 2025. Final follow-up occurred May 16, 2025. Intervention(s): Patients were randomized 1:1 to receive either dapagliflozin (10 mg orally; n = 392) or placebo once daily (n = 392), beginning on the day before surgery and continuing through the second postoperative day (total of 4 doses). Main Outcome and Measure: The primary outcome was the between-group difference in AKI (defined as an increase in serum creatinine level by at least 0.3 mg/dL [26.5 micromol/L] within 48 hours after surgery, a 1.5-fold creatinine increase within 7 days of surgery, or urine output less than 0.5 mL/kg/h for 6 to 12 hours according to Kidney Disease: Improving Global Outcomes criteria) during the first 7 postoperative days. Result(s): Of 784 participants enrolled, 778 (99%) completed follow-up testing (median age, 68 [61-74] years; 76% male; 97% White; median body mass index, 27 [IQR, 25-30]; and median estimated glomerular filtration rate, 80 [IQR, 67-89] mL/min/1.73 m2). Compared with placebo, dapagliflozin reduced the incidence of AKI (28% vs 52%; relative risk, 0.54 [95% CI, 0.45-0.65]; P < .001) over 7-day follow-up after surgery. Atrial fibrillation and reoperation were the most frequent adverse events. The incidence of atrial fibrillation was 45% (176/392) in the dapagliflozin group vs 45% (176/392) in the placebo group, and the incidence of reoperation was 11% (43/392) vs 10% (39/392), respectively. Conclusions and Relevance: In patients undergoing elective cardiac surgery, 4 doses of dapagliflozin, beginning the day before surgery, reduced the incidence of AKI during the 7-day postoperative period. Trial Registration: ClinicalTrials.gov Identifier: NCT05590143. <136> Accession Number 651856174 Title Comparison of Box Breathing and Deep Breathing Exercises on Functional Capacity in CABG Patients: A Pilot Study. Source Journal of Clinical and Diagnostic Research. Conference: Thera-Connect 2K25 International Conference. Faridabad India. 20(2 Supplement) (pp 29), 2026. Date of Publication: 01 Feb 2026. Author Gupta A.; Jain N.; Reyalch N. Institution (Gupta, Jain) School of Physiotherapy, SGT University, Haryana, Gurugram, India (Reyalch) School of Ph siothera SGT Universit Guru ram Har, India Publisher JCDR Research and Publications Pvt Ltd Abstract introduction: Coronary Artery Bypass Grafting (CABG) patients frequently present with reduced functional capacity after surgery, largely due to impaired pulmonary function and deconditioning. Breathing exercises are a cornerstone of cardiac rehabilitation. However, limited evidence exists comparing the effectiveness of box breathing with incentive spirometer-based deep breathing exercises in this population. Aim(s): To compare the effects of box breathing and incentive spirometer-assisted deep breathing on functional capacity in post-CABG patients. material and method: This pilot study will recruit post-CABG patients who will be randomly divided into two groups. Group A will perform box breathing (6 cycles per session) daily for 5 consecutive days. Group B will perform deep breathing exercises using an incentive spirometer for the same duration. Functional capacity will be assessed using the Six-Minute Walk Test (6MWT) before and after the intervention. Data will be analysed to evaluate within-group and between-group differences. expected result: It is anticipated that both groups will demonstrate improvements in 6MWT distance, indicating enhanced functional capacity. Box breathing is expected to show outcomes comparable to, or possibly greater than, incentive spirometer-based deep breathing. Conclusion(s): This pilot study will provide preliminary insights into the role of different breathing strategies in improving functional capacity in CABG patients. Findings may support the inclusion of simple, equipment-free methods like box breathing in cardiac rehabilitation programmes. <137> Accession Number 2047966924 Title Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Systematic Review and Meta-analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S703-S704), 2026. Date of Publication: 01 Aug 2026. Author Kurugalage R.; Khan N.; Bhatia A.; Mukherjee A.; Khan E. Institution (Kurugalage, Mukherjee, Khan) Flinders Medical Centre, Bedford Park, Adelaide, SA, Australia (Khan) Lyell McEwin Hospital, Elizabeth Vale, Adelaide, SA, Australia (Bhatia) Western Sydney Local Health District, Westmead, Sydney, NSW, Australia (Khan) Department of Cardiology, Southern Adelaide Local Health Network, Adelaide, SA, Australia Publisher Elsevier Ltd Abstract Introduction: Normal flow, low gradient severe aortic stenosis (NFLG-SAS) is a discordant presentation that comprises a proportion of severe aortic stenosis cases. It is defined by a small aortic valve area despite low transvalvular gradients with preserved left ventricular ejection fraction and normal flow. This phenotype remains a key diagnostic and management challenge, with persistent uncertainty regarding the benefit and optimal timing of aortic valve replacement (AVR). Method(s): We followed the PRISMA 2020 guidelines and a preregistered protocol (CRD420251163544). Eligible studies directly compared AVR (transcatheter or surgical) with conservative management in adults with NFLG. Two reviewers independently screened records, extracted data, and assessed risk of bias resolving discrepancies by consensus. Prespecified primary outcome was all-cause mortality. Where at least two studies reported comparable adjusted hazard ratios (HRs), random-effects pooling was performed, with unmatched and propensity-matched estimates synthesised separately. Crude event-based relative risk (RR) was pooled as supportive analyses. Where quantitative synthesis was not feasible, outcomes were summarised narratively. Result(s): Five comparative studies (n=1,435) were included. All-cause mortality was lower with AVR in pooled unmatched analyses (hazard ratio (HR) 0.37, 95% CI 0.18-0.77, p=0.028) and was consistent across propensity-matched cohorts (HR 0.32, 95% CI 0.15-0.65, p=0.020). Meta-analysis of crude death events also favoured AVR (relative risk (RR) 0.45, 95% CI 0.23-0.89, p=0.037). Secondary outcomes, including cardiovascular mortality and heart failure hospitalisation, generally favoured AVR, although the latter was not statistically significant. Early AVR (<=3 months) showed a favourable trend versus delayed intervention, and outcomes were similar between transcatheter or surgical AVR. Discussion(s): Across available observational evidence, AVR is consistently associated with reduced all-cause mortality compared with conservative management in NFLG-SAS. Copyright © 2026 <138> Accession Number 2047973960 Title Comparative Outcomes of Extrathoracic, Intrathoracic and Facilitated Transfemoral Access for Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S663-S664), 2026. Date of Publication: 01 Aug 2026. Author Zaka A.; Mutahar D. Institution (Zaka, Mutahar) Gold Coast University Hospital, Ormeau, QLD, Australia Publisher Elsevier Ltd Abstract Aim: We aimed to compare safety and efficacy of non-femoral approaches and facilitated transfemoral (TF) access in TAVI. Method(s): PubMed, EMBASE, Web of Science, and CENTRAL were searched through February 2026 for multivariable-adjusted or propensity-matched observational studies. Three prespecified comparisons were performed: facilitated TF versus extrathoracic (ET) access, facilitated TF versus intrathoracic (IT) access, and ET versus IT access. The primary endpoint was all-cause mortality at 30 days. Risk ratios (RR) were pooled using a random-effects model. Result(s): Eighteen studies (n=11,832; IT n=6,800; ET n=5,032) were included. IT access was associated with higher 30-day mortality versus ET access (RR 1.90, 95% CI 1.56-2.30). Facilitated TF was associated with a trend towards reduced mortality compared to ET access, but this did not achieve statistical significance (RR 0.70, 95% CI 0.39-1.27). Compared to IT access, facilitated TF was associated with reduced risk of major vascular complications (RR 0.45, 95% CI 0.35-0.60) and major bleeding (RR 0.34, 95% CI 0.25-0.48) (Figure). Conclusion(s): IT access was associated with increased 30-day mortality, bleeding and AKI compared with ET access, while facilitated TF access demonstrated similar early mortality and reduced vascular complications compared to ET access in appropriately selected patients. [Formula presented] Copyright © 2026 <139> Accession Number 2047985505 Title Management Algorithm for Vasoplegic Shock After Cardiac Surgery: An Interdisciplinary Collaboration. Source Annals of Thoracic Surgery. (no pagination), 2026. Date of Publication: 2026. Author Chatterjee S.; Ortoleva J.; Arora R.C.; Dalton K.R.; Engelman D.T.; Girardi N.I.; Grant M.C.; Miles T.J.; Moon M.R.; Suero O.R.; Wittwer E.; Wieruszewski P.M. Institution (Chatterjee, Moon) Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States (Chatterjee, Moon) The Texas Heart Institute at Baylor College of Medicine, Houston, TX, United States (Chatterjee) Division of Trauma and Acute Care Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States (Ortoleva) Department of Anesthesiology, Boston Medical Center, Boston, MA, United States (Ortoleva) Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States (Arora) Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States (Dalton) Department of Clinical Pharmacology, Baylor-St Luke's Medical Center, Houston, TX, United States (Engelman) Heart & Vascular Program, Baystate Health, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, United States (Girardi) Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States (Grant) Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States (Miles) Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States (Suero) Divisions of Cardiovascular Anesthesia and Critical Care Medicine, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, United States (Wittwer) Division of Critical Care, Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States (Wieruszewski) Department of Pharmacy, Mayo Clinic, Rochester, MN, United States (Wieruszewski) Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States Publisher Elsevier Inc. Abstract Background Vasoplegic shock is distributive shock that follows cardiopulmonary bypass, characterized by hypotension, low systemic vascular resistance, and catecholamine resistance despite preserved or elevated cardiac output. Reported incidence ranges from 5% to 50%. Associated adverse outcomes include acute kidney injury, prolonged intensive care unit stay, and mortality. A single, universally accepted consensus definition is lacking, and few evidence-based best-practice management strategies exist. Methods A panel of 12 clinicians-cardiac surgeons, anesthesiologists, intensivists, and pharmacists-from 6 institutions conducted a structured expert review. PubMed and Embase were searched for research studies, including clinical trials, retrospective analyses, and mechanistic studies covering epidemiology, risk factors, prevention, and therapeutic strategies. Through iterative discussion and consensus building, the panel developed a pragmatic, algorithmic framework for management. Results Risk factors include preoperative renin-angiotensin-aldosterone inhibition, prior cardiac surgery, longer bypass duration, and higher transfusion burden. Preventive strategies include adjusting preoperative medications, managing intraoperative anesthetics and perfusion, and judicious transfusion thresholds. First-line therapy remains norepinephrine, with early addition of vasopressin, followed by angiotensin II for escalating support. Adjuncts such as methylene blue, hydroxocobalamin, and corticosteroids are complementary and considered in refractory cases, guided by mechanism and adverse effect profile. Conclusions Vasoplegic shock is a common, high-mortality complication after cardiac surgery. We present an expert-derived treatment pathway intended as practical guidance for escalation, and we identify future research priorities. Copyright © 2026 The Authors. <140> Accession Number 2047978414 Title Machine Learning for Mortality Prediction After Transcatheter Mitral Valve Repair: A Systematic Review and Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S685), 2026. Date of Publication: 01 Aug 2026. Author Shinwarie M.; Hashemi S.; Mansour M.; Yap N.; Parikh S.; Shinwarie O. Institution (Shinwarie, Yap) Townsville University Hospital, QLD, Australia (Hashemi, Parikh) Metro South Health, QLD, Australia (Mansour, Shinwarie) Toowoomba Hospital, QLD, Australia Publisher Elsevier Ltd Abstract Background: Machine learning (ML) risk prediction models are increasingly proposed to improve prognostication in transcatheter mitral valve repair/transcatheter edge-to-edge repair (TMVR/TEER), but the overall discriminative performance remains uncertain. We performed a focused meta-analysis of ML models predicting mortality after TMVR/TEER. Method(s): Eligible studies developed or applied ML models in TMVR/TEER populations and reported discrimination for mortality prediction using the area under the receiver operating characteristic curve (AUC). Due to heterogeneous endpoints, quantitative synthesis was restricted to studies predicting 1-year mortality. AUCs with 95% confidence intervals were logit-transformed and pooled using a random-effects model. Result(s): Three ML studies met eligibility criteria. Two studies reported ML prediction of 1-year mortality and were pooled (Zweck 2021; Hausleiter 2024). The pooled ML discrimination for 1-year mortality was AUC 0.787 (95% CI 0.742-0.826) with minimal observed heterogeneity (I2 = 0%). In both studies, ML models demonstrated higher AUCs than conventional risk tools reported within the same cohorts (e.g., EuroScore II, COAPT score, and other clinical scores). One additional ML study evaluated I -hospital mortality (Cruz 2024) and was not pooled; it reported strong discrimination for the best ML model (AUC 0.84+/-0.04). Conclusion(s): ML models show good discrimination for predicting 1-year mortality after TMVR/TEER, with consistent performance across available studies. Evidence remains limited by the small number of eligible studies and differing outcome time horizons; further external validation and standardised reporting are required. Copyright © 2026 <141> Accession Number 2047967176 Title Early Intervention Versus Watchful Waiting in Asymptomatic Severe Aortic Stenosis: A Meta-Analysis. Source Heart Lung and Circulation. Conference: Heart Lung and Circulation. Sydney Australia. 35(Supplement 3) (pp S675-S676), 2026. Date of Publication: 01 Aug 2026. Author Ma J.; Haji K.; Zheng W.; Wilson W.; Taylor A.; Chan W. Institution (Ma, Zheng) Alfred Health, Melbourne, VIC, Australia (Haji, Chan) Western Health, Melbourne, VIC, Australia (Wilson, Taylor, Chan) Royal Melbourne Hospital, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Introduction: In severe asymptomatic aortic stenosis (AS), the optimal timing of intervention - early aortic valve replacement (AVR) versus watchful waiting (WW) - remains uncertain. Method(s): We performed a study-level meta-analysis of randomised controlled trials (RCTs) and observational studies (search to April 21, 2025) comparing early AVR (surgical or transcatheter) with WW in asymptomatic severe AS. RCTs and observational studies were analysed separately and pooled where appropriate. The primary endpoint was the composite aggregate burden of death, stroke, and unplanned cardiovascular (CV) hospitalisation. Result(s): Four RCTs (n=1,427) and 14 observational cohorts (n=4,337) were included. Early AVR was performed in 2,601 patients (45.1%), of whom 80.8% underwent surgical AVR. In the WW group, 58.4% subsequently underwent AVR over a median follow-up of 3.8 years. Overall, early AVR halved the incidence of the primary composite endpoint versus WW (IRR 0.51, 95% CI 0.44-0.59; p<0.001). In RCTs, early AVR reduced CV hospitalisation (HR 0.41, 95% CI 0.28-0.61) and stroke (HR 0.62, 95% CI 0.43-0.90) (Figure). Pooled analysis showed lower all-cause mortality with early AVR (HR 0.41, 95% CI 0.36-0.56; p<0.001). Discussion(s): Early AVR in asymptomatic severe AS was associated with lower major CV events and all-cause mortality compared with WW. [Formula presented] Copyright © 2026 <142> Accession Number 651847010 Title Response by Rodes-Cabau et al to Letter Regarding Article, "Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing Device Thrombosis Following Left Atrial Appendage Closure: The ANDES Randomized Clinical Trial". Source Circulation. 154(4) (pp e44-e45), 2026. Date of Publication: 28 Jul 2026. Author Rodes-Cabau J.; Nombela-Franco L.; Pavesi M.; Cote M.; Salaun E. Institution (Rodes-Cabau, Cote, Salaun) Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City (Rodes-Cabau) Department of Research and Innovation, Spain (Rodes-Cabau, Pavesi) Department of Biostatistics, Barcelona Clinical Coordinating Center, Mon Clinic Foundation, Spain (Nombela-Franco) Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria Hospital Clinico San Carlos, Madrid, Spain <143> Accession Number 651847830 Title Letter by Li and Xiong Regarding Article, "Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing Device Thrombosis Following Left Atrial Appendage Closure: The ANDES Randomized Clinical Trial". Source Circulation. 154(4) (pp e40-e41), 2026. Date of Publication: 28 Jul 2026. Author Li W.; Xiong Q. Institution (Li) Department of Cardiology, Fengcheng People's Hospital, Affiliated Fengcheng Hospital of Yichun University, China (W.L.), Jiangxi, China (Xiong) Department of Cardiology, Fengcheng People's Hospital, Affiliated Fengcheng Hospital of Yichun University, China (Q.X.), Jiangxi, China <144> Accession Number 651847448 Title Letter by Zhang and Zhang Regarding Article, "Short-Term Anticoagulation Versus Dual Antiplatelet Therapy for Preventing Device Thrombosis Following Left Atrial Appendage Closure: The ANDES Randomized Clinical Trial". Source Circulation. 154(4) (pp e42-e43), 2026. Date of Publication: 28 Jul 2026. Author Zhang X.; Zhang P. Institution (Zhang, Zhang) Department of Medical Ultrasound, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China

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