EPICORE Embase Updates: October 2026

Total documents retrieved: 148 Results Generated From: Embase <1980 to 2026 Week 40> Embase Weekly Updates (updates since 2026-09-25) - (148 records) <1> Accession Number 2026545382 Title Intraoperative hypotension and postoperative complications in noncardiac surgery: a narrative review. Source Acta Anaesthesiologica Belgica. 73 (pp 141-147), 2022. Date of Publication: 01 Dec 2022. Author Vossen R.; Lauweryns J. Institution (Vossen, Lauweryns) Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, Leuven, Belgium Publisher BeSARPP Abstract Background: The incidence of IOH varies between 5% and 99%, depending on which definition is used. There have been numerous reports on the association between IOH and different postoperative outcomes. Objective(s): The goal of this study was to evaluate the association between intraoperative hypotension (IOH) and common postoperative outcomes, namely acute kidney injury, myocardial injury, cerebral ischemia, and postoperative delirium. Method(s): For this review, we developed a search strategy and searched all relevant medical databases. We searched for cohorts focusing on IOH and the different postoperative outcomes conducted in the past ten years. Eventually we were able to include 16 articles. Result(s): Regarding acute kidney injury (AKI), there is sufficient high-quality evident that IOH is an independent risk factor for developing AKI. We identified three studies evaluating the association between IOH and myocardial injury. They found a high incidence of myocardial injury, up to 30%. Furthermore, we found an independent association between IOH and myocardial injury. Regarding cerebral ischemia, we identified four cohorts. For now, there has not been a consensus regarding the association between IOH and cerebral ischemia. A few, but not all,studies find an association between IOH and cerebral ischemia. Conflicting evidence regarding a possible association between IOH and postoperative delirium was found. Discussion and conclusion: There seems to be enough evidence that episodes of IOH might be associated with both AKI and myocardial ischemia. The data regarding IOH and cerebral ischemia and POD however are inconsistent. There is a lot of variety between studies regarding the definition of IOH as the study population, so no hard conclusion can be drawn from this review. Copyright © 2022 ARSMB-KVBMG. All rights reserved. <2> Accession Number 2049300643 Title Progressive Spastic Paraparesis Caused by Thoracic Spinal Epidural Lipomatosis: A Case Report and Systematic Review. Source Medical sciences. 14(5) (no pagination), 2026. Article Number: 559. Date of Publication: 01 Sep 2026. Author Gawel W.S.; Fercho J.M.; Kaluzna O.; Krasula Z.; Tyburski M.; Nakoneczna J.; Kopec R.; Szypenbejl J.; Sobon J.; Birski M.; Furtak J.; Sieminski M. Institution (Gawel, Fercho, Kaluzna, Krasula, Tyburski, Nakoneczna, Kopec, Szypenbejl) Scientific Circle of Neurotraumatology, Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland (Fercho, Szypenbejl, Sieminski) Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland (Fercho, Sobon, Birski, Furtak) Neurosurgery Department, 10th Military Research Hospital and PolyClinic SPZOZ in Bydgoszcz, 85-681, Bydgoszcz, Poland (Furtak) Faculty of Medicine, Bydgoszcz University of Science and Technology, 85-796, Bydgoszcz, Poland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background: Spinal epidural lipomatosis (SEL) is a rare disorder characterized by excessive epidural fat accumulation. Diagnosis may be challenging because imaging findings are frequently overlooked, and evidence-based management guidelines, particularly thoracic disease, remain limited. Case report: We present a case report of a 54-year-old male patient, who suffered from lower limb spastic paresis and associated muscle spasms (Nurick grade V). After a difficult diagnostic process, MRI of the thoracic spine confirmed dorsal/posterior spinal epidural lipomatosis (SEL; Manjila grade IIb-alpha) extending from Th2 to Th9, with moderate thecal sac compression. A small Th6-Th7 intervertebral disc prolapse was also present, without evidence of scoliosis, syrinx, spinal cord edema, or myelomalacia. Following bilateral thoracic decompression and complete resection of the SEL tissue, the patient's neurological function improved markedly, from Nurick grade V preoperatively to Nurick grade II at 11 months of follow-up. Consequently, bilateral laminectomy of the thoracic region was performed with total resection of the SEL tissue. Following surgery, the patient's neurological symptoms improved markedly (Nurick grade II; 11 months postoperatively), and histopathological examination confirmed the diagnosis of spinal epidural lipomatosis. Method(s): We performed a systematic review of case reports of SEL occurring, or co-occurring in the thoracic region based on the literature identified on PubMed, Scopus and Web of Science databases, after using search terms: "(thoracic) AND ("spinal" OR "epidural") AND (lipomatosis)" and filters: [English], [humans] and [year 2020-2026], with the accordance to the PRISMA guidelines. Result(s): We identified 21 cases of thoracic SEL from 19 articles. In 12 cases the patients were male, in 9 female. Reported etiological associations included type 1 diabetes mellitus, exogenous corticosteroid exposure, obesity/metabolic syndrome, Cushing syndrome, and CLOVES syndrome. Given the small, case-report-based sample, these findings should be considered reported associations rather than estimates of prevalence or independent risk factors. Surgical treatment of thoracic SEL can be accomplished by various techniques such as laminectomy (continuous or skip), laminoplasty, or minimally invasive procedures-including endoscopic spine surgery. Conclusion(s): Large-volume, multicenter studies with long-term clinico-radiological follow-up would be necessary to understand the natural history and treatment outcomes, and to form evidence-based guidelines for interventions. Our case report and findings highlight that thoracic SEL should be included in the differential diagnosis of unexplained compressive myelopathy, even when imaging studies are inconclusive. Rapid identification or possibly reversible causes of myelopathy and initiation of treatment can significantly relieve symptoms, so it is important to remember this disease in the diagnostic process. Copyright © 2026 by the authors. <3> Accession Number 2034411844 Title Effect of minimally invasive cardiac surgery on hospital length of stay: A systematic review and meta-analysis. Source Acta Anaesthesiologica Belgica. 75(3) (pp 197-214), 2024. Date of Publication: 01 Sep 2024. Author Hoogma D.F.; van Bos T.; Polfliet F.; Verbrugghe P.; Oosterlinck W.; van Den Eynde J.; Rex S. Institution (Hoogma, van Bos, Rex) University Hospitals Leuven, Department of Anesthesiology, KU Leuven, Herestraat 49, Leuven, Belgium (Hoogma, Verbrugghe, Oosterlinck, van Den Eynde, Rex) University of Leuven, Biomedical Sciences Group, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, Leuven, Belgium (Polfliet) Jessa Hospital, Department of Anesthesiology, Stadsomvaart 11, Hasselt, Belgium (Verbrugghe, Oosterlinck) University Hospitals Leuven, Department of Cardiac Surgery, KU Leuven, Herestraat 49, Leuven, Belgium Publisher BeSARPP Abstract Background: Perioperative management using minimally invasive cardiac surgery (MICS), compared to full sternotomy (FS) cardiac surgery, is considered to improve postoperative recovery, and reduce hospital length of stay (LOS). Method(s): A comprehensive systematic search was conducted across MEDLINE/PubMed, Embase, and the Cochrane library to identify RCT comparing MICS to FS approach for aortic valve, mitral valve, and coronary artery bypass surgery. Meta-analysis of extracted data was performed using random effects models. Result(s): A total of 33 RCTs including 2920 patients were identified. Overall MD (95% CI) for hospital and intensive care unit (ICU) LOS after MICS was significantly shorter compared to FS (-0.88 days (-1.55;-0.20), p<0.013; 2606 patients) and (-0.23 days (-0.41;-0.05), p=0.012; 2242 patients), respectively. Additionally, postoperative blood loss was reduced with the use of MICS, (-192.07 ml (-292.32;-91.82), p=0.002; 718 patients). There was no evidence for differences between both groups in terms of postoperative ventilation times, duration of surgery, reintervention rate, incidence of postoperative atrial fibrillation or stroke, hospital mortality, or 1-year mortality. Conclusion(s): Within the limitations of a meta-analysis, MICS was found to be effective in promoting faster recovery by reducing postoperative blood loss, ICU, and hospital LOS. Copyright © 2024 BeSARPP. All rights reserved. <4> Accession Number 2049252204 Title Long-term outcomes of transcatheter mitral valve repair in patients with cancer: a systematic review and meta-analysis. Source GeroScience. (no pagination), 2026. Date of Publication: 2026. Author Biondi F.; Cadeddu C.; Camilli M.; Cuomo A.; Mandoli G.E.; Minghini A.; Novo G.; Madonna R. Institution (Biondi, Madonna) Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy (Cadeddu) Department of Medical Sciences and Public Health, Cardiology Unit, University Hospital Duilio Casula-Azienda Ospedaliero, University of Cagliari, Cagliari, Italy (Camilli) Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy (Camilli) Department of Cardiovascular Sciences CUORE, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (Cuomo) Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy (Mandoli) Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy (Minghini) Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, Genoa, Italy (Novo) Department of Health Promotion, Mother and Child Care Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy (Madonna) Cardiology Division, Pisa University Hospital, Via Paradisa, 2, Pisa, Italy Publisher Springer Science and Business Media Deutschland GmbH Abstract Surgical and transcatheter mitral valve interventions are the mainstay of treatment for mitral regurgitation (MR). Their impact in patients with cancer has recently gained attention in observational studies but remains poorly characterized. We performed a systematic review and meta-analysis to evaluate outcomes of mitral valve interventions, with particular focus on M-TEER, in patients with active or prior cancer. PubMed and Scopus were systematically searched according to the PRISMA 2020 Statement. This systematic review was prospectively registered in PROSPERO (CRD420261368392). Studies reporting outcomes of transcatheter or surgical mitral valve interventions in patients with cancer were eligible. The primary outcome was all-cause mortality. Secondary outcomes included short-term mortality, procedural success, heart failure worsening or hospitalization, and reintervention. Hazard ratios (HRs) were pooled using random-effects models when appropriate. When HRs were not directly available, they were reconstructed according to established methods for time-to-event data synthesis. Eight observational studies met the inclusion criteria. Seven studies evaluated M-TEER, accounting for the vast majority of patients included in the quantitative analyses (1522 patients with cancer and 4716 controls), whereas only one study assessed surgical mitral valve intervention. In the pooled analysis of M-TEER studies, cancer was associated with a significantly higher risk of all-cause mortality during follow-up (HR 1.72, 95% CI 1.03-2.90; I2 = 74.8%). This association remained consistent across prespecified subgroup and sensitivity analyses. No significant differences were observed in 30-day mortality or procedural success between patients with and without cancer. Data on heart failure outcomes and reintervention were insufficient for quantitative synthesis. This study provides a quantitative synthesis of available evidence regarding long-term outcomes after M-TEER in patients with cancer. Patients with cancer undergoing M-TEER have higher long-term mortality than those without cancer, despite similar procedural success and short-term outcomes. These findings suggest the observed excess mortality occurs in patients with cancer but the available evidence does not establish the factors responsible for this association, which could be mediated by frailty, CV comorbidity, treatment-related comorbidity mitral regurgitation (MR) characteristics, or other residual confounders. Of note, studies comparing matched cohorts found a non-significant difference in HR for long-term mortality. Current evidence is limited by observational data and residual confounding. Prospective cardio-oncology studies are needed to improve patient selection and identify individuals most likely to benefit from transcatheter mitral valve intervention. Copyright © The Author(s), under exclusive licence to American Aging Association 2026. <5> Accession Number 2048844328 Title Left Atrial Appendage Closure Versus Oral Anticoagulation in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Source Circulation: Arrhythmia and Electrophysiology. 19(9) (pp e015245), 2026. Date of Publication: 01 Sep 2026. Author Rao A.; Ravi V.; Murthi M.; Chikatimalla R.; Talla V.; Nagaraj N.; Dhar G.; Jolly N.; Vij A. Institution (Rao) Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre (Ravi) Division of Electrophysiology, Heart and Vascular Institute, Saint Francis Health System, Tulsa (Murthi, Vij) Division of Cardiology (Chikatimalla) Department of Internal Medicine, University of Texas Health Science Center at Tyler (R.C.). (Talla) Vydehi Institute of Medical Sciences and Research Centre, Bengaluru (Nagaraj) Jagadguru Jayadeva Murugarajendra Medical College, Davanagere (Dhar, Jolly, Vij) Division of Cardiology Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Left atrial appendage closure (LAAC) is an alternative to oral anticoagulation (OAC) for stroke prevention in patients with atrial fibrillation, but randomized controlled trials have primarily focused on composite end points, potentially obscuring differences in individual clinical outcomes. We compared the efficacy and safety of LAAC versus OAC with an emphasis on individual clinical outcomes. METHOD(S): - A systematic review and meta-analysis of randomized controlled trials comparing LAAC with OAC in adults with atrial fibrillation was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from January 2000 to March 2026. The primary efficacy end point was any stroke, and the primary safety end point was major bleeding. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model. RESULT(S): - Six randomized controlled trials comprising 7004 patients (3681 LAAC; 3323 OAC) were included. LAAC was associated with a higher risk of ischemic stroke (RR, 1.41 [95% CI, 1.04-1.91]; P=0.03; 3.2% versus 2.1%), without a significant difference in any stroke (RR, 1.08 [95% CI, 0.82-1.42]; P=0.60) or the composite of stroke, systemic embolism, or death (RR, 0.99 [95% CI, 0.77-1.29]; P=0.96). Cardiovascular mortality (RR, 0.88; P=0.40) and all-cause mortality (RR, 0.92; P=0.36) were similar between groups. Major bleeding, including procedural events, did not differ significantly (RR, 0.93; P=0.40), although LAAC was associated with a significantly lower risk of nonprocedural major bleeding (RR, 0.57 [95% CI, 0.43-0.77]; P<0.01; 6.2% versus 10.7%). CONCLUSION(S): - In patients with atrial fibrillation, LAAC is associated with a higher risk of ischemic stroke, but lower risk of nonprocedural major bleeding compared with OAC, with no significant differences in composite thromboembolic outcomes or mortality, underscoring the importance of individualized risk-benefit assessment in stroke prevention strategies. Copyright © 2026 American Heart Association, Inc. <6> Accession Number 2041816283 Title Updated evidence on peri-operative neutrophil-to-lymphocyte ratio in cardiac surgery: A dual analysis of prognostic and diagnostic value for post-operative atrial fibrillation. Source Heart Rhythm. 23(9) (pp 1865-1881), 2026. Date of Publication: 01 Sep 2026. Author Awad M.K.A.; Ali A.E.; Mazroua M.S.; Ali K.; Awad R.K.; Mohamed T.R.; Abdelmaksoud M.; Hashim M.A.; Nikollari R.; Vardas P.N.; Abu-Daya H. Institution (Awad, Mohamed, Abdelmaksoud) Division of Critical Care, Department of Anesthesia and Critical Care, Faculty of Medicine, Ain Shams University, Cairo, Egypt (Ali) Department of Internal Medicine, Crestwood Medical Center, Huntsville, AL, United States (Mazroua) Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States (Ali) Department of Medicine, Hennepin Healthcare, Minneapolis, MN, United States (Awad) Department of Critical Care, Cairo University, Cairo, Egypt (Hashim) Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, United States (Nikollari) Department of Internal Medicine, St. Barnabas Hospital Health System, Bronx, NY, United States (Vardas) Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, United States (Abu-Daya) Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, United States Publisher Elsevier B.V. Abstract Background Post-operative atrial fibrillation (POAF) is a frequent complication after cardiac surgery, increasing morbidity. The neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammation, has been studied as a predictor. Objective We aimed to assess the association between NLR and new-onset POAF. Methods We systematically searched PubMed, Scopus, Web of Science, and Embase through June 2025 for studies reporting pre-operative or post-operative NLR and incidence of POAF in adult cardiac surgery patients. Diagnostic test accuracy (DTA) was assessed to evaluate the predictive performance of pre-operative NLR for POAF, using pooled sensitivity, specificity, and likelihood ratios. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity. Results 32 studies (20,056 patients) were included. In 27 studies excluding pre-operative atrial fibrillation (13,630 patients), POAF was associated with significantly higher pre-operative NLR (standardized mean difference [SMD] = 0.51; 95% confidence interval [CI]: 0.34-0.67; P <.001; I2 = 94.0%). Post-operative NLR was also elevated in POAF patients (SMD = 0.30; 95% CI: 0.13-0.47; P <.001; I2 = 70.7%). Among 4 studies including patients with prior atrial fibrillation (6364 patients), no significant association was observed (SMD = 0.04; P =.21). DTA analysis of 12 studies showed pooled sensitivity of 0.52, specificity of 0.71, and diagnostic odds ratio of 3.74 (area under the curve [AUC] = 0.713), indicating moderate diagnostic accuracy. Conclusion Elevated NLR is associated with increased risk of POAF. Distinguishing new-onset POAF and accounting for surgical type are essential when evaluating NLR as a predictive biomarker. Copyright © 2025 Heart Rhythm Society. <7> Accession Number 2027012973 Title Glycemic Control and Adverse Clinical Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus: Results from KNOW-CKD. Source Diabetes and Metabolism Journal. 47(4) (pp 535-546), 2023. Date of Publication: 2023. Author Heo G.Y.; Koh H.B.; Kim H.W.; Park J.T.; Yoo T.-H.; Kang S.-W.; Kim J.; Kim S.W.; Kim Y.H.; Sung S.A.; Oh K.-H.; Han S.H. Institution (Heo, Koh, Kim, Park, Yoo, Kang, Han) Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University, College of Medicine, Seoul, South Korea (Kim) Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University, College of Medicine, Seoul, South Korea (Kim) Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea (Kim) Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan, South Korea (Sung) Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, School of Medicine, Seoul, South Korea (Oh) Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea Publisher Korean Diabetes Association Abstract Background: The optimal level of glycosylated hemoglobin (HbA1c) to prevent adverse clinical outcomes is unknown in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). Method(s): We analyzed 707 patients with CKD G1-G5 without kidney replacement therapy and T2DM from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD), a nationwide prospective cohort study. The main predictor was time-varying HbA1c level at each visit. The primary outcome was a composite of development of major adverse cardiovascular events (MACEs) or all-cause mortality. Secondary outcomes included the individual endpoint of MACEs, allcause mortality, and CKD progression. CKD progression was defined as a >=50% decline in the estimated glomerular filtration rate from baseline or the onset of end-stage kidney disease. Result(s): During a median follow-up of 4.8 years, the primary outcome occurred in 129 (18.2%) patients. In time-varying Cox model, the adjusted hazard ratios (aHRs) for the primary outcome were 1.59 (95% confidence interval [CI], 1.01 to 2.49) and 1.99 (95% CI, 1.24 to 3.19) for HbA1c levels of 7.0%-7.9% and >=8.0%, respectively, compared with <7.0%. Additional analysis of baseline HbA1c levels yielded a similar graded association. In secondary outcome analyses, the aHRs for the corresponding HbA1c categories were 2.17 (95% CI, 1.20 to 3.95) and 2.26 (95% CI, 1.17 to 4.37) for MACE, and 1.36 (95% CI, 0.68 to 2.72) and 2.08 (95% CI, 1.06 to 4.05) for all-cause mortality. However, the risk of CKD progression did not differ between the three groups. Conclusion(s): This study showed that higher HbA1c levels were associated with an increased risk of MACE and mortality in patients with CKD and T2DM. Copyright © 2023 Korean Diabetes Association. <8> Accession Number 2044821674 Title Comparing right ventricle to pulmonary artery conduit with modified Blalock-Taussig shunt in hypoplastic left heart syndrome undergoing Norwood procedure: A meta-analysis. Source Asian Journal of Surgery. 49(10) (pp 5113-5122), 2026. Date of Publication: 01 Oct 2026. Author Yasa K.P.; Pertiwi P.F.K.; Sudarma I.W.; Harta I.K.A.P.; Bhaskara N.S.S. Institution (Yasa, Sudarma, Harta) Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Udayana University, Bali, Denpasar, Indonesia (Yasa, Sudarma, Harta) Prof. Dr. I.G.N.G. Ngoerah General Hospital, Bali, Denpasar, Indonesia (Pertiwi, Bhaskara) Faculty of Medicine, Udayana University, Prof. dr. I.G.N.G Ngoerah General Hospital, Bali, Denpasar, Indonesia Publisher Elsevier (Singapore) Pte Ltd Abstract The Norwood procedure is the first palliative surgery for Hypoplastic Left Heart Syndrome (HLHS). Traditionally, pulmonary circulation was supplied via a modified Blalock-Taussig (mBT) shunt, but the right ventricle-to-pulmonary artery (RV-PA) conduit has recently been introduced. A systematic review and meta-analysis identified 13 studies with 905 patients comparing RV-PA and mBT outcomes. RV-PA was associated with significantly lower short-term mortality (RR: 0.62 [0.45-0.85], p = 0.003) and interstage mortality (RR: 0.18 [0.05-0.63], p = 0.008). Before the hemi-Fontan procedure, RV-PA showed better late hemodynamic outcomes, including a lower pulmonary-to-systemic (Qp/Qs) ratio (MD: 0.25 [-0.43 to -0.07], p = 0.007), higher aortic diastolic pressure (MD: 5.22 [2.56-7.87], p < 0.001), and higher Nakata index (MD: 30.54 [3.34-57.75], p = 0.03). RV-PA had no significant impact on right ventricular compliance, as indicated by similar RV end-diastolic pressure (RVEDP; MD: 0.44 [-0.52 to 1.40], p = 0.37). Although RV-PA had a higher but non-significant incidence of shunt stenosis (RR: 4.68 [0.21-105.18], p = 0.33), its advantages outweighed this limitation. Kaplan-Meier analysis showed superior 3-year survival for RV-PA (72% vs. 61% for mBT, p = 0.005). These findings support RV-PA as the preferred shunt for improving survival, hemodynamic outcomes, and perioperative success in HLHS patients undergoing the Norwood procedure. Copyright © 2026 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/ <9> Accession Number 651319165 Title The Effect of Acupressure on Procedural Pain, Anxiety, and Hemodynamic Parameters During Chest Tube Removal in Open-Heart Surgery Patients: A Randomized Sham-Controlled Study. Source Pain management nursing : official journal of the American Society of Pain Management Nurses. 27(5) (pp e1017-e1026), 2026. Date of Publication: 01 Oct 2026. Author Kandemir D.; Yuksel S.; Cam Yanik T.; Ozdemir F.E.; Altun Ugras G. Institution (Kandemir) Surgical Receiving Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom (Yuksel) Faculty of Nursing, Department of Surgical Nursing, Necmettin Erbakan University, Konya, Turkey (Cam Yanik) Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Turkey (Ozdemir) Cardiovascular Surgery Intensive Care Unit, Mersin University Hospital, Mersin, Turkey (Altun Ugras) Faculty of Nursing, Department of Surgical Nursing, Mersin University, Mersin, Turkey Abstract BACKGROUND: Patients undergoing open-heart surgery often experience procedural pain and anxiety during chest tube removal (CTR), which can lead to serious complications, along with potential changes in hemodynamic parameters such as blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation. AIM: This study aimed to explore the effects of acupressure on procedural pain, anxiety, and hemodynamic parameters during CTR in open-heart surgery patients. METHOD(S): This prospective, two-arm (1:1), randomized sham-controlled trial included 68 open-heart surgery patients with chest tubes. Participants were randomly assigned to either the true acupressure group (n = 34) or the sham acupressure group (n = 34). Before CTR, patients in the true acupressure group received 12 minutes of pressure at points LI4, LI11, and HT7 on both hands, while those in the sham acupressure group received pressure applied 1.5 cm away from the same points. Data were collected at baseline (T0), immediately after CTR (T1), and 15 minutes after CTR (T2) using the Visual Analog Scale (VAS), the State Anxiety Inventory (STAI-S), and hemodynamic parameters. RESULT(S): At baseline, pain, anxiety, and hemodynamic parameters were comparable between the two groups (p > .05). Immediately after CTR (T1), pain levels were significantly lower in the true acupressure group compared with the sham acupressure group, with an effect size of 0.71 (t = 2.925, Cohen's d = 0.709, p = .005). Anxiety levels were also significantly lower in the true acupressure group both immediately after CTR (T1; effect size = 0.50, t = 2.046, Cohen's d = 0.496, p = .045) and 15 minutes post-removal (T2; effect size = 0.51, t = 2.111, Cohen's d = 0.512, p = .035). Acupressure had no significant effect on hemodynamic parameters (p > .05). CONCLUSION(S): Acupressure was effective in reducing procedural pain and anxiety associated with CTR in open-heart surgery patients, while having no measurable impact on hemodynamic parameters. CLINICAL TRIALS ID: NCT05875337 (Registered May 15, 2023). Copyright © 2026 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved. <10> Accession Number 2045600748 Title Combining external placebo-arm data in a prevention trial: effects of cocoa extract supplementation on cardiovascular disease. Source European Journal of Epidemiology. 41(8) (pp 949-958), 2026. Date of Publication: 01 Aug 2026. Author Hamaya R.; Li S.; Rist P.M.; Shadyab A.H.; Manson J.E.; Sesso H.D. Institution (Hamaya, Li, Rist, Manson, Sesso) Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States (Li) Division of Life Sciences and Medicine, Institute of Public Health Sciences, University of Science and Technology of China, Hefei, China (Rist, Manson, Sesso) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States (Shadyab) Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States (Manson) Mary Horrigan Connors Center for Women's Health Research, Brigham and Women's Hospital, Boston, MA, United States Publisher Springer Science and Business Media B.V. Abstract Rigorous integration of external controls in large-scale cardiovascular prevention randomized controlled trials (RCTs) is under-explored. The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS), a primary prevention RCT of cocoa extract supplementation, initially showed a statistically non-significant effect on total cardiovascular disease (CVD). We aimed to obtain more robust estimates of cocoa extract effects by integrating external control data from The VITamin D and OmegA-3 TriaL (VITAL), a similarly designed large-scale RCT. We analyzed 21,442 COSMOS participants (median 3.6-year follow-up) and used the VITAL omega-3 placebo arm as an external control. Outcomes included the original COSMOS primary CVD endpoint (a composite of myocardial infarction [MI], stroke, cardiovascular death, and coronary revascularization) and major adverse cardiovascular events (MACE; MI, stroke, and cardiovascular death). Two statistical approaches were used: a propensity score-based inverse probability weighting (IPW)-weighted Cox proportional hazard model and a doubly robust method to estimate 4-year risk ratios (RRs) and 95% confidence intervals (CIs) via bootstrapping. IPW-weighted VITAL-placebo data showed similar covariate distributions and 4-year event rates to COSMOS-placebo. While COSMOS data alone showed non-significant RRs (CVD: 0.91 [95% CI 0.79, 1.04]; MACE: 0.84 [0.70, 1.00]), incorporating VITAL-placebo showed protective effects of cocoa extract for cardiovascular endpoints ; RRs were 0.87 [0.76, 0.98] for CVD and 0.80 [0.68, 0.93] for MACE in Cox models; and those were 0.84 [0.74, 0.95] for CVD and 0.77 [0.67, 0.89] for MACE in the doubly robust method. E-values and sensitivity analyses indicated robustness. The present results suggest that original non-significant results of COSMOS could be due to type 2 error. While additional assumptions are needed, external control integration offers a feasible approach to strengthen interpretations of large-scale prevention trials. Copyright © Springer Nature B.V. 2026. <11> [Use Link to view the full text] Accession Number 2039579064 Title Perioperative dexmedetomidine reduces the risk of postoperative complications in high-risk patients undergoing non-cardiac surgery: A randomized controlled trial. Source Chinese Medical Journal. 139(18) (pp 2770-2779), 2026. Date of Publication: 20 Sep 2026. Author Meng Z.; Ding T.; Zhao W.; Guo L.; Li M.; Zhao Z.; Zhang Y.; Li C.; Mu D.; Wang D. Institution (Meng, Ding, Li, Li, Mu, Wang) Department of Anesthesiology, Peking University First Hospital, Beijing, China (Meng) Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China (Zhao, Zhao) Department of Anesthesiology, The Fourth Hospital of Hebei Medical University, Hebei, Shijiazhuang, China (Guo, Zhang) Department of Anesthesiology, Liaocheng People's Hospital in Shandong Province, Shandong, Liaocheng, China Publisher Lippincott Williams and Wilkins Abstract Abstract - Background: - Dexmedetomidine may suppress the surgery-induced inflammatory response, which is considered the underlying mechanism of postoperative complications. This study was designed to investigate whether perioperative dexmedetomidine could decrease the risk of postoperative complications among high-risk patients. Method(s): - This multicenter randomized controlled trial is a superiority trial. Central randomization was used. Elderly patients (age >=60 years) with revised cardiac risk index (RCRI) >=3 and scheduled for major non-cardiac surgery were enrolled. Patients in dexmedetomidine group received intraoperative dexmedetomidine (a loading dose of 0.5 mug/kg followed by 0.3 mug.kg-1.h-1) as adjuvant to general anesthesia and postoperative dexmedetomidine (2 mug/h for 72 h) as supplementation to patient-controlled analgesia with sufentanil. Patients in the control group received an equivalent dose of normal saline as placebo during anesthesia and sufentanil only for postoperative analgesia. The primary outcome was the incidence of major postoperative complications including neurologic, cardiovascular, renal, pulmonary coagulation, infectious, and gastrointestinal systems within postoperative 30 days. Secondary outcomes included pain intensity, sleep quality, postoperative length of in-hospital stay, and medical expenses during hospitalization. Neutrophil-to-lymphocyte ratio (NLR) was used to monitor inflammatory response. Result(s): - This study included 272 patients, with similar median age (70 years vs. 69 years) and median RCRI (both 3) between dexmedetomidine and control groups. The incidence of major postoperative complications in the dexmedetomidine group was significantly lower than that in the control group (38.2% [52/136] vs. 52.9% [72/136], relative risk [RR] = 0.722, 95% confidence interval (CI) 0.554-0.942, P = 0.015). Postoperative in-hospital stay was shorter in the dexmedetomidine group than that in the control group (mean difference [MD] = -1 day, 95% CI: -2 to 0 days, P = 0.013). Other secondary outcomes were comparable between the two groups. The highest NLR within postoperative first 3 days in the dexmedetomidine group was lower than that in the control group (MD = -2.1, 95% CI: -4.1 to -0.3, P = 0.037). The proportion of all drug-related adverse events were comparable between the two groups. Conclusion(s): - Dexmedetomidine, infused from the beginning of anesthesia to postoperative 72 h, decreased the risk of postoperative complications in high-risk elderly patients undergoing non-cardiac surgery. Trial registration: - No. ChiCTR2000030566 at www.chictr.org.cn Copyright © 2025 The Chinese Medical Association, produced by Wolters Kluwer Health, LLC. under the CC-BY-NC-ND license. <12> Accession Number 2047278727 Title Validity of Glucose Measurement Methods During Surgery: A Systematic Review. Source Canadian Journal of Diabetes. 50(6) (pp 448-455.e5), 2026. Date of Publication: 01 Aug 2026. Author Heatlie L.; Ejaredar M.; Lithgow K.C.; Dillane D.; Manek R.; Gill S.; Cameron A.; Fuzery A.K.; Pham M.; Subramanian A.; Ruzycki S.M. Institution (Heatlie, Ejaredar, Lithgow, Pham, Ruzycki) Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (Dillane) Faculty of Medicine & Dentistry, Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, AB, Canada (Manek, Gill) Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (Cameron) Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada (Fuzery) Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, Canada (Subramanian) School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia (Ruzycki) Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada Publisher Elsevier B.V. Abstract Intraoperative hyperglycemia is associated with adverse patient outcomes and there are major quality gaps in intraoperative glucose measurement and management. It is unclear how anesthesiologists can accurately and feasibly measure glucose values during surgery. Our purpose in this systematic review was to describe the current literature describing the precision and accuracy of intraoperative glucose measurement to inform clinical decision-making for anaesthesiologists. A systematic search strategy identified English-language studies that compared 2 or more methods to measure a blood glucose value during surgery for adult, nonpregnant patients. MEDLINE, PubMed, Embase, and CINAHL were searched from inception until 2024. A grey literature search and hand searching of reference lists for included articles was also completed. Abstracts and full text were screened and then extracted in duplicate by study team members. Of 8,691 unique studies identified, 23 studies were included in the analysis (1,258 total patients, 4,071 pairs of glucose measurements). There was important heterogeneity between these studies with respect to the blood source, blood fraction, comparator measurement method, reference measurement method, and statistical analysis used. This heterogeneity precluded meta-analysis of results. Hypoglycemia was rare (9 of 1,992 measurements, 0.45%). Most studies did not use international accuracy standards to determine whether differences between their comparator measurement method and reference measurement method were clinically acceptable. The optimal method to measure intraoperative glucose is not known. In the meantime, anesthesiologists should consider the characteristics of existing glucose measurement methods when selecting a method for their settings and patients. Copyright © 2026 <13> Accession Number 2048881879 Title Hospital costs and procedural learning curves of robotic mitral valve surgery: a systematic review and meta-analysis. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 933. Date of Publication: 01 Dec 2026. Author Nguyen D.; Le M.H.N.; Taha A.M.; Rutledge-Jukes H.; Thuan P.Q.; Tran T.; Le P.T.V.; Le T.T.B.; Dinh N.H.; Huynh P.K.; Sun L.Y.; Kpodonu J. Institution (Nguyen) Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States (Nguyen) Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, United States (Le) Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States (Taha, Huynh) PASSIO Laboratory, North Carolina A & T State University, Greensboro, NC, United States (Rutledge-Jukes) Washington University School of Medicine, Saint Louis, MO, United States (Thuan, Dinh) Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam (Tran) John T. Milliken Department of Medicine, Washington University School of Medicine, Saint Louis, MO, United States (Le) Ascension Saint Joseph Hospital Chicago, Chicago, IL, United States (Le) Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States (Sun) Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford University, Palo Alto, CA, United States (Kpodonu) Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States Publisher Springer Nature Abstract Robotic-assisted mitral valve surgery offers a less invasive alternative to traditional open sternotomy, with potential benefits including faster recovery and reduced morbidity. However, the higher upfront expenses have slowed its broader acceptance. This study aimed to synthesize existing evidence comparing robotic and conventional mitral valve procedures regarding overall hospital expenses, intraoperative and post-procedure costs, as well as learning trajectory parameters including aortic cross-clamp and cardiopulmonary bypass durations. A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted up to May 2026 to identify studies reporting cost or learning curve outcomes. A random-effects model with restricted maximum likelihood estimation was used in R software for all pooled analyses. Seventeen studies met inclusion criteria. Total hospital costs from five studies (91,541 participants) showed no significant difference between approaches (MD + 1,620 USD; p = 0.423) with high heterogeneity (I2 = 99.3%). Leave-one-out analysis excluding one large US database study demonstrated significantly lower total costs for robotic surgery (p < 0.001) with no heterogeneity. Robotic procedures had higher intraoperative costs (MD + 2,144 USD; p < 0.001) but lower postoperative costs (MD -556 USD; p < 0.001). The learning phase trended toward longer cross-clamp and bypass times versus proficiency, with no differences between proficiency and mastery phases. Robotic mitral surgery demonstrated no significant difference in total hospital costs compared with conventional approaches in the primary analysis, with higher intraoperative costs offset by lower postoperative expenses. However, substantial heterogeneity and limited learning curve evidence prevent definitive conclusions. Future studies should adopt standardized economic and learning curve methodologies. Copyright © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2026. <14> Accession Number 636033241 Title Ventricular Assist Device Driveline Infections: A Systematic Review. Source Thoracic and Cardiovascular Surgeon. 70(6) (pp 493-504), 2021. Date of Publication: 14 Sep 2021. Author Krzelj K.; Petricevic M.; Gasparovic H.; Biocina B.; McGiffin D. Institution (Krzelj, Gasparovic, Biocina) Department of Cardiac Surgery, University Hospital Center Zagreb, Zagreb, Croatia (Petricevic) Division of Health Studies, Department of Cardiac Surgery, University of Split, University Hospital Center Zagreb, Zagreb, Croatia (Gasparovic, Biocina) School of Medicine, University of Zagreb, Zagreb, Croatia (McGiffin) Department of Cardiothoracic Surgery and Transplantation, Alfred Hospital, Melbourne, VIC, Australia (McGiffin) Monash University, Clayton, VIC, Australia Publisher Georg Thieme Verlag Abstract Infection is the most common complication in patients undergoing ventricular assist device (VAD) implantation. Driveline exit site (DLES) infection is the most frequent VAD infection and is a significant cause of adverse events in VAD patients, contributing to morbidity, even mortality, and repetitive hospital readmissions. There are many risk factors for driveline infection (DLI) including younger age, smaller constitution of patients, obesity, exposed velour at the DLES, longer duration of device support, lower cardiac index, higher heart failure score, DLES trauma, and comorbidities such as diabetes mellitus, chronic kidney disease, and depression. The incidence of DLI depends also on the device type. Numerous measures to prevent DLI currently exist. Some of them are proven, whereas the others remain controversial. Current recommendations on DLES care and DLI management are predominantly based on expert consensus and clinical experience of the certain centers. However, careful and uniform DLES care including obligatory driveline immobilization, previously prepared sterile dressing change kits, and continuous patient education are probably crucial for prevention of DLI. Diagnosis and treatment of DLI are often challenging because of certain immunological alterations in VAD patients and microbial biofilm formation on the driveline surface areas. Although there are many conservative and surgical methods described in the DLI treatment, the only possible permanent solution for DLI resolution in VAD patients is heart transplantation. This systematic review brings a comprehensive synthesis of recent data on the prevention, diagnostic workup, and conservative and surgical management of DLI in VAD patients. Copyright © 2022 Georg Thieme Verlag. All rights reserved. <15> Accession Number 2048847940 Title Association between the Fibrosis-4 index and stroke and related outcomes: a meta-analysis. Source Frontiers in Neurology. 17 (pp 1-16), 2026. Article Number: 1791832. Date of Publication: 10 Aug 2026. Author Lai W.; Yu H.; Wang H. Institution (Lai) Graduate School of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China (Yu, Wang) The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China Publisher Frontiers Media SA Abstract Objective - This meta-analysis evaluated the associations between the Fibrosis-4 index (FIB-4) and overall stroke, ischemic stroke, hemorrhagic outcomes, poor functional outcome, and all-cause mortality. Methods - PubMed, Embase, and the Cochrane Library were searched from inception to November 4, 2025. Cohort and cross-sectional studies evaluating categorical or continuous FIB-4 were eligible. Quantitative syntheses were stratified by outcome, FIB-4 modeling approach, and effect measure, with odds ratios (ORs) and hazard ratios (HRs) analyzed separately. Prediction intervals were calculated for random-effects analyses containing at least three independent estimates. Results - Twenty-two studies, including 20 cohort studies and two cross-sectional studies, were included, of which 20 contributed to at least one quantitative synthesis. Elevated categorical FIB-4 was associated with greater odds of overall stroke (OR=1.86, 95% CI: 1.63-2.14), ischemic stroke (OR=2.03, 95% CI: 1.72-2.40), symptomatic intracranial hemorrhage (OR=2.52, 95% CI: 1.79-3.53), poor functional outcome (OR=2.88, 95% CI: 2.47-3.35), and all-cause mortality (OR=2.98, 95% CI: 2.51-3.53). Continuous FIB-4 was also associated with overall stroke (HR=1.08, 95% CI: 1.02-1.14), symptomatic intracranial hemorrhage (OR=1.33, 95% CI: 1.20-1.48), poor functional outcome (OR=1.26, 95% CI: 1.11-1.43), and all-cause mortality (HR=1.08, 95% CI: 1.03-1.12). However, prediction intervals crossed the null for the continuous analyses of poor functional outcome and all-cause mortality, and the categorical overall-stroke analysis was exploratory. Conclusion - Higher FIB-4 was associated with stroke and adverse stroke-related outcomes across several observational analyses. FIB-4 may provide adjunctive risk information, but prospective validation and formal assessment of its incremental clinical value are required before routine implementation. Systematic review registration - https://www.crd.york.ac.uk/prospero/search, identifier: CRD420251207801. Copyright © 2026 Lai, Yu and Wang. <16> Accession Number 2048433363 Title Transseptal versus left atrial approach for mitral valve surgery: A systematic review and meta-analysis. Source Asian Cardiovascular and Thoracic Annals. 34(7) (pp 642-655), 2026. Date of Publication: 01 Sep 2026. Author Paramkusam S.M.C.; Paramkusam A.V.; Abuzayed B.; Omaruddin L.; Pavuluri K.S.; Ghosh A.; Basri A.; Malik A.B.; Ramkhalawon S.V.; Mukunde A.-C.; Imam B.; Ezhil S.R. Institution (Paramkusam) Katuri Medical College and Hospital, Andhra Pradesh, Guntur, India (Paramkusam) Jonelta Foundation School of Medicine - UPHSD, Las Pinas, Philippines (Abuzayed) Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom (Omaruddin) Royal College of Surgeons, Bahrain, Ireland (Pavuluri) Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom (Ghosh) Nazareth Hospital, Philadelphia, PA, United States (Basri) Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan (Malik) Washington University in St Louis, St Louis, United States (Ramkhalawon) SAJ Flacq Hospital, Flacq, Mauritius (Mukunde) Universidad de Montemorelos, Montemorelos, Mexico (Imam) University of Pittsburgh Medical Center, Pittsburgh, United States (Ezhil) M.S. Ramaiah Medical College, Bangalore, India (Paramkusam, Paramkusam, Abuzayed) Publisher SAGE Publications Inc. Abstract Objective: Surgical access to the mitral valve can be achieved through various techniques, with the transseptal (TS) and left atrial (LA) approaches being the most commonly used in mitral valve surgery (MVS). However, the optimal approach remains a subject of debate, as studies report differing perioperative and postoperative outcomes associated with each technique. This meta-analysis aims to systematically compare the clinical outcomes of TS versus LA approaches in MVS. Method(s): This meta-analysis followed the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus databases was performed until June 2025. The primary outcome was permanent pacemaker (PPM) implantation. Result(s): Twenty-five studies were included. The TS approach was associated with higher risk of PPM implantation (risk ratio: 1.44, 95% confidence interval [1.07-1.95]; P = 0.01), postoperative atrial fibrillation, postoperative junctional rhythm, atrioventricular block, need for temporary pacing and longer cardiopulmonary bypass time, aortic cross-clamp time (CCT), hospital-stay and bleeding. No significant differences were found in intensive care unit stay, mortality, infections, stroke and renal failure. Subgroup analysis of isolated MVS showed no differences in most outcomes except for a higher risk of PPM implantation and postoperative atrial fibrillation in the TS group. Conclusion(s): Our meta-analysis demonstrates that the TS approach is associated with longer operative times and a higher risk of postoperative conduction disturbances and PPM implantation. However, no significant differences were observed in other major clinical outcomes. These findings do not support the overall superiority of either approach, and surgical access should be individualized according to patient anatomy, procedural requirements, and surgeon experience. Further high-quality studies are needed to strengthen the available evidence. Copyright © The Author(s) 2026 <17> Accession Number 633048120 Title Wound Infection after CABG Using Internal Mammary Artery Grafts: A Meta-Analysis. Source Thoracic and Cardiovascular Surgeon. 69(7) (pp 639-648), 2020. Date of Publication: 13 Aug 2020. Author Oswald I.; Boening A.; Pons-Kuehnemann J.; Grieshaber P. Institution (Oswald, Boening, Grieshaber) Department of Adult and Pediatric Cardiovascular Surgery, Justus Liebig University Giessen, Rudolf-Buchheim-Strabetae 7, Giessen, Germany (Pons-Kuehnemann) Institute of Medical Informatics, Department of Medical Statistics, Justus Liebig University Giessen, Giessen, Germany Publisher Georg Thieme Verlag Abstract Background Internal mammary arteries show better long-term patency rates than venous grafts. The use of both mammary arteries is associated with a higher risk of sternal wound infections. This meta-analysis was designed to assess the incidence of a wound healing disorder after bilateral compared with single mammary artery bypass grafting. Compared with existing meta-analysis this paper includes more current literature and one randomized controlled trial. Methods A literature search was performed using PubMed and the Cochrane Library. The quality of the articles was assessed by the Newcastle Ottawa Scale. The odds ratio was used as a measure of the chance of developing a wound healing disorder after bilateral internal mammary artery (BIMA) surgery. Meta-analyses were performed for different subgroups. Results Twenty studies met the quality criteria, including one randomized controlled trial. The use of both mammary arteries significantly increased the risk of superficial (odds ratio [OR] 1.72) and deep (OR 1.75) wound healing disorder in the total population (OR 1.80) as well as in the diabetic subgroup (OR 1.38) and with both preparation techniques. The increased risk with BIMA grafting was present independently of the preparation technique (pedicled: OR 1.89, skeletonized: OR 1.37). Conclusion Bilateral internal mammary artery grafting, especially in high-risk and diabetic patients, is associated with an increased risk of wound healing impairment. Skeletonized preparation does not eliminate the elevated wound healing disorder risk after BIMA use. Copyright © 2021 Georg Thieme Verlag. All rights reserved. <18> Accession Number 633132939 Title Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic Valve Implantation for Aortic Stenosis and Porcelain Aorta with a Systematic Review of Transfemoral versus Transapical Approach. Source Thoracic and Cardiovascular Surgeon. 68(7) (pp 623-632), 2019. Date of Publication: 26 Jun 2019. Author Useini D.; Haldenwang P.; Schlomicher M.; Christ H.; Naraghi H.; Moustafine V.; Strauch J. Institution (Useini, Haldenwang, Schlomicher, Naraghi, Moustafine, Strauch) Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz-1, Bochum, Germany (Christ) Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany Publisher Georg Thieme Verlag Abstract Background aWe have aimed to analyze early and mid-term outcomes of patients undergoing transapical/transfemoral transcatheter aortic valve implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo) in our institution. Additionally, we postulated that the TA approach may be associated with a more favorable neurological outcome than the TF approach; hence, a systematic literature review was conducted. Methods aBetween 2011 and 2017, 15 patients with PAo underwent TA-TAVI and 4 patients with PAo TF-TAVI at our institution. The assessment of PAo was done either intraoperatively after aborted sternotomy or via computed tomography for elective TAVI. We conducted mid-term follow-up. Furthermore, a systematic review was performed to compare the mortality and neurological outcomes of TF and TA-TAVI approaches. Results aTA/TF-TAVIs were performed with 100% device success, without paravalvular leakage >= 2 and without procedural death. The 30-day mortality/stroke rates were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The 6-month, 1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%, 82%/66.6%, and 50%/0%, respectively. The pooled results derived from the literature review were as follows: The prevalence of PAo in the TAVI population is 9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI versus 16.2% in TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI versus 6.3% in TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9% in TF-TAVI. Conclusion aTA-TAVI shows promising early and mid-term outcomes in patients with PAo. TF-TAVI performed in patients with PAo is likely to be associated with higher rates of stroke than TA-TAVI. Copyright © 2020 Georg Thieme Verlag. All rights reserved. <19> Accession Number 629723817 Title Recurrence Risk in Patients with Cryptogenic Stroke, Patent Foramen Ovale, and Thrombophilia: A Systematic Review and Meta-Analysis. Source Thrombosis and Haemostasis. 119(11) (pp 1839-1848), 2019. Date of Publication: 04 Aug 2019. Author Hviid C.V.B.; Simonsen C.Z.; Hvas A.-M. Institution (Hviid, Hvas) Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark (Simonsen) Department of Neurology, Aarhus University Hospital, Aarhus, Denmark (Hvas) Department of Clinical Medicine, Aarhus University, Aarhus, Denmark Publisher Georg Thieme Verlag Abstract Objective ?A patent foramen ovale (PFO) is frequently associated with cryptogenic stroke in the young. Endovascular closure is superior to antithrombotic treatment in prevention of recurrence, but in the presence of a concomitant thrombophilia, the best preventive strategy is unknown. This review investigates if thrombophilia increases the risk of recurrence in patients with cryptogenic stroke and PFO and attempts to evaluate the best antithrombotic strategy after PFO closure in these patients. Methods ?Medline, Embase, and Web of Science were searched until April 2018. Study quality was assessed by the National Heart, Lung and Blood Institute Quality assessment tool. Odds ratio (OR) and hazard ratio for recurrence were pooled in a random effect model stratified by secondary preventive strategy. Results ?Eleven studies were included. Inherited or acquired thrombophilia was associated with an increased risk of recurrence (OR = 2.41, 95% confidence interval [CI]: 1.44-4.06). Looking only at patients treated with PFO closure, the risk of recurrence just lost significance (OR = 2.07, 95% CI: 0.95-4.48). The antithrombotic treatment after PFO closure was heterogeneous and recurrent events occurred in patients with both inherited and acquired thrombophilia treated by antiplatelet as well as anticoagulant therapy. Conclusion ?Thrombophilia is associated with an increased risk of recurrence in patients with PFO and cryptogenic stroke, which may persist after PFO closure. This suggests a need for antithrombotic therapy after PFO closure. Study heterogeneity precludes strong conclusions on antithrombotic treatment, but life-long antiplatelet therapy to patients without preexisting indication for anticoagulant therapy seems reasonable. Copyright © 2019 Georg Thieme Verlag KG Stuttgart . New York. <20> Accession Number 2047576478 Title Artificial intelligence and biomarker-driven prediction of post-coronary artery bypass grafting atrial fibrillation: Integrating clinical, genomic, and metabolic insights. Source Heart Rhythm O2. 7(9) (pp 1800-1808), 2026. Date of Publication: 01 Sep 2026. Author Ghani M.U.; Prasad A.; Nagarajan J.S.; Patel D.T.; Desai R.; Gnanaguruparan S.; Chatterjee S. Institution (Ghani) Department of Internal Medicine, Central Michigan University, Mt. Pleasant, MI, United States (Prasad) Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, TX, United States (Nagarajan) Department of Medicine, SUNY Upstate Medical University, Syracuse, New York (Patel) Department of Medicine, Mercy Catholic Medical Center, Darby, PA, United States (Desai) Independent Researcher, Outcomes Research, Atlanta, GA, United States (Gnanaguruparan) Division of Cardiology, Christiana Hospital, Newark, DE, United States (Chatterjee) Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States Publisher Elsevier B.V. Abstract Background Postoperative atrial fibrillation (POAF) remains one of the most frequent and consequential complications after coronary artery bypass grafting, occurring in 15%-30% of patients and contributing to increased morbidity, prolonged hospitalization, and higher long-term mortality. Despite decades of investigation, traditional risk models have shown limited predictive accuracy owing to the multifactorial nature of POAF. Objective This review synthesizes the emerging evidence from recent studies applying artificial intelligence (AI) and machine learning (ML) approaches for POAF prediction, with focus on clinical, biochemical, genomic, and molecular dimensions. Methods We conducted a structured narrative review of PubMed/MEDLINE, Embase, and Google Scholar for studies evaluating AI and ML-based prediction of POAF following isolated coronary artery bypass grafting published from January 2020 through 2025. Search terms included POAF, coronary artery bypass grafting, ML, AI, pharmacogenomics, and biomarkers. A total of 9 studies met inclusion criteria and were synthesized narratively given the heterogeneity in study designs and outcomes. Results Across studies, modern algorithms demonstrate areas under the curve receiver operating characteristic between 0.80 and 0.93, with performance exceeding that reported for traditional clinical risk scores. However, external validation, model calibration, and biases remain to be fully addressed before clinical translation is considered. Conclusion The convergence of interpretable AI, metabolic and genetic biomarkers, and clinical data offers a promising path toward individualized risk stratification and targeted postoperative management. Copyright © 2026 Heart Rhythm Society. <21> Accession Number 634019146 Title Effect of Prolonged Hypothermic Cardiopulmonary Bypass, Heparin, and Protamine on Platelet: A Small-Group Study. Source Thoracic and Cardiovascular Surgeon. 69(8) (pp 719-722), 2021. Date of Publication: 19 Jan 2021. Author Epstein D.; Vishnepolsky A.; Bolotin G.; Atweh N.; Bonstein L.; Lehavi A. Institution (Epstein) Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel (Vishnepolsky, Lehavi) Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel (Bolotin) Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel (Bolotin, Bonstein, Lehavi) Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel (Atweh, Bonstein) Blood Bank and Platelet Immunology Laboratories, Rambam Health Care Campus, Haifa, Israel Publisher Georg Thieme Verlag Abstract Cardiopulmonary bypass (CPB) is associated with platelet dysfunction (PD), an important cause of postoperative bleeding. The etiology of PD is not completely understood. We mapped the platelets' function during CPB to determine the etiology of PD. Platelets activation, measured by procaspase activating compound-1 and P-selectin expression (CD62P), after activation by adenosine diphosphate and thrombin receptor activator peptide, were decreased by protamine. Changes during CPB were insignificant. Platelet-leukocyte aggregation was increased by CPB but not by protamine. Platelet apoptosis marker, annexin V, was increased by protamine. Changes during CPB were insignificant. Our findings demonstrate that protamine given after CPB plays a central role in PD and count decrease. Copyright © 2021 American Medical Association. All rights reserved. <22> Accession Number 635266114 Title Alternatives for Vitamin K Antagonists as Thromboprophylaxis for Mechanical Heart Valves and Mechanical Circulatory Support Devices: A Systematic Review. Source Seminars in Thrombosis and Hemostasis. 47(6) (pp 724-734), 2021. Date of Publication: 31 May 2021. Author Liesdek O.C.D.; Urbanus R.T.; De Heer L.M.; Fischer K.; Suyker W.J.L.; Schutgens R.E.G. Institution (Liesdek, De Heer, Suyker) Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands (Liesdek, Urbanus, Fischer, Schutgens) Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands Publisher Thieme Medical Publishers, Inc. Abstract The holy grail of anticoagulation in patients with intracardiac devices, such as mechanical heart valves (MHVs) and left ventricular assist devices (LVADs), comprises safe prevention of thrombosis without interrupting normal hemostasis. Device-induced thrombosis and anticoagulant-related bleeding problems are dreaded complications that may cause a significantly reduced quality of life and increased morbidity and mortality. Vitamin K antagonists are the current standard for oral anticoagulation therapy in patients with MHVs and LVADs. Even within the therapeutic range, hemorrhage is the primary complication of these drugs, which emphasizes the need for safer anticoagulants for the prevention of device-induced thrombosis. Device-induced thrombosis is a complex multifactorial phenomenon that likely requires anticoagulant therapy targeting multiple pathways. Here, we review the preclinical and clinical data describing the efficacy of a variety of anticoagulants as thromboprophylaxis after implantation of intracardiac devices. Copyright © 2021 American Institute of Physics Inc.. All rights reserved. <23> Accession Number 622011607 Title Randomized (CO)mparison of (TRI)fecta and (P)erimount Magna ease supraannular aortic Xenografts-COTRI.P study. Source Thoracic and Cardiovascular Surgeon. 67(4) (pp 266-273), 2018. Date of Publication: 01 May 2018. Author Van Linden A.; Arsalan M.; Korschgen T.; Blumenstein J.; Kempfert J.; Hecker F.; Walther T. Institution (Van Linden, Arsalan, Hecker, Walther) Department of Cardiac Surgery, Kerckhoff Klinik, Bad Nauheim, Germany (Van Linden, Arsalan, Hecker, Walther) Department of Cardiac Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany (Korschgen) Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany (Blumenstein) Department of Cardiology, St. Johannes Hospital, Dortmund, Germany (Kempfert) Department of Cardiac Surgery, German Heart Center, Berlin, Germany Publisher Georg Thieme Verlag Abstract Background Modern supraannular aortic xenografts offer a special design, thus providing maximized opening area for improved hemodynamics. The aim of this study was a prospectively randomized comparison of the Trifecta and the Perimount Magna Ease valves based on metric annulus sizing. Methods A total of 100 patients with aortic stenosis undergoing aortic valve replacement (AVR) with or without concomitant procedures were prospectively included. After decalcification of the annulus, stratified intraoperative randomization was performed. The diameter of the aortic annulus was measured using metric Hegar dilators and randomization was based on this metric annulus diameter. Exercise echocardiography was performed at 10-month follow-up. Results Mean age was 69 years, with 36% female. Predominant implanted valve sizes were 23 mm (39%) and 25 mm (32%). Unadjusted mean pressure gradient was significantly lower and effective orifice area larger for the Trifecta group (10.8 +/- 5 vs. 13.2 +/- 4 mm Hg, p = 0.02 and 1.93 +/- 0.39 vs. 1.70 +/- 0.30 cm 2, p = 0.002) at discharge. In patients with small annuli, based on the metric annulus size there were no significant differences in gradients or the orifice area. At exercise echocardiography follow-up, there were no significant hemodynamic differences between both prostheses. Conclusions The Trifecta and the Perimount Magna Ease prostheses both show excellent hemodynamic performance after AVR. In patients with larger annuli, the Trifecta valve seems to be even superior to the Magna Ease, which may be advantageous in obese patients. Copyright © 2019 Georg Thieme Verlag KG Stuttgart * New York. <24> Accession Number 2035796594 Title Long-term Survival in Elderly Patients after Coronary Artery Bypass Grafting Compared to the Age-matched General Population: A Meta-analysis of Reconstructed Time-to-Event Data. Source Thoracic and Cardiovascular Surgeon. 74(1) (pp 1-7), 2024. Date of Publication: 19 Nov 2024. Author Kirov H.; Caldonazo T.; Toshmatov S.; Tasoudis P.; Mukharyamov M.; Diab M.; Doenst T. Institution (Kirov, Caldonazo, Toshmatov, Mukharyamov, Diab, Doenst) Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany (Tasoudis) Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC, United States Publisher Georg Thieme Verlag Abstract Background Coronary artery disease (CAD) limits life expectancy compared to the general population. Myocardial infarctions (MIs) are the primary cause of death. The incidence of MI increases progressively with age and most MI deaths occur in the population older than 70 years. Coronary artery bypass grafting (CABG) may prevent the occurrence of new MIs by bypassing most CAD lesions, providing downstream collateralization to the diseased vessel, and consequently prolonging survival. We systematically assessed the survival-improving potential of CABG by comparing elderly CABG patients to the age-matched general population. Methods Three databases were assessed. The primary and single outcome was long-term all-cause mortality. Time-to-event data of the individual studies were extracted and reconstructed in an overall survival curve. As a sensitivity analysis, summary hazard ratios (HRs) and 95% confidence intervals (CIs) for all individual studies were pooled and meta-analytically addressed. The control group was based on the age-matched general population of each individual study. Results From 1,352 records, 4 studies (4,045 patients) were included in the analysis. Elderly patients (>70 years) who underwent CABG had a significantly lower risk of death in the follow-up compared to the general age-matched population in the overall survival analysis (HR: 0.88; 95% CI: 0.83, 0.94; p < 0.001: mean follow-up was 7 years). Conclusion Elderly patients who undergo CABG appear to have significantly better long-term survival compared to the age-matched general population. This advantage becomes visible after the first year and underscores the life-prolonging effect of bypass surgery, which may eliminate the expected reduction in life expectancy through CAD. Copyright © 2024. Thieme. All rights reserved. <25> Accession Number 2048867376 Title Hemodynamic effects of dexmedetomidine versus propofol in cardiac surgery: a systematic review and meta-analysis. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 543. Date of Publication: 01 Dec 2026. Author Montaseri M.; Saberian M.; Jackson A.C.; Bahramnejad F.; Bahramnezhad F. Institution (Montaseri) Critical Care Nursing Department, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Saberian) Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of (Jackson) Centre on Behavioral Health, University of Hong Kong, Pokfulam, Hong Kong (Bahramnejad) Department of Health Information Technology, Sirjan School of Medical Sciences, Sirjan, Iran, Islamic Republic of (Bahramnezhad) Department of Critical Care Nursing, Nursing and Midwifery Care Research Center, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of Publisher BioMed Central Ltd Abstract Background: Cardiac surgery, particularly open-heart procedures such as coronary artery bypass grafting and valve surgery, is one of the most common curative options for ischemic heart disease, congenital heart defects, and valvular disease but is also associated with severe hemodynamic hazards. Intravenous anesthetic agents such as propofol and dexmedetomidine are employed to sedate such patients in routine clinical practice. There is, however, conflicting and sporadic evidence in the literature regarding the relative effects of these two agents on hemodynamic parameters. This review systematically analyzed and contrasted the hemodynamic effects of dexmedetomidine and propofol in patients undergoing cardiac surgery. Method(s): Systematic searches in the PubMed, Scopus, Embase, Web of Science, CINAHL, Cochrane Library, and Google Scholar databases were performed for randomized controlled trials published between December 2000 and 18 January 2025. Studies in which adult patients underwent cardiac surgery (e.g., coronary artery bypass grafting or valve surgery) and received dexmedetomidine or propofol for intraoperative or immediate postoperative intensive care unit (ICU) sedation were included. This was a PRISMA-guided review, and the extracted data were meta-analyzed and descriptively analyzed. The primary outcomes were hypotension and bradycardia. Secondary outcomes included vasopressor requirements, tachycardia, heart rate, atrial fibrillation (AF), ventricular tachycardia, and bleeding. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were pooled via random-effects models. Sensitivity analysis and assessment of publication bias were performed as needed. Result(s): Compared with propofol, dexmedetomidine significantly increased the risk for hypotension (OR = 1.76; 95% CI: 1.25-2.48; p < 0.001) and bradycardia (OR = 2.89; 95% CI: 1.28-6.49; p = 0.01). Alternatively, dexmedetomidine significantly reduced vasopressor requirements (OR = 0.52; 95% CI: 0.32-0.84; p = 0.007) and lowered the heart rate (MD = - 4.78 beats/min; 95% CI: - 7.47 to - 2.26; p < 0.001). No considerable differences were observed in tachycardia, ventricular tachycardia, AF, or bleeding. Sensitivity analysis was employed to check for the stability of the findings, and no publication bias was detected. Conclusion(s): This meta-analysis revealed that, compared with propofol, dexmedetomidine is associated with a greater incidence of hypotension and bradycardia but lower vasopressor requirements. No considerable differences were observed in ventricular tachycardia, AF, bleeding or any other hemodynamic parameters. Evidence for several secondary outcomes remains limited; therefore, findings for less frequently reported endpoints should be interpreted cautiously. Clinical trial number: Not applicable. Copyright © The Author(s) 2026. <26> Accession Number 2036018403 Title Overall Accuracy of the Modified Duke Criteria-A Systematic Review and Meta-analysis. Source Thoracic and Cardiovascular Surgeon. 74(2) (pp 92-98), 2024. Date of Publication: 29 Nov 2024. Author Caldonazo T.; Tasoudis P.; Doenst T.; Moris D.; Kang L.; Moschovas A.; Kirov H.; Treml R.E.; Sa M.P.; Hagel S.; Diab M. Institution (Caldonazo, Doenst, Moschovas, Kirov, Diab) Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany (Tasoudis) Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, United States (Moris, Kang) Department of Surgery, Duke University Hospitals, Durham, NC, United States (Treml) Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University Jena, Jena, Germany (Sa) Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States (Sa) Upmc Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Hagel) Institute for Infectious Diseases and Infection Control, Friedrich- Schiller-University Jena, Germany (Diab) Department of Cardiac Surgery, Herz- und Kreislaufzentrum, Rotenburg an der Fulda, Germany Publisher Georg Thieme Verlag Abstract Background Rapid and accurate diagnosis of infective endocarditis (IE) allows timely management of this life-threatening disease and improves outcome. The Duke criteria have traditionally been the clinical method for diagnosing IE. These criteria were reformulated at different timepoints. We aimed to evaluate the real accuracy of the modified Duke criteria based on several studies that concluded the diagnosis of IE. Methods Three databases were assessed. Studies were considered for inclusion if they reported the use of modified Duke criteria as the initial approach and the confirmation of the diagnosis with the gold standard methods. The meta-analysis of diagnostic test accuracy was performed after fitting the hierarchical summary receiver operating characteristic model (HSROC) with bivariate model and displaying the summarized measures of sensitivity and specificity, and positive and negative likelihood ratios. Results A total of 11 studies were included. Accuracy in the included studies ranged from 62.3 to 92.2%, sensitivity ranged from 58.3 to 84.0%, and specificity ranged from 50.0 to 100%. The combined overall sensitivity and specificity were 85% (95% CI: 0.77-0.90) and 98% (95% CI: 0.89-0.99), respectively. The positive likelihood ratio was 40.2 (95% CI: 7.26-220.74) and the negative likelihood ratio was 0.15 (95% CI: 0.01-0.23). Conclusion The analysis reveals that the modified Duke criteria have a high positive likelihood ratio, suggesting a robust correlation between a positive test result and the existence of IE, and a very good overall specificity at 98%. The latter aspect holds significant importance in order to prevent unnecessary overtreatment, given the intricacies involved in managing IE. Copyright © 2026 Georg Thieme Verlag. All rights reserved. <27> Accession Number 621610469 Title A Contemporary meta-Analysis of antegrade versus retrograde cerebral perfusion for thoracic aortic surgery. Source Thoracic and Cardiovascular Surgeon. 67(5) (pp 351-362), 2018. Date of Publication: 06 Apr 2018. Author Takagi H.; Mitta S.; Ando T. Institution (Takagi, Mitta) Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan (Ando) Department of Cardiology, Detroit Medical Center, Detroit, MI, United States (Takagi) Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, Japan Publisher Georg Thieme Verlag Abstract Objective To determine which of antegrade and retrograde cerebral perfusion (ACP and RCP) surpasses for a reduction in postoperative incidence of neurological dysfunction and all-cause death in thoracic aortic surgery, we performed a meta-Analysis of contemporary comparative studies. Methods MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 2010 to June 2017. For each study, data regarding the endpoints in both the ACP and RCP groups were used to generate odds ratios (ORs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs in the fixed-effect model. Results We identified and included 19 eligible studies with a total of 15,365 patients undergoing thoracic aortic surgery by means of ACP (a total of 7,675 patients) or RCP (a total of 7,690 patients). Pooled analysis demonstrated no statistically significant differences in postoperative incidence of stoke (17 studies enrolling a total of 9,421 patients; OR, 0.92; 95% CI, 0.79-1.08; p = 0.32) and mortality (16 studies including a total of 14,452 patients; OR, 1.07; 95% CI, 0.90-1.26; p = 0.46) between ACP and RCP, whereas a trend toward a significant reduction in incidence of temporary neurological dysfunction (TND) for ACP (12 studies enrolling a total of 7922 patients; OR, 0.85; 95% CI, 0.69-1.04; p = 0.12) was found. Conclusion In thoracic aortic surgery, postoperative incidence of stroke and mortality was similar between ACP and RCP, whereas a trend toward a reduction of TND incidence existed in ACP. Copyright © 2019 Georg Thieme Verlag KG. <28> Accession Number 622222736 Title Survival after aortic valve replacement with bovine or porcine valve prostheses: A systematic review and meta-analysis. Source Thoracic and Cardiovascular Surgeon. 67(4) (pp 282-290), 2018. Date of Publication: 17 May 2018. Author Glaser N.; Jackson V.; Franco-Cereceda A.; Sartipy U. Institution (Glaser, Jackson, Franco-Cereceda, Sartipy) Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (Glaser) Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden (Jackson, Franco-Cereceda, Sartipy) Department of Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden Publisher Georg Thieme Verlag Abstract Background Bovine and porcine bioprostheses are commonly used for surgical aortic valve replacement. It is unknown if the long-term survival differs between the two valve types. We performed a systematic review and meta-analysis to compare survival in patients who underwent aortic valve replacement and received a bovine or a porcine prosthesis. Methods We performed a systematic search of Medline, Embase, Web of Science, and the Cochrane Library. Cohort studies that compared survival between patients who underwent aortic valve replacement and received either a bovine or a porcine bioprosthesis and that reported overall long-term survival with hazard ratio (HR) and 95% confidence interval (CI) were included. Two authors independently reviewed articles considered for inclusion, extracted the information from each study, and performed the quality assessment. We performed a meta-analysis using a random effects model to calculate the pooled HR (95% CI) for all-cause mortality. We did sensitivity analyses to assess the robustness of our findings. Results Seven studies published between 2010 and 2015 were included, and the combined study population was 49,190 patients. Of these, 32,235 (66%) received a bovine, and 16,955 (34%) received a porcine bioprosthesis. There was no significant difference in all-cause mortality between patients who received a bovine compared with a porcine bioprosthesis (pooled HR 1.00, 95% CI: 0.92-1.09). Heterogeneity between studies was moderate (55.8%, p = 0.04). Conclusions This systematic review and meta-analysis suggest no difference in survival between patients who received a bovine versus a porcine bioprosthesis after aortic valve replacement. Our study provides valuable evidence for the continuing use of both bovine and porcine bioprosthetic valves for surgical aortic valve replacement. Copyright © 2019 Georg Thieme Verlag KG Stuttgart* New York. <29> Accession Number 2048830301 Title Association between frailty and postoperative delirium after transcatheter aortic valve replacement: a meta-analysis. Source Frontiers in Psychiatry. 17 (no pagination), 2026. Article Number: 1840158. Date of Publication: 21 May 2026. Author Liu Z.; Wu N.; Wu F.; Liu T.; Ren K. Institution (Liu, Wu, Wu, Liu) Department of Cardiovascular Surgery, Air Force 986 Hospital, Air Force Medical University, Xi'an, China (Ren) Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China Publisher Frontiers Media SA Abstract Background - Postoperative delirium (POD) is a common complication following transcatheter aortic valve replacement (TAVR) and is associated with adverse outcomes in older patients. Frailty, a multidimensional geriatric syndrome, has been increasingly recognized as a potential risk factor for POD. However, existing evidence remains inconsistent. This meta-analysis aimed to evaluate the association between frailty and POD after TAVR. Methods - A systematic search of PubMed, Embase, and Web of Science was conducted from inception to January 22, 2026. Cohort studies evaluating the association between preprocedural frailty and POD after TAVR were included. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model accounting for the influence of potential heterogeneity. Results - Ten cohort studies involving 7, 702 patients were included. Frailty was present in 2, 062 (26.8%) patients, and 786 (10.2%) developed POD. Pooled analysis showed that frailty was significantly associated with an increased risk of POD after TAVR (OR: 2.17, 95% CI: 1.60-2.95; I2 = 55%). The association was stronger in studies with sample size >= 500 compared with < 500 (OR: 2.74 vs. 1.38; p for subgroup difference < 0.001). The effect estimates were consistent across subgroups stratified by study design, age, sex, frailty assessment methods, follow-up duration, analytic models, and study quality (all p for subgroup difference > 0.05). Notably, studies using CAM-ICU to diagnose POD showed a stronger association than those using DSM criteria or other methods (OR: 3.60 vs. 1.56 and 2.53; p = 0.006). Meta-regression identified sample size as a significant source of heterogeneity (p = 0.02). Conclusions - Frailty is associated with an increased risk of POD after TAVR. These findings highlight the importance of frailty assessment for perioperative risk stratification and support targeted strategies to prevent delirium in high-risk patients undergoing TAVR. Systematic review registration - https://www.crd.york.ac.uk/prospero/, identifier CRD420261352173. Copyright © 2026 Liu, Wu, Wu, Liu and Ren. <30> Accession Number 2023496263 Title Definition, Documentation, and Classification of Complications in Pediatric Surgical Literature-A Plea for Standardization. Source European Journal of Pediatric Surgery. 33(2) (pp 105-113), 2023. Date of Publication: 31 Jan 2023. Author Madadi-Sanjani O.; Brendel J.; Kuebler J.F.; Ure B.M. Institution (Madadi-Sanjani, Brendel, Kuebler, Ure) Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany Publisher Georg Thieme Verlag Abstract Severity grading systems for complications in surgical patients have been used since 1992. An increasing assessment of these instruments in pediatric surgery is also noticed, without their validation in children. To analyze the current practice, we performed a literature review with focus on the assessment and grading of complications. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting on postoperative complications as a primary or secondary endpoint using a severity grading system were included. Definition for simple adverse events, classification systems used, and the time horizon of postoperative documentation were analyzed. A total of 566 articles were screened, of which 36 met the inclusion criteria. About 86.1% of the papers were retrospective and 13.9% prospective analyses. None of the studies were prospective-randomized trials. Twenty (55.6%) studies did not include a definition of adverse events, whereas the remaining 16 (44.4%) showed variations in their definitions. All studies applied the Clavien-Dindo classification, whereas five (13.9%) additionally used the Comprehensive Complication Index. One study compared alternative grading instruments with the Clavien-Dindo classification, without demonstrating the superiority of any classification in pediatric surgery. Twenty-two studies (61.1%) did not report the time horizon of perioperative complication documentation, while 8 studies (22.2%) used 30 days and 6 studies (16.7%) used 3 months of postoperative documentation. Definition and classification of postoperative complications are inconsistent in the pediatric surgical literature. Establishment of a standardized protocol is mandatory to accurately compare outcome data. Copyright © 2021. Thieme. All rights reserved. <31> Accession Number 2029657734 Title Outcomes of Patients with a Mechanical Heart Valve and Poor Anticoagulation Control on Warfarin. Source Thrombosis and Haemostasis. 124(7) (pp 613-624), 2023. Date of Publication: 29 Dec 2023. Author Johansson I.; Benz A.P.; Kovalova T.; Balasubramanian K.; Fukakusa B.; Lynn M.J.; Nair N.; Sikder O.; Patel K.; Gayathri S.; Robinson M.; Hardy C.; Tyrwhitt J.; Schulman S.; Eikelboom J.W.; Connolly S.J. Institution (Johansson, Benz, Kovalova, Balasubramanian, Hardy, Tyrwhitt, Eikelboom, Connolly) Population Health Research Institute, Hamilton Health Sciences, McMaster University, ON, Canada (Johansson) Division of Cardiology, Department of Medicine K2, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden (Benz) Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany (Fukakusa) Division of Cardiology, Department of Pediatrics, The University of British Columbia, Vancouver, Canada (Lynn) Department of Medicine, University of British Columbia, Vancouver, Canada (Nair) Division of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada (Sikder) Division of Medicine, School of Nursing, McMaster University, Hamilton, Canada (Patel) Department of Medicine, University of Ottawa, Ottawa, ON, Canada (Gayathri) Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada (Robinson, Schulman) Department of Medicine and Thrombosis, Atherosclerosis Research Institute, McMaster University, Hamilton, Canada Publisher Georg Thieme Verlag Abstract Background Patients with a mechanical heart valve (MHV) require oral anticoagulation. Poor anticoagulation control is thought to be associated with adverse outcomes, but data are limited. Objective To assess the risks of clinical outcomes in patients with a MHV and poor anticoagulation control on warfarin. Methods We conducted a retrospective study of consecutive patients undergoing MHV implantation at a tertiary care center (2010-2019). Primary outcome was a composite of ischemic stroke, systemic embolism, or prosthetic valve thrombosis. Major bleeding and death were key secondary outcomes.We constructedmultivariable regression models to assess the association between time in therapeutic range (TTR) on warfarin beyond 90 days after surgery with outcomes. Results We included 671 patients with a MHV (80.6% in aortic, 14.6% in mitral position; mean age 61 years, 30.3% female). Median follow-up was 4.9 years, meanTTR was 62.5% (14.5% TTR<40%, 24.6% TTR 40-60%, and 61.0% TTR>60%). Overall rates of the primary outcome, major bleeding, and death were 0.73, 1.41, and 1.44 per 100 patient-years. Corresponding rates for patients with TTR <40% were 1.31, 2.77, and 3.22 per 100 patient-years. In adjusted analyses, every 10% decrement in TTR was associated with a 31% increase in hazard for the primary outcome (hazard ratio [HR]: 1.31, 95% confidence interval [CI]: 1.13-1.52), 34% increase in major bleeding (HR: 1.34, 95% CI: 1.17-1.52), and 32% increase in death (HR: 1.32, 95% CI: 1.11-1.57). Conclusion In contemporary patients with a MHV, poor anticoagulation control on warfarin was associated with increased risks of thrombotic events, bleeding, and death. Copyright © 2023. The Author(s). <32> Accession Number 2041282072 Title Septal Myectomy in Pediatric Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis. Source Pediatric Cardiology. 47(7) (pp 2820-2827), 2026. Date of Publication: 01 Oct 2026. Author Cappellaro A.P.; de Almeida L.F.C.; Gismondi R.A.O.C.; Ayala R.; Thet M.S.; Dearani J.A. Institution (Cappellaro) Centro Universitario Mauricio de Nassau de Barreiras, Barreiras, Brazil (de Almeida) Department of Medical Sciences, Universidade Federal Fluminense, Niteroi, Brazil (Gismondi) Department of Cardiology, Universidade Federal Fluminense, Niteroi, Brazil (Ayala) Cardiovascular Surgery Department, Robert Bosch Hospital, Stuttgart, Germany (Thet) Department of Surgery & Cancer, Imperial College London, South Kensington, United Kingdom (Dearani) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States Publisher Springer Abstract Evidence regarding outcomes of septal myectomy in pediatric patients with obstructive hypertrophic cardiomyopathy (HOCM) remains limited. This meta-analysis aimed to assess surgical outcomes and long-term survival in this population. A systematic review was conducted using PubMed, Embase, Scopus, and Cochrane databases to identify studies evaluating septal myectomy in pediatric patients with obstructive HCM. Eight clinical trials comprising a total of 490 pediatric patients met the inclusion criteria. Among children undergoing septal myectomy for HOCM, the pooled early and late mortality rates were 3.3% and 8.5%, respectively. Concomitant mitral valve repair was performed in 7.3% of patients. Rates of complete atrioventricular block and permanent pacemaker implantation were 9.9% and 5.1%, respectively. The mean durations of intensive care and hospital stay were 34.6 h and 12.9 days. Postoperative wound infection and reoperation occurred in 3.4% and 6.4% of cases. Echocardiographic assessments demonstrated a marked reduction in LVOT gradient (from 86.9 to 16.2 mmHg) with preserved left ventricular ejection fraction. Mitral regurgitation decreased from 49.8 to 6.4%, and systolic anterior motion from 84.9 to 19.9%. Septal myectomy in pediatric patients with HOCM is a safe and effective procedure, associated with favorable survival and substantial symptomatic and hemodynamic improvement. However, results must be interpreted cautiously due to moderate-quality retrospective data. Copyright © The Author(s) 2025. <33> Accession Number 627817512 Title Optimal Timing of P2Y12 Inhibitor Loading in Patients Undergoing PCI: A Meta-Analysis. Source Thrombosis and Haemostasis. 119(6) (pp 1000-1020), 2019. Date of Publication: 27 Mar 2019. Author Komosa A.; Lesiak M.; Krasinski Z.; Grygier M.; Siniawski A.; Skorupski Wl.; Olasinska-Wisniewska A.; Pyda M.; Araszkiewicz A.; Mitkowski P.; Grajek S.; Mularek-Kubzdela T.; Hengstenberg C.; Siller-Matula J.M. Institution (Komosa, Lesiak, Grygier, Siniawski, Skorupski, Olasinska-Wisniewska, Pyda, Araszkiewicz, Mitkowski, Grajek, Mularek-Kubzdela, Siller-Matula) 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland (Krasinski) Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland (Hengstenberg, Siller-Matula) Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria Publisher Georg Thieme Verlag Abstract Background and Aim The timing of P2Y12 inhibitor loading in patients undergoing percutaneous coronary intervention (PCI) is a matter of debate. The aim of our study was to compare the efficacy and safety of oral P2Y12 inhibitors: clopidogrel, ticagrelor and prasugrel administered at two different time points in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or post-PCI). Methods This is a systematic review and meta-analysis. Randomized controlled trials and non-randomized studies were included. Outcomes evaluated were combined major adverse cardiovascular events (MACEs), myocardial infarction (MI), target vessel revascularization, death and bleeding complications. Summary estimates of the relative risks with therapy were calculated. Results Twenty-three studies met the selection criteria and included 60,907 patients. Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction (RRR) of MACE (95% confidence interval [CI] = 0.68-0.89; p < 0.001). Early clopidogrel loading was associated with a 25% RRR of MACE (95% CI = 0.65-0.85; p < 0.001), a 30% RRR of MI (95% CI = 0.6-0.82; p < 0.0001) and 25% RRR of death (95% CI = 0.64-0.87; p = 0.0002), without an impact on major bleedings. In ST-elevation myocardial infarction as well as non-ST elevation acute coronary syndrome (NSTE-ACS), early clopidogrel loading resulted in 35 and 22% RRR in 30 days MACE (p < 0.001), respectively, with no impact in elective PCI. Whereas early loading with prasugrel and ticagrelor did not improve ischaemic outcomes, prasugrel administered early increased bleeding risks in NSTE-ACS. Conclusion Early clopidogrel loading is associated with a better efficacy and similar safety, whereas timing of ticagrelor or prasugrel loading had no effects on ischaemic events. Copyright © 2019 Georg Thieme Verlag KG Stuttgart . New York. <34> Accession Number 632860784 Title Effect of the Different Mechanical Mitral Valve Sounds on the Patients' Quality of Life. Source Thoracic and Cardiovascular Surgeon. 68(6) (pp 492-497), 2019. Date of Publication: 06 Sep 2019. Author Huang J.-S.; Hong Z.-N.; Sun K.-P.; Cao H.; Chen Q. Institution (Huang, Hong, Sun, Chen) Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (Cao) Department of Cardiac Surgery, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China Publisher Georg Thieme Verlag Abstract Background The purpose of this study was to compare the opening and closing sounds of three different mechanical mitral valves and to analyze their effects on the quality of life of patients. Methods Ninety patients who underwent mechanical mitral valve replacement (MVR) were divided into three groups: those who received Advancing the Standard (ATS), St. Jude Medical (SJM), or Carbomedics (CM) mechanical valves. The sound pressure of the different valves was measured with a microphone. A detailed, self-designed questionnaire with a 1 to 10 analog scale and the 36-item Short Form Health Survey (SF-36) score was used to assess the quality of life of the patients. Result The sound pressure measured by ATS was 64.4 +/- 3.1 dB, while that measured by SJM, and CM was 64.5 +/- 4.7 and 67.2 +/- 5.3 dB, respectively. The overall subjective interference score in the ATS group was the lowest compared with that in the SJM and CM groups (ATS: 1.3 +/- 0.9 dB, SJM: 3.9 +/- 1.6 dB, CM: 4.1 +/- 1.5 dB). Relatives and nonfamily members of the ATS group also had the lowest analog scale scores. Specific questions showed that the ATS valve had the least impact on sleep and daily life (impact on sleep: ATS: 4/30, SJM: 9/30, CM: 11/30, impact on daily life: ATS: 2/30, SJM: 8/30, CM: 8/30). The SF-36 score showed that there were significant differences in social functioning, role-emotional, mental health, and vitality. Conclusion Patients receiving ATS mechanical MVR may be less disturbed by valve noise than those receiving SJM or CM mechanical MVR in a single Chinese cardiac center. Copyright © 2020 Association for Computing Machinery. All rights reserved. <35> Accession Number 2032392818 Title Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion. Source Thoracic and Cardiovascular Surgeon. 73(8) (pp 609-617), 2024. Date of Publication: 17 May 2024. Author Kirov H.; Fischer J.; Caldonazo T.; Tasoudis P.; Runkel A.; Soletti G.J.; Cancelli G.; Dell'Aquila M.; Mukharyamov M.; Doenst T. Institution (Kirov, Fischer, Caldonazo, Runkel, Mukharyamov, Doenst) Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany (Tasoudis) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, United States (Soletti, Cancelli, Dell'Aquila) Weill Cornell Medicine, New York, NY, United States Publisher Georg Thieme Verlag Abstract Objectives Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MIs). However, evidence for CABG in patients with chronic total occlusion (CTO) has not been fully elucidated and the impact of PCI is discussed controversially. Methods We performed a meta-analysis of studies comparing outcomes in patients with/without multivessel disease undergoing CABG or PCI for CTO. The primary outcome was long-term all-cause mortality (>=5 years). Secondary outcomes were MIs, repeat revascularization, cardiac mortality, major adverse cardiovascular events, and stroke, as well as short-term mortality (30 days/in-hospital) and stroke. A pooled Kaplan-Meier survival curve after reconstruction analysis was generated. Random-effects models were used. Results Six studies totaling 12,504 patients were included. In the pooled Kaplan-Meier analysis, PCI showed a significantly higher risk of death in the follow-up compared with CABG (hazard ratio [HR]: 2.12, 95% confidence interval [CI]: 1.88-2.38, p < 0.01). During the observation period, PCI was also associated with higher rates of MI (odds ratio [OR]: 2.86, 95% CI: 1.82-4.48, p < 0.01) and more repeat revascularization (OR: 4.88, 95% CI: 1.99-11.91, p = 0.0005). The other outcomes did not show significant differences. Conclusion CABG is associated with superior survival to PCI over time in patients with CTO who are eligible for both PCI and CABG. This survival advantage is associated with fewer events of MI and repeat revascularization. Copyright © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG. <36> Accession Number 636682518 Title Pyoderma Gangrenosum after Cardiac Surgery. Source Thoracic and Cardiovascular Surgeon. 71(1) (pp 53-61), 2021. Date of Publication: 11 Dec 2021. Author Petrov A.; Kappert U.; Schmidt T.; Matschke K.E.; Wilbring M. Institution (Petrov, Kappert, Matschke, Wilbring) Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany (Schmidt) Department of Cardiac Anesthesiology, University Heart Center Dresden, Dresden, Germany Publisher Georg Thieme Verlag Abstract Background-Pyoderma gangrenosum after cardiac surgery is a rare, noninfectious ulcerating skin disease mimicking sternal wound infection. Methods-A systematic search of literature for pyoderma gangrenosum complicating cases of cardiac surgery was conducted between September 1985 and September 2020 on PubMed and Cochrane databases. A systematic review and detailed overview of clinical presentation, diagnostic, treatment, and outcome is provided. Results-A total of 15 studies enclosing 15 patients suffering from pyoderma gangrenosum following cardiac surgery were identified. Onset of symptoms was observed after a median of 5 days. Patients were predominantly male (81.3%) with a median age of 64 years. Typical clinical presentation mimicked sternal site infection, mainly by means of mediastinitis. Specific signs were rapid progression, erythematous to violaceous color of the wound border, accompanied by unspecific symptoms including fever, malaise, and severe pain. Additionally, pathergy (development of ulcers at the sites of minor cutaneous trauma) was reported frequently. Biopsy is mandatory with a cutaneous neutrophilic inflammation confirming the diagnosis. Initial treatment mostly (75.0% of reported cases) was misled, addressing suspicion of surgical site infection. After correct diagnosis, the treatment was switched to an immunosuppressive therapy. Full sternal wound closure took between 5 weeks and 5 months. Reported case mortality was 12.5% in actually low-risk surgeries. Conclusion-Despite pyoderma gangrenosum has typical signs, it remains an exclusion diagnosis. The treatment is completely opposite to the main differential diagnosis-The typical surgical site infection. Knowledge about diagnosis and treatment is essential in the context of avoiding fatal mistreatment. Copyright © 2023 Georg Thieme Verlag. All rights reserved. <37> Accession Number 2020664012 Title Mechanical Heart Valves, Pregnancy, and Bleeding: A Systematic Review and Meta-Analysis. Source Seminars in Thrombosis and Hemostasis. 49(5) (pp 542-552), 2022. Date of Publication: 29 Sep 2022. Author Jakobsen C.; Larsen J.B.; Fuglsang J.; Hvas A.-M. Institution (Jakobsen, Larsen) Thrombosis and Hemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus C, Denmark (Larsen, Fuglsang) Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark (Fuglsang) Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus C, Denmark (Hvas) Faculty of Health, Aarhus University, Aarhus C, Denmark Publisher Thieme Medical Publishers, Inc. Abstract Anticoagulant therapy is essential in pregnant women with mechanical heart valves to prevent valve thrombosis. The risk of bleeding complications in these patients has not gained much attention. This systematic review and meta-analysis investigate the prevalence of bleeding peri-partum and post-partum in women with mechanical heart valves and also investigate whether bleeding risk differed across anticoagulant regimens or according to delivery mode. The present study was conducted according to The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Studies reporting bleeding prevalence in pregnant women with mechanical heart valves receiving anticoagulant therapy were identified through PubMed and Embase on December 08, 2021. Data on bleeding complications, delivery mode, and anticoagulation therapy were extracted. A total of 37 studies were included, reporting 423 bleeding complications in 2,508 pregnancies. A meta-analysis calculated a pooled prevalence of 0.13 (95% confidence interval [CI]: 0.09-0.18) bleeding episodes per pregnancy across anticoagulant regimens. The combination of unfractionated heparin (UFH) and vitamin K antagonist (VKA) and single VKA therapy showed the lowest risk of bleeding (8 and 12%). Unexpectedly, the highest risk of bleeding was found in women receiving a combination of low-molecular-weight-heparin (LMWH) and VKA (33%) or mono-therapy with LMWH (22%). However, this could be dose related. No difference in bleeding was found between caesarean section versus vaginal delivery (p = 0.08). In conclusion, bleeding episodes are common during pregnancy in women with mechanical heart valves receiving anticoagulant therapy. A combination of UFH and VKA or VKA monotherapy showed the lowest risk of bleeding. Copyright © 2022. Thieme. All rights reserved. <38> Accession Number 2049235159 Title 2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Source Journal of the American College of Cardiology. 88(13) (pp 1543-1643), 2026. Date of Publication: 29 Sep 2026. Author Thompson A.; Fleischmann K.E.; Smilowitz N.R.; de las Fuentes L.; Mukherjee D.; Aggarwal N.R.; Ahmad F.S.; Allen R.B.; Altin S.E.; Auerbach A.; Berger J.S.; Chow B.; Dakik H.A.; Eisenstein E.L.; Gerhard-Herman M.; Ghadimi K.; Kachulis B.; Leclerc J.; Lee C.S.; Macaulay T.E.; Mates G.; Merli G.J.; Parwani P.; Poole J.E.; Rich M.W.; Ruetzler K.; Stain S.C.; Sweitzer B.J.; Talbot A.W.; Vallabhajosyula S.; Whittle J.; Williams K.A. Publisher Elsevier Inc. Abstract Aim: The "2026 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. Method(s): A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Structure: Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed. Copyright © 2026 by the American College of Cardiology Foundation <39> Accession Number 2022260477 Title Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review. Source Arquivos de Neuro-Psiquiatria. 80(12) (pp 1196-1203), 2022. Date of Publication: 29 Dec 2022. Author de Almeida dos Santos D.P.; Thirumala P.D.; Reddy G.; de Barros D.F.; Faria V.N.R.; Shandal V.; Kurtz P. Institution (de Almeida dos Santos, de Barros) Hospital Copa Star, Centro de Terapia Intensiva, RJ, Rio de Janeiro, Brazil (de Almeida dos Santos, Reddy, Faria) Sinapse Clinica, RJ, Rio de Janeiro, Brazil (Reddy) Intraneuro, RJ, Rio de Janeiro, Brazil (Thirumala, Shandal) University of Pittsburgh Medical Center, Pittsburgh, PA, United States (Faria) Universidade Federal de Uberlandia, Faculdade de Engenharia Eletrica, Uberlandia MG, Brazil (Kurtz) Instituto D'Or de Pesquisa e Ensino, Departamento de Cuidado Intensivo, SP, Sao Paulo, Brazil Publisher Associacao Arquivos de Neuro-Psiquiatria Abstract Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98; p < 0.0001). Copyright © 2022. Academia Brasileira de Neurologia. All rights reserved. <40> Accession Number 2048881440 Title Robotic-assisted versus video-assisted thoracoscopic anatomical lung resection for early-stage non-small cell lung cancer: a systematic review and meta-analysis. Source Journal of Robotic Surgery. 20(1) (no pagination), 2026. Article Number: 938. Date of Publication: 01 Dec 2026. Author Johow Reichert M.; Urnia N.; Jofre A.; Sanhueza L.; Ortega J.I.; Mordojovich G. Institution (Johow Reichert, Sanhueza) Department of Surgery, Hospital Padre Hurtado, Santiago, Chile (Urnia) Department of Surgery, Hospital Clinico San Borja Arriaran, Santiago, Chile (Urnia) Faculty of Medicine, Universidad de Chile, Santiago, Chile (Jofre) Hospital San Juan de Dios de Teno, Teno, Chile (Ortega, Mordojovich) Department of Surgery, Thoracic Surgery Unit, Clinica Alemana de Santiago, Santiago, Chile (Ortega) Faculty of Medicine, Clinica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile Publisher Springer Nature Abstract Non-small cell lung cancer (NSCLC) represents 80-85% of lung cancer cases. Anatomical resection remains the cornerstone treatment for early-stage disease. Video-assisted (VATS) and robotic-assisted (RATS) thoracic surgery are alternatives to thoracotomy, though RATS's advantages over VATS remain controversial. We conducted this systematic review and meta-analysis to compare their perioperative and oncologic outcomes for anatomical resection in early-stage NSCLC. We searched PubMed, Cochrane Library, CINAHL, Web of Science, ClinicalTrials.gov, LILACS, and Google Scholar from October 8, 2025, updated June 15, 2026, for studies comparing RATS and VATS in adults with early-stage (up to IIA) NSCLC undergoing anatomical resection. Non-anatomical resections, hybrid techniques, and neoadjuvant therapy were excluded. Risk of bias was assessed with the Newcastle-Ottawa Scale and Cochrane RoB 2.0. Pooled estimates (odds ratios [OR] or mean differences [MD], 95% CI) were generated in Review Manager; certainty was graded using GRADE. Registered with PROSPERO (CRD420251229273). Twenty-eight studies (3 randomized, 25 observational; 68,349 participants) were included. Survival endpoints could not be pooled due to heterogeneity. RATS showed fewer conversions to thoracotomy (OR 0.54; 95% CI 0.50-0.58), shorter hospital stay (MD -0.33 days; -0.61 to -0.06), and greater lymph node retrieval (MD 0.82; 95% CI 0.35-1.30), with no differences in perioperative outcomes. Heterogeneity was substantial and largely unexplained. Oncologic endpoints could not be quantitatively compared. Perioperative advantages favoring RATS were modest, heterogeneous, and of low-to-very-low certainty. Adequately powered randomized trials are needed. No external funding was received. Copyright © The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature 2026. <41> Accession Number 2048830293 Title Concomitant surgical ablation for atrial fibrillation in mitral valve surgery: a systematic review of clinical outcomes and surgical strategies. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1857413. Date of Publication: 13 Aug 2026. Author Nurbay Z.; Tuleutayev R.; Zhakayev M.; Dzhumabekov A.; Musrepov N. Institution (Nurbay, Musrepov) Department of Cardiac Surgery, SCE "City Cardiology Center", Almaty, Kazakhstan (Tuleutayev, Zhakayev) Department of Cardiac Surgery, JSC "Research Institute of Cardiology and Internal Diseases", Almaty, Kazakhstan (Dzhumabekov) Department of Clinical Work, Kazakh Medical University "KSPH", Almaty, Kazakhstan Publisher Frontiers Media SA Abstract Background - Atrial fibrillation frequently coexists with mitral valve disease and is associated with adverse clinical outcomes. Concomitant surgical ablation has emerged as an effective strategy to restore sinus rhythm during mitral valve surgery. Methods - A systematic review was conducted according to PRISMA guidelines. Electronic databases were searched for studies published between January 1991 and January 2026. Eligible studies included adult patients undergoing mitral valve surgery with concomitant surgical ablation. Due to heterogeneity, a qualitative synthesis was performed. Results - A total of 25 studies were included. Early evidence established the Cox-Maze III procedure as an effective approach with high rates of sinus rhythm restoration. Contemporary data demonstrate that the Cox-Maze IV procedure provides comparable efficacy with reduced technical complexity. Long-term follow-up showed sustained sinus rhythm in a substantial proportion of patients, with possible reductions in thromboembolic events and possible survival benefit reported in some observational studies. However, interpretation of these findings is limited by clinical and methodological heterogeneity. However, an increased risk of permanent pacemaker implantation remains a consistent finding. Procedural success is influenced by lesion set configuration, completeness of ablation, and surgical approach. Conclusions - Concomitant surgical ablation during mitral valve surgery is consistently associated with better rhythm outcomes, while evidence for harder clinical endpoints, including stroke and survival, remains less certain. Individualized surgical approaches remain essential to balance rhythm efficacy, procedural complexity, and the risk of permanent pacemaker implantation. Copyright © 2026 Nurbay, Tuleutayev, Zhakayev, Dzhumabekov and Musrepov. <42> [Use Link to view the full text] Accession Number 2043043604 Title Association of Preoperative Frailty and Postoperative Outcomes in Older Adults Undergoing Major Cardiac Procedures: A Systematic Review and Meta-Analysis. Source Anesthesia and Analgesia. 143(4) (pp 684-695), 2026. Date of Publication: 01 Oct 2026. Author Thangavelu V.; Bhatia O.; Hasija A.; Rajapakse N.; Yan E.; Saripella A.; Englesakis M.; Chung F. Institution (Thangavelu, Bhatia, Rajapakse, Chung) Temerty Faculty of Medicine, University of Toronto, Toronto, OH, Canada (Hasija) Michael G. DeGroote School of Medicine, McMaster University, Hamilton, OH, Canada (Yan, Saripella, Chung) Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, OH, Canada (Yan) Postgraduate PhD Program, Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, OH, Canada (Englesakis) Library & Information Services, Department of Anesthesia and Pain Management, University Health Network, Toronto, OH, Canada Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Frailty, characterized by reduced physiological resilience, is a pivotal risk factor in older adults undergoing major cardiac procedures. Although previous analyses have linked frailty to adverse surgical outcomes, knowledge gaps persist due to methodological inconsistency across frailty tools and limited synthesis of complications such as delirium, infection, and renal dysfunction. The objective of this systematic review and meta-analysis is to determine the prevalence of preoperative frailty in older adults undergoing major cardiac procedures, and assess its association with postoperative outcomes, including cardiac, respiratory, renal, infectious, stroke, and bleeding complications, postoperative delirium, hospital and intensive care unit (ICU) length of stay, nonhome discharge, hospital readmission, and both 30-day and 1-year mortality. METHOD(S): - A prespecified protocol was registered with PROSPERO (CRD#42024574916), following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Embase, and Cochrane databases were searched for English-language studies of patients undergoing major cardiac procedures, including coronary artery bypass grafting (CABG), aortic or mitral valve replacement or repair, transcatheter aortic valve replacement (TAVR), or combined procedures. Validated frailty instruments (eg, Fried Frailty Phenotype, Clinical Frailty Scale) were required to determine preoperative frailty, along with reporting at least 1 postoperative outcome. Noncardiac surgeries, minor procedures, case reports, and reviews were excluded. Random-effects meta-analyses generated odds ratio (OR) or standardized mean difference (SMD) values with 95% confidence intervals (CI). RESULT(S): - Nineteen studies (n = 11, 667; mean +/- SD age 71.9 +/- 8.1 years, 28% female) met inclusion criteria, spanning North America, Europe, Asia, and Oceania. The overall prevalence of preoperative frailty was 16.8%. Frailty was significantly associated with delirium (OR, 4.11; 95% confidence interval [CI], 2.00-8.45; P <.001), infection (OR, 3.72; 95% CI, 2.27-6.12; P <.001), renal complications (OR, 2.72; 95% CI, 2.05-3.60; P <.001), and extended hospital (SMD, 0.69 ; 95% CI, 0.35-1.02; P <.001) and ICU (SMD, 0.72; 95% CI, 0.51-0.94; P <.001) stays. Frailty increased the odds of 30-day (OR, 3.58; 95% CI, 2.16-5.93; P <.001) and 1-year (OR, 2.25; 95% CI, 1.56-3.25; P <.001) mortality. CONCLUSION(S): - Frailty affects nearly 1 in 5 older adults requiring major cardiac procedures. Frailty was significantly associated with adverse postoperative outcomes, including delirium, infections, renal complications, extended length of stay, and mortality. As frailty is potentially modifiable, targeted strategies-such as prehabilitation, nutritional optimization, and enhanced perioperative monitoring-may improve outcomes. Incorporating routine frailty screening into standard preoperative practice allows for earlier identification of high-risk patients, efficient resource allocation, and perioperative care planning. Copyright © 2025 International Anesthesia Research Society <43> [Use Link to view the full text] Accession Number 2045462723 Title Management and Outcomes of Postmyocardial Infarction Left Ventricular Pseudoaneurysm: A Case-level Systematic Review. Source Critical Pathways in Cardiology. 25(3) (no pagination), 2026. Article Number: e0424. Date of Publication: 01 Sep 2026. Author Karimanasseri C.; Rahimov D.; Sankisa D.; Nasher N.; Mustafa M.; Allimulla A.; Vizzeswarapu S.; Plestis K.A.; Entwistle J.W.; Bavaria J.E.; Tchantchaleishvili V. Institution (Karimanasseri, Sankisa, Mustafa, Allimulla, Vizzeswarapu) The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States (Rahimov, Nasher, Plestis, Entwistle, Bavaria, Tchantchaleishvili) Department of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, United States Publisher Lippincott Williams and Wilkins Abstract Left ventricular pseudoaneurysm (LVPA) is a rare mechanical complication of acute myocardial infarction (MI) associated with significant mortality. Given the paucity of available data in the literature, we sought to pool existing evidence to better understand the current management strategies and outcomes. Electronic search was performed in February 2025 to identify all studies reporting management of post-MI LVPA. A total of 158 reports, with a total of 159 patients, were included. Patient-level data were extracted for analysis. A total of 159 patients were included in the analysis. The median age was 65 years [Interquartile range (IQR), 57-75], and 70% (106/159) of patients were male. The most frequent site of MI was the inferior wall (31.4%, 49/156), and the most common method of MI management was thrombolysis (49%, 64/131). The median time from MI to presentation signs/symptoms of LVPA was 21 days (IQR, 0-152). The most common LVPA location was the anterior/apical wall (27.7%, 44/159). Sixty-six percent of patients (105/159) underwent surgical repair, while 22% of patients (35/159) were managed medically, and 5.7% (9/159) of patients underwent transcatheter repair. In-hospital/30-day mortality was 10% (16/159), with operative mortality after surgical repair of 4.8% (5/105). Mortality from reoperative surgery was 18.8% (3/16) as opposed to 2.2% (2/89) in patients without redo sternotomy (P = 0.004). Periprocedural mortality among patients treated with transcatheter intervention occurred in a single case (11.1%), involving a patient with prior coronary artery bypass grafting. At a median follow-up of 6 months (IQR, 1-12), overall survival was 86.1% (137/159). Surgery remains the standard therapy of LVPA, with acceptable operative risk; however, reoperative sternotomy carries a higher surgical risk. In carefully selected patients, percutaneous repair may serve as a viable alternative to surgery. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <44> Accession Number 2049197883 Title Mental Health and Substance Use Disorders in Advanced Heart Failure Patients Undergoing VAD Implantation and Cardiac Transplantation: How Much do We Know?. Source Current Cardiology Reviews. 22(6) (no pagination), 2026. Article Number: E1573403X386810. Date of Publication: 2026. Author Nair N.; Grzyb C.; Du D.; Mahesh B. Institution (Nair) Division of Cardiology, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States (Nair, Grzyb) Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA, United States (Du) Department of Industrial, Manufacturing, and Systems Engineering, Texas Tech University, Lubbock, TX, United States (Mahesh) Division of Cardiothoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States Publisher Bentham Science Publishers Abstract Introduction: Patients who undergo cardiac transplantation or implantation of LVADs are significantly affected by mental health disorders and substance use problems, which can negatively impact their compliance and quality of life. There is a paucity of research regarding mental health and substance abuse disorders in the post-LVAD implant/ cardiac transplant population. This narrative review will focus on the knowledge gaps Methods: A qualitative review was performed by conducting a literature search using PubMed and Google Scholar. Adults 18 years and older with LVAD or cardiac transplant were included. The keywords used were anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorders in LVAD patients, and anxiety, depression, mood disorder, panic disorder, PTSD, and adjustment disorder in heart transplant patients. No geographical parameters were used in the search. All papers retrieved were reviewed qualitatively, and relevant information obtained was synthesized to arrive at the results and conclusions presented in this review. Result(s): This narrative review showed that anxiety, depression, mood disorder, panic disorder, PTSD, adjustment disorder, and eating disorder exist in patients undergoing advanced surgical therapies (durable LVADs and cardiac transplantation). Most of the relevant studies are retrospective chart analyses done in single centers. Incidence and prevalence vary widely. Discussion(s): This review highlights the importance of mental health surveillance in patients undergoing LVAD and cardiac transplantation to enhance outcomes by improving behavioral health and compliance. Conclusion(s): There are no granular guidelines to address psychosocial evaluation in this population. The current literature does not help to distinguish any differences mechanical support would have on the psychology of these patients as compared to cardiac transplantation. Knowledge gaps exist in risk assessment and risk stratification of patients, which need further investigation. Copyright 2026, Bentham Science Publishers <45> Accession Number 2048978607 Title Comparison of C-MAC Videolaryngoscope and Macintosh Laryngoscope for Ease of Double-Lumen Tube Insertion in Patients Undergoing Elective Thoracic Surgeries: A Prospective Randomized Controlled Study. Source International Journal of Pharmacy Research and Technology. 16(2) (no pagination), 2026. Date of Publication: 01 Jul 2026. Author Dhar S.; Uikey T.; Sawarkar J.; Dond S.; Jadhav S.U.; Mahatme S.; Tajne M. Institution (Dhar, Mahatme, Tajne) Department of Anaesthesia, Government Medical College, Maharashtra, Nagpur, India (Uikey, Sawarkar, Dond, Jadhav) Datta Meghe Institute of Higher Education and Research Centre, Maharashtra, Nagpur, India Publisher Advanced Scientific Research Abstract Background: Double-lumen tube placement is the gold standard for lung isolation during elective thoracic surgery but is technically more challenging than single-lumen intubation due to its larger size and rotational requirements. The C-MAC videolaryngoscope may improve glottic visualization and facilitate easier DLT (Double-Lumen Tube) insertion compared with the conventional Macintosh laryngoscope. Method(s): A prospective randomized controlled study was conducted among patients undergoing elective thoracic surgeries requiring DLT insertion. Participants were randomly allocated to either the C-MAC videolaryngoscope group or the Macintosh laryngoscope group. The primary outcomes included IDS (Intubation Difficulty Score), intubation time, first-pass success rate, and overall success rate. Secondary outcomes were hemodynamic responses (heart rate, systolic and diastolic blood pressure, and mean arterial pressure) and airway-related complications, including mucosal trauma, sore throat, and hoarseness. Result(s): The C-MAC videolaryngoscope demonstrated superior intubation performance compared with the Macintosh laryngoscope. First-pass success was significantly higher with C-MAC (93.8%) than with Macintosh (75.0%; p=0.039). Overall success was 100% with C-MAC compared with 93.8% with Macintosh. C-MAC was associated with lower intubation difficulty, shorter intubation time, improved glottic visualization, fewer intubation attempts, reduced need for optimization maneuvers, and fewer airway-related complications. Hemodynamic responses were also more favourable with C-MAC during DLT insertion. Conclusion(s): The C-MAC videolaryngoscope offers significant advantages over the conventional Macintosh laryngoscope for DLT insertion during elective thoracic surgery. Its higher first-pass success, reduced intubation difficulty, shorter intubation time, improved glottic visualization, and lower complication rates make it a reliable and effective device for thoracic airway management. Copyright (c) 2026 Authors This work is licensed under a Creative Commons Attribution 4.0 International License.https://creativecommons.org/licenses/by/4.0/. <46> Accession Number 631471259 Title Topical Use of Tranexamic Acid in Cardiac Surgery: A Meta-Analysis. Source Thoracic and Cardiovascular Surgeon. 68(3) (pp 212-218), 2019. Date of Publication: 06 Jun 2019. Author Habbab L.M.; Semelhago L.; Lamy A. Institution (Habbab, Semelhago, Lamy) Division of Cardiac Surgery, Hamilton General Hospital, McMaster University, McMaster Clinic, 237 Barton Street East, Hamilton, ON, Canada Publisher Georg Thieme Verlag Abstract Background This meta-analysis was conducted to investigate the evidence for the efficacy and safety of intrapericardial tranexamic acid (TXA) in cardiac surgery. Methods We searched MEDLINE from 2000 to 2017 for randomized controlled trials that compared intrapericardial TXA to placebo. We performed a meta-analysis for the eligible trials that focused on chest tube drainage measured during the first 24 hours after surgery as a primary outcome. We also examined the secondary outcome measures of these trials such as the incidence of transfusion requirements following surgery and the evidence for any increase in complication rates. Results A total of seven randomized controlled trials (six on-pump and one off-pump) comparing topical application of TXA to placebo in 692 patients were eligible for the blood loss outcome data. These trials randomized 372 patients to receive TXA and 320 patients as controls. The use of intrapericardial TXA was associated with a considerable reduction in 24-hour blood loss in all seven studies and a weighted mean difference of -343.56 mL (95% confidence interval: -316.41, -370.72) significantly differed from zero (p = 0.005) with a heterogeneity of I 2 = 0%. The incidence of packed RBC transfusion in TXA patients was significantly lower in one study and was not significant but with trend in favor of TXA in five out of the six studies in which it was reported. In one trial, TXA was not detected in any patient and in another the studied groups were similar in postoperative complications, such as graft patency, myocardial infarction, cerebral infarction, atrial fibrillation, seizures, and infections. Conclusions Findings from this meta-analysis suggest that intrapericardial use of TXA in patients undergoing cardiac surgery can decrease postoperative bleeding without increasing the risk of postoperative seizures. Future large randomized, double-blind, controlled clinical trials are needed to confirm these promising findings. Copyright © 2020 EDP Sciences. All rights reserved. <47> Accession Number 2047498941 Title Bayesian Reanalysis of Revascularization Strategies for Left Main Disease: Coronary Artery Bypass Grafting vs Percutaneous Intervention. Source Annals of Thoracic Surgery. 122(4) (pp 1004-1013), 2026. Date of Publication: 01 Oct 2026. Author Li Z.; Larson J.; Vervoort D.; Rakhshan S.; Servito M.; Tam D.Y.; Liu K.; Fremes S.E. Institution (Li) Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada (Li, Vervoort, Rakhshan, Tam, Fremes) Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (Larson) Toronto Metropolitan University, Toronto, ON, Canada (Vervoort, Servito, Liu, Fremes) Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada (Rakhshan) Western University, London, ON, Canada (Servito) Division of Cardiac Surgery, University of Manitoba, Manitoba, Winnipeg, Canada (Tam, Fremes) Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada Publisher Elsevier Inc. Abstract Background The preferred revascularization strategy for left main disease between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) remains controversial, given discordant conclusions from randomized and observational evidence for mortality. Accordingly, we performed a bayesian reanalysis of the meta-analysis by Sabatine and coworkers to assess the probability of effectiveness using different assumptions. Methods Data were extracted from the meta-analysis of 4 trials by Sabatine and coworkers. The primary outcome was all-cause mortality; secondary outcomes included myocardial infarction, stroke, repeated revascularization, and composite outcomes. Bayesian methods estimated 5-year hazard ratios and absolute risk reductions using priors ranging from no prior preference to data-informed assumptions. Results For all-cause mortality, bayesian analysis indicated a higher probability of lower mortality with CABG, exceeding 80% across priors. Under the minimally informative prior, the hazard ratio was 1.1 (95% credible interval, 0.91-1.33), and the absolute risk reduction was 0.88% (95% credible interval: -0.92% to 2.76%). Under the downweighted historical prior, the hazard ratio was 1.40 (1.25-1.56) and the absolute risk reduction 4.61% (3.06%-6.11%). CABG also showed highly probable benefits for myocardial infarction, repeated revascularization, and composite outcomes. Conversely, stroke favored PCI (hazard ratio, 0.83 [0.58-1.19]; absolute risk reduction -0.40% [-1.40% to 0.62%]). Conclusions This reanalysis suggests a higher probability that CABG is associated with reduced mortality, myocardial infarction, repeated revascularization, and composite outcomes, whereas PCI offers a lower risk of stroke. Interpretation of mortality was prior dependent, whereas other outcomes were largely prior agnostic. Copyright © 2026 The Authors. <48> Accession Number 2049110750 Title Erector Spinae Plane Block vs. Intercostal Nerve Block for Pain Management in Thoracic Surgeries and Chest Wall Traumas: A Meta-Analysis. Source Current Pain and Headache Reports. 30(1) (no pagination), 2026. Article Number: 124. Date of Publication: 01 Dec 2026. Author Duplechin M.O.; Mashaw S.A.; Schwab S.J.; Mira A.J.; Serio M.A.; Ahmadzadeh S.; Miller B.C.; Shekoohi S.; Kaye A.D. Institution (Duplechin, Mashaw, Schwab, Mira, Serio) School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA, United States (Ahmadzadeh, Miller, Shekoohi, Kaye) Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, United States Publisher Springer Abstract Background: Thoracic surgeries and chest wall traumas often result in severe postoperative pain, leading to significant morbidity and prolonged hospital stays. Intercostal nerve blocks have been a common strategy for managing this pain. In this regard, the ESPB is being utilized increasingly as a promising alternative as it offers more extensive pain relief and has a better safety profile. Objective(s): A meta-analysis comparing analgesic efficacy, measured by pain scores and opioid consumption, as well as hospital length of stay and time spent under analgesia, between ESPB and ICNB in patients undergoing thoracic surgeries and chest wall trauma was performed. Method(s): A systematic literature search was conducted across three databases, identifying 2,141 potential studies. After eliminating duplicates (n = 728), the remaining studies were screened in two stages: initially by reviewing abstracts and titles (n = 1,413), followed by a full-text review of the remaining studies (n = 10). These selected studies assessed postoperative pain scores and opioid consumption. Pain was measured using the Numeric Rating Scale (NRS) and Visual Analog Scale (VAS) at 1 h, 24 h, and 48 h postoperatively, while opioid consumption was quantified in intravenous morphine milligram equivalents at 24 and 48 h. Result(s): The ESPB demonstrated significantly lower pain scores at 1 h (P < 0.00001), 24 h (P < 0.00001), and 48 h (P = 0.0008) postoperatively compared to the ICNB. Postoperative opioid consumption, measured in intravenous morphine milligram equivalents at 24 h (P = 0.10) and 48 h (P = 0.20) showed no significant difference between the two groups. Additionally, there were no significant differences observed in hospital stay duration (P = 0.06) or time spent under analgesia (P = 0.33). Conclusion(s): While ESPB provides superior pain relief at all measured time points postoperatively, there were no significant differences in postoperative opioid consumption, hospital stay, or time under analgesia between ESPB and ICNB. Both techniques effectively manage thoracic pain, but ESPB offers enhanced analgesic effects. Further research is necessary to refine these techniques and establish clearer guidelines for their use in specific clinical contexts. Copyright © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026. <49> Accession Number 2047119340 Title Ivabradine in Heart Transplant Recipients with Sinus Tachycardia: A Systematic Review and Meta-Analysis. Source Journal of Cardiovascular Pharmacology. 88(2) (pp 86-95), 2026. Date of Publication: 01 Aug 2026. Author Hamzah K.A.; Kurmasha Y.H.; Rasheed W.M.; Al-Shammari A.S.; Shahzaib M.; Akoum A.; Shweliya M.A.; Ramadan A.; Al-Taii H.; Refaat M.M. Institution (Hamzah) Department of Internal Medicine, Alkindy College of Medicine, University of Baghdad, Baghdad, Iraq (Kurmasha) Department of Internal Medicine, College of Medicine, University of Kufa, Najaf, Iraq (Rasheed) Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan (Al-Shammari, Shweliya) Department of Internal Medicine, University of Baghdad College of Medicine, Baghdad, Iraq (Shahzaib) Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan (Akoum) Department of Internal Medicine, Hennepin Healthcare, Minneapolis, MN, United States (Ramadan) Department of Internal Medicine, Faculty of Medicine, South Valley University, Qena, Egypt (Al-Taii) Department of Cardiology, Aultman Hospital, Canton, OH, United States (Refaat) Department of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon Publisher Lippincott Williams and Wilkins Abstract Abstract: - Sinus tachycardia is common after heart transplantation (HTx) and may worsen graft function through increased oxygen demand and remodeling. Ivabradine, a selective If channel inhibitor, lowers heart rate (HR) independently of sympathetic activity. This meta-analysis evaluates its efficacy and safety versus standard care in HTx recipients. A comprehensive search of PubMed, Embase, WoS, Scopus, and Cochrane was conducted through September 2025. Eligible studies included randomized and nonrandomized comparative trials. Data were pooled with a random-effects model to estimate mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes. Six studies, including 852 adult HTx recipients, were included. Ivabradine consistently reduced HR across all time points. Statistical significance was reached at 24 months (MD -16.82 bpm; P = 0.04) and 36 months (MD -12.94 bpm; P = 0.04). A significant reduction was observed in left ventricular mass index (MD -11.10 g/m2; 95% confidence interval -17.15 to -5.06; P < 0.05; I^2 = 0%). While left ventricular mass (LVM) and left ventricular ejection fraction (LVEF) showed trends toward improvement at the final follow-up (MD = -11.23 for LVM and +2.94% for LVEF), neither reached statistical significance (P = 0.06 and P = 0.48, respectively). No significant differences were found between the ivabradine and control groups regarding all-cause mortality (RR 1.16 at the final follow-up; P = 0.90), graft rejection (RR 1.14; P = 0.87), or systolic blood pressure (MD 0.50 mm Hg; P = 0.83). Ivabradine lowers HR after HTx but shows no clear benefit on mortality, rejection, or ejection fraction. It does not significantly affect blood pressure, supporting its tolerability, particularly when beta-blockers are not tolerated. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <50> Accession Number 631132940 Title Impaired Fibrinolysis Predicts Adverse Outcome in Acute Coronary Syndrome Patients with Diabetes: A PLATO Sub-Study. Source Thrombosis and Haemostasis. 120(3) (pp 412-422), 2020. Date of Publication: 23 Jan 2020. Author Sumaya W.; Wallentin L.; James S.K.; Siegbahn A.; Gabrysch K.; Himmelmann A.; Ajjan R.A.; Storey R.F. Institution (Sumaya, Storey) Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom (Wallentin, James) Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden (Wallentin, James, Siegbahn, Gabrysch) Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden (Siegbahn) Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden (Himmelmann) AstraZeneca Research and Development, Gothenburg, Sweden (Ajjan) Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom (Sumaya) Department of Infection, Immunity and Cardiovascular Disease, Medical School, University of Sheffield, Beech Hill Road, Sheffield, United Kingdom Publisher Georg Thieme Verlag Abstract Hypofibrinolysis is a key abnormality in diabetes but the role of impaired clot lysis in predicting vascular events and mortality in this population is yet to be determined. We aimed to investigate the relationship between fibrin clot properties and clinical outcomes in patients with diabetes and recent acute coronary syndrome (ACS). Plasma samples were collected at hospital discharge from 974 ACS patients with diabetes randomised to clopidogrel or ticagrelor in the PLATO trial. A validated turbidimetric assay was employed to study fibrin clot lysis and maximum turbidity. One-year rates of cardiovascular (CV) death, spontaneous myocardial infarction (MI) and PLATO-defined major bleeding events were assessed after sample collection. Hazard ratios (HRs) were determined using Cox proportional analysis. After adjusting for CV risk factors, each 50% increase in lysis time was associated with increased risk of CV death/MI (HR 1.21; 95% confidence interval [CI] 1.02-1.44; p = 0.026) and CV death alone (HR 1.38; 1.08-1.76; p = 0.01). Similarly, each 50% increase in maximum turbidity was associated with increased risk of CV death/MI (HR 1.25; 1.02-1.53; p = 0.031) and CV death alone (HR 1.49; 1.08-2.04; p = 0.014). The relationship between lysis time and the combined outcome of CV death and MI remained significant after adjusting for multiple prognostic vascular biomarkers (p = 0.034). Neither lysis time nor maximum turbidity was associated with major bleeding events. Impaired fibrin clot lysis predicts 1-year CV death and MI in diabetes patients following ACS. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier NCT00391872. Copyright © 2020 Georg Thieme Verlag. All rights reserved. <51> Accession Number 2046132495 Title Does a Digital Prehabilitation Solution Informed by Evidence-Based Interventions Reduce the Healthcare Burden and Improve Outcomes for Patients Awaiting Cardiac Surgery?-A Systematic Review. Source Heart Lung and Circulation. 35(9) (pp 1224-1244), 2026. Date of Publication: 01 Sep 2026. Author Hines C.; Farragher J.; Vlahos R.; Denehy L.; Doull L.; El-Ansary D. Institution (Hines, Farragher, Vlahos, El-Ansary) School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia (Hines, Farragher, El-Ansary) Shanghai University of Medicine and Health Sciences, Shanghai, China (Hines) Royal Melbourne Hospital, Melbourne, VIC, Australia (Denehy) Department of Physiotherapy, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia (Denehy) Department of Health Services Research: Allied Health, Peter MacCallum Cancer Centre, Parkville, VIC, Australia (Denehy) School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, United Kingdom (Doull) Department of Surgery, The University of Melbourne, Parkville, VIC, Australia (El-Ansary) Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia Publisher Elsevier Ltd Abstract Background and Aims: Prehabilitation before cardiac surgery targets modifiable risk factors to enhance surgical readiness and recovery. It can reduce complications, mortality, and hospital stay; however, remains underused in routine cardiac care. As digital health gains traction, remote delivery of prehabilitation offers a promising way to expand access and equity to cardiac patients. This review examines the delivery, outcomes, and effectiveness of digital prehabilitation for adults awaiting cardiac surgery. Method(s): This review followed the Preferred Reporting Items of Systematic Reviews and Meta-Analyses Analyses 2020 guidelines and was registered with PROSPERO (ID: 452250). Seven databases were searched, identifying studies which evaluated digital prehabilitation in cardiac surgery patients. Screening, selection, and data extraction were performed, and outcomes were categorised by feasibility, health outcomes, and healthcare utilisation. Result(s): Analysis showed significant findings in favour of digital prehabilitation over standard care in terms of feasibility, efficacy, complications, and costs/healthcare utilisation. Interrogation of the results data via meta-analysis was unsuitable due to the heterogeneity of the methodologies and evaluation time points. Conclusion(s): Digital prehabilitation is a safe, feasible and potentially effective strategy to improve outcomes and reduce healthcare burden in cardiac surgery. Copyright © 2026 The Author(s) <52> Accession Number 632892099 Title Publication Performance in German Academic Heart Surgery. Source Thoracic and Cardiovascular Surgeon. 69(1) (pp 19-25), 2020. Date of Publication: 08 Sep 2020. Author Debus E.S.; Dolg M.; Reichenspurner H.; Grundmann R.T. Institution (Debus, Dolg, Grundmann) Herz-und Gefabetazentrum, Universitatsklinikum Hamburg-Eppendorf, Martinistrabetae 52, Hamburg, Germany (Reichenspurner) Cardiovascular Surgery, Universitatsklinikum Hamburg-Eppendorf, Hamburg, Germany Publisher Georg Thieme Verlag Abstract Background: This study was designed to evaluate the publication performance of management teams consisting of chief and senior physicians in German university cardiac surgery units over a 10-year period and to facilitate benchmarking. Method(s): The cutoff date for consideration of staffing from the unit Web site and publications was July 1, 2017. The literature search was based on an evaluation of the PubMed database. The 5-year impact factor (IF) from 2016 was assigned to each journal. Result(s): Two thousand five hundred thirty-five publications (average IF 3.02) were registered, published in 323 journals. Of a total of 341 management team members, 235 (68.9%) published as first or last author over the 10-year period. The number of publications from the units divided into quintiles varied considerably with the first six units contributing 39.0% of all publications and the last nine units 9.4%. With a cumulative IF total of 3265, the publications of the first six units accounted for 42.7% of the cumulative IF, the last unit quintile amounted to 621 (8.1%) of the cumulative IF. When considering publications per managing member, the first quintile averaged 11.9 publications (29.6 IF) per managing member, the last quintile 3.3 publications (8.0 IF) per member. Conclusion(s): The six units of the first quintile published on average 3.6 times more per managing member than the nine units in the last quintile and the average cumulative IF per member in the first quintile was almost five times higher. Further investigation must show whether this considerable difference in publication activity between the university units is also observed in other operative fields. Copyright © 2021 Georg Thieme Verlag. All rights reserved. <53> Accession Number 2049303784 Title Renal near-infrared spectroscopy for predicting acute kidney injury in pediatric cardiac surgery: A systematic review and meta-analysis. Source Heart, Vessels and Transplantation. 10(3) (no pagination), 2026. Date of Publication: 05 Sep 2026. Author Verma A.; Bajpai S.; Taluja A.; Shah P.; Banker K. Institution (Verma, Taluja, Shah, Banker) Department of Cardiac Anesthesia, Civil Hospital Campus, Asarwa, Gujarat, Ahmedabad, India (Bajpai) Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States Publisher Bishkek: Center for Scientific Research and Development of Education Abstract Objective: Renal near-infrared spectroscopy (NIRS) is a non-invasive, real-time monitoring technique that measures regional renal oxygen saturation (rSO_2) and may enable early detection of renal hypoperfusion. This systematic review and meta-analysis aimed to evaluate the role of renal NIRS in predicting postoperative acute kidney injury (AKI) in pediatric patients undergoing cardiac surgery. Method(s): A systemic search of PubMed, Cochrane Library, Google scholar and DOAJ database was conducted to identify relevant studies published between 2010 and 2024. The primary outcome was the pooled incidence of AKI. Secondary outcome included subgroup analyses based on AKI definition, geographic region, monitoring site, timing, side of monitoring and laterality. Heterogeneity was assessed using I2 and Tau2 statistics. Result(s): Eighteen studies comprising 1,330 participants were included. The pooled odds ratio (OR) for AKI was (OR- 0.22; 95% CI (confidence interval): 0.11 to 0.41; I2=92.1%; p<0.0001) indicating substantial heterogeneity. In the secondary outcome of subgroup analyses, the pooled odds ratio was higher in studies using KDIGO (Kidney Disease: Improving Global Outcomes) criteria (OR - 0.54; 95% CI: 0.27 to 1.07) than in those using pRIFLE (Pediatric Risk, Injury, Failure, Loss and End) (OR - 0.18; 95%CI: 0.06 to 0.44) criteria. In Asian studies, KDIGO-based estimates was OR - 0.27 (95% CI: 0.20 to 0.35), while intraoperative monitoring estimates - OR - 0.38 (95% CI: 0.15 to 0.96). Cerebral/renal site monitoring was associated with - OR - 0.34; (95% CI: 0.18 to 0.63), and right-sided monitoring estimates - OR - 0.20 (95% CI: 0.07-0.50). Conclusion(s): Renal NIRS identifies a clinically relevant pooled AKI incidence of 21 (6% approximately in postoperative pediatric cardiac surgery patients, with notable differences by definition, timing, and monitoring approach. Despite heterogeneity, these findings support to renal NIRS as a promising tool for early risk stratification and potential intervention to mitigate AKI. Copyright © 2026 Heart, Vessels and Transplantation This is an open access article CC-BY-NC-ND 4(0).license <54> Accession Number 2049104557 Title Impact of Cipepofol versus Propofol on Long-Term Cardiovascular Outcomes After TAVR: An Extended Follow-Up of a Randomized Trial. Source Drug Design, Development and Therapy. 20 (no pagination), 2026. Article Number: 621481. Date of Publication: 2026. Author Ni T.; Lv Y.; Zhou L.; Yu J.; Tao X.; Cao H.; Yao Y.; Yan M. Institution (Ni, Lv, Zhou, Yu, Tao, Cao, Yao, Yan) Department of Anesthesiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China Publisher Dove Medical Press Ltd Abstract Background: Patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) under general anesthesia are particularly vulnerable to hemodynamic instability. General anesthesia remains a common approach and is necessary in selected patients, although conscious sedation is increasingly used. A previous randomized trial showed greater peri-induction hemodynamic stability with cipepofol than with propofol, but whether this translates into improved clinical outcomes is uncertain. Method(s): We conducted a post hoc, exploratory extended follow-up of a single-center randomized trial. Patients were randomly assigned to cipepofol or propofol. In-hospital analyses included 122 TAVR-treated participants (61 per group), whereas the 30-day and 1-year analyses included 118 participants with follow-up data in the full analysis set (59 per group). The primary endpoint was the 1-year composite of all-cause mortality, stroke, acute kidney injury, myocardial infarction, and new-onset atrial fibrillation (NOAF). For this exploratory analysis, the components were grouped based on their hypothesized association with periprocedural hemodynamic instability and were also reported separately. Result(s): At 1 year, the primary composite endpoint occurred in 13/59 (22.0%) patients in the cipepofol group and 22/59 (37.3%) patients in the propofol group (hazard ratio [HR] 0.56; 95% confidence interval [CI] 0.28 to 1.10; P = 0.093). NOAF, analyzed separately as an exploratory secondary endpoint, occurred less frequently with cipepofol than with propofol (7/59 [11.9%] vs 17/59 [28.8%]; HR 0.39; 95% CI 0.16 to 0.95; P = 0.037). At 30 days, the composite endpoint occurred in 9/59 (15.3%) and 14/59 (23.7%) patients, respectively (HR 0.63; 95% CI 0.27 to 1.45; P = 0.277). The in-hospital composite endpoints were 10/61 (16.4%) and 16/61 (26.2%), respectively (P = 0.185). Conclusion(s): In this exploratory extended follow-up, cipepofol did not significantly reduce the 1-year primary composite endpoint compared with propofol. The observed lower incidence of NOAF should be regarded as hypothesis-generating given the limited sample size, multiple comparisons, and intermittent rhythm surveillance. The applicability of these findings is limited to patients undergoing transfemoral TAVR under general anesthesia and does not extend to procedures performed under conscious sedation. Copyright © 2026 Ni et al. <55> Accession Number 2024497413 Title Comparison of Bretschneider HTK and Blood Cardioplegia (4:1): A Prospective Randomized Study. Source Thoracic and Cardiovascular Surgeon. 72(1) (pp 11-20), 2023. Date of Publication: 13 Jan 2023. Author Ak K.; Dericioglu O.; Midi A.; Kararmaz A.; Er Z.; Dogusan Z.; Arsan S. Institution (Ak) Department of Cardiovascular Surgery, Marmara University School of Medicine, Marmara Uninersitesi Hastanesi Mimar Sinan, Cad. Fevzi Cakmak Mah. Ust Kaynarca Kalp ve Damar Cerrahisi Bolumu Pendik, Istanbul, Turkey (Dericioglu, Arsan) Department of Cardiovascular Surgery, Marmara University School of Medicine, Istanbul, Turkey (Midi) Department of Pathology, Bahcesehir University, School of Medicine, Istanbul, Turkey (Kararmaz) Department of Anesthesiology and Reanimation, Marmara University School of Medicine, Istanbul, Turkey (Er) Department of Cardiovascular Surgery, Bozok University Faculty of Medicine, Ringgold Standard Institution, Yozgat, Yozgat, Turkey (Dogusan) Department of Pathology, Bone Marrow Transplantation Unite, Yeni Yuzyll University School of Medicine, Istanbul, Turkey Publisher Georg Thieme Verlag Abstract Background We compared the effect of intermittent blood and histidine-tryptophan-ketoglutarate (HTK) solution of Bretschneider on myocardial histopathology and perioperative outcome. Methods Forty adult cardiac surgery patients were grouped into two (n = 20 for each): (1) Intermittent blood cardioplegia (IBC): had repeated cold 4:1 blood cardioplegia and (2) HTK: had a single dose of cold HTK for cardioprotection. Creatine kinase (CK)-MB, Troponin-I (cTn-I), pH, and lactate were studied in coronary sinus blood before and after aortic cross-clamping (AXC) and systemic blood at postoperative 6 th, 24 th, and 48 thhours. Myocardial biopsy was performed before and after AXC for light microscopy. Vacuolation, inflammation, edema, and glycogen were graded semiquantitatively (from 0 to 3). The myocardial apoptotic index was evaluated via the terminal deoxynucleotidyl transferase dUTP nick end labeling. Results There were no differences in perioperative clinical outcomes between the groups. The coronary sinus samples after AXC were more acidotic (7.15 +/- 0.14 vs. 7.32 +/- 0.07, p = 0.001) and revealed higher CK-MB (21.0 +/- 12.81 vs. 12.60 +/- 11.80, p = 0.008) in HTK compared with IBC. The HTK had significantly a higher amount of erythrocyte suspension intraoperatively compared with IBC (0.21 +/- 0.53 vs. 1.68 +/- 0.93 U, p = 0.001). Microscopically, myocardial edema was more pronounced in HTK compared with IBC after AXC (2.25 +/- 0.91 vs. 1.50 +/- 0.04, p = 0.013). While a significant increase in the apoptotic index was seen after AXC in both groups (p = 0.001), no difference was detected between the groups (p = 0.417). Conclusion IBC and HTK have a similar clinical outcome and protective effect, except for more pronounced myocardial edema and increased need for intraoperative transfusion with HTK. Copyright © 2022 Georg Thieme Verlag. All rights reserved. <56> Accession Number 2024497414 Title Risk Prediction Models for Long-Term Survival after Cardiac Surgery: A Systematic Review. Source Thoracic and Cardiovascular Surgeon. 72(1) (pp 29-39), 2023. Date of Publication: 07 Feb 2023. Author Argus L.; Taylor M.; Ouzounian M.; Venkateswaran R.; Grant S.W. Institution (Argus) The University of Manchester, Manchester, United Kingdom (Taylor, Venkateswaran) Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom (Ouzounian) Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (Grant) Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom (Grant) Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesborough, United Kingdom Publisher Georg Thieme Verlag Abstract Background The reporting of alternative postoperative measures of quality after cardiac surgery is becoming increasingly important as in-hospital mortality rates continue to decline. This study aims to systematically review and assess risk models designed to predict long-term outcomes after cardiac surgery. Methods The MEDLINE and Embase databases were searched for articles published between 1990 and 2020. Studies developing or validating risk prediction models for long-term outcomes after cardiac surgery were included. Data were extracted using checklists for critical appraisal and systematic review of prediction modeling studies. Results Eleven studies were identified for inclusion in the review, of which nine studies described the development of long-term risk prediction models after cardiac surgery and two were external validation studies. A total of 70 predictors were included across the nine models. The most frequently used predictors were age (n = 9), peripheral vascular disease (n = 8), renal disease (n = 8), and pulmonary disease (n = 8). Despite all models demonstrating acceptable performance on internal validation, only two models underwent external validation, both of which performed poorly. Conclusion Nine risk prediction models predicting long-term mortality after cardiac surgery have been identified in this review. Statistical issues with model development, limited inclusion of outcomes beyond 5 years of follow-up, and a lack of external validation studies means that none of the models identified can be recommended for use in contemporary cardiac surgery. Further work is needed either to successfully externally validate existing models or to develop new models. Newly developed models should aim to use standardized long-term specific reproducible outcome measures. Copyright © 2022 Georg Thieme Verlag. All rights reserved. <57> Accession Number 2022297808 Title Effect of Decompressive Craniectomy with Stepwise Decompression of the Intracranial Compartment on Postoperative Neurologic Function, Hemodynamics, and Glasgow Outcome Scale Score of Patients with Severe Traumatic Brain Injury. Source Journal of Neurological Surgery, Part A: Central European Neurosurgery. 84(6) (pp 536-541), 2022. Date of Publication: 26 Dec 2022. Author Wu H.; Jiang B.; Yan X.; Zhan C.; Dai W.; Yu G. Institution (Wu, Jiang, Yan, Zhan, Dai, Yu) Department of Neurosurgery, Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Zhejiang Province, Quzhou, China Publisher Georg Thieme Verlag Abstract Background: We assess the effects of standard decompressive craniectomy with stepwise decompression of the intracranial compartment on the postoperative neurologic function, hemodynamics, and Glasgow Outcome Scale (GOS) score of patients with severe traumatic brain injury (sTBI). Method(s): One hundred sTBI patients admitted from July 2017 to February 2019 were enrolled and randomly divided into step and standard groups (n = 50) using a random number table. The standard group received traditional standard decompression during surgery, while the step group underwent multistep decompression during surgery. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured immediately after surgery (T0), 3 hours after surgery (T1), 6 hours after surgery (T2), and 12 hours after surgery (T3). The postoperative Glasgow Coma Scale (GCS) score, neurologic function deficit score, and GOS score were evaluated. Result(s): After treatment, the excellent/good rate of neurologic function improvement and GCS and GOS scores of the step group significantly exceeded those of the standard group (p < 0.05). Compared with the standard group, the HR, SBP, DBP, and MAP decreased significantly in the step group at T1, T2, and T3 (p < 0.05). Conclusion(s): Standard decompressive craniectomy under multistep decompression can markedly improve the neurologic function, hemodynamics, and prognosis of patients. Copyright © 2022. Thieme. All rights reserved. <58> Accession Number 2038606937 Title Regional anaesthesia for postoperative pain after median sternotomy in cardiac surgery: a scoping review and meta-analysis. Source Acta Anaesthesiologica Belgica. 77(3) (pp 227-235), 2026. Date of Publication: 01 Sep 2026. Author Batonga J.; Tuna T.; Duranteau O. Institution (Batonga, Tuna, Duranteau) Anesthesiology Departement, Hopitaux Universitaires de Bruxelles - Site Erasme, Anderlecht, Belgium (Tuna, Duranteau) Medical School, Universite Libre de Bruxelles, Anderlecht, Belgium Publisher BeSARPP Abstract Introduction: Regional anaesthesia (RA) is an established option for analgesia in cardiac surgery performed via median sternotomy. Despite the growth of minimally invasive approaches, sternotomy remains widely used and is associated with substantial postoperative pain and related complications. Perioperative analgesic management in cardiac surgery is therefore typically multimodal. The primary objective of this study was to evaluate the efficacy and limitations of RA techniques to determine whether RA could serve as a core component of postoperative pain management after sternotomy. Method(s): We conducted a systematic review of the literature across multiple databases to identify studies reporting postoperative outcomes of RA techniques with respect to reduction of post-sternotomy pain. Six studies in which the primary endpoint was postoperative pain after cardiac surgery met the eligibility criteria and were included in the meta-analysis. Result(s): Pooled analysis of the six studies indicated that RA was associated with a clinically meaningful reduction in post-sternotomy pain intensity (pooled mean difference approximately -3 points on a 0-10 scale), along with decreased opioid consumption. Considerable between-study heterogeneity was observed (I2 = 99.5%), reflecting variation in RA techniques, comparators, and perioperative protocols; nevertheless, the direction of effect consistently favoured RA. Conclusion(s): RA appears effective for improving postoperative analgesia after cardiac surgery via median sternotomy and may reduce perioperative opioid requirements. Incorporation of RA into Enhanced Recovery After Cardiac Surgery pathways could support postoperative recovery and mitigate opioid-related adverse effects. Given the substantial heterogeneity across studies, further well-designed trials using standardised analgesic outcomes are warranted to refine indications and optimise technique selection. Copyright © 2026, BeSARPP. All rights reserved. <59> Accession Number 2049341272 Title Comparative Effectiveness of Ivabradine, Carvedilol and its Combination on Post Operative Hemodynamic Stability in Off Pump Coronary Artery Bypass Graft Patients with Low Ejection Fraction. Source International Journal of Current Pharmaceutical Review and Research. 17(12) (pp 2313-2318), 2025. Date of Publication: 2025. Author Mondal C.; Mazumder P.; Kundu S. Institution (Mondal) Department of Anesthesiology, Medical College & Hospital, 88 College Street, Kolkata, India (Mazumder) Department of Cardiac Anesthesiology, Medical College & Hospital, 88 College Street, Kolkata, India (Kundu) Department of Anesthesiology, Medical College & Hospital, 88 College Street, Kolkata, India Publisher Dr. Yashwant Research Labs Pvt. Ltd. Abstract Introduction: Patients with low left ventricular ejection fraction (LVEF) undergoing off-pump coronary artery bypass graft (OPCAB) surgery are at increased risk of perioperative hemodynamic instability. Although both Ivabradine and Carvedilol have been individually used to optimize perioperative heart rate and hemodynamics, evidence is scarce regarding the comparative effectiveness of Ivabradine, Carvedilol, and their combination in this high-risk population. Aim(s): To compare the effectiveness of Ivabradine alone, Carvedilol alone, and a combination of Ivabradine + Carvedilol in maintaining post-operative hemodynamic stability in OPCAB patients with pre-existing low LVEF. Material(s) and Method(s): This prospective, randomized, controlled study included 63 adults (>=18 years) with LVEF <=40% undergoing elective off-pump CABG at the Department of Cardiac Anesthesia, Medical College Hospital, Kolkata. Patients received either carvedilol or ivabradine perioperatively. Demographics were recorded, and heart rate and blood pressure were monitored. Data were analyzed using SPSS; p < 0.05 was considered significant. Result(s): Baseline demographics, including age, gender, weight, height, and BMI, were comparable across the Ivabradine, Carvedilol, and combination groups, with no statistically significant differences (all p?> 0.05). Mean blood pressure was similar at baseline (p = 0.429) and gradually declined over time in all groups without significant inter-group differences. Baseline heart rate was also comparable (p = 0.633); however, heart rate reduction during follow-up was significantly greater in the combination group from 6 to 48 hours (p <= 0.002), while differences at 3 hours remained non-significant (p = 0.126). Conclusion(s): In OPCAB patients with low LVEF, combined therapy with Ivabradine and Carvedilol appears more effective than either agent alone in achieving post-operative hemodynamic stability, reducing heart rate, decreasing incidence of arrhythmia, and minimizing inotrope and ventilatory support. This combination may represent an optimal perioperative rate-control strategy in high-risk cardiac surgery patients. Copyright © This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. <60> Accession Number 2048851687 Title The need for equity in interventional cardiology care in sub-Saharan Africa. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1812816. Date of Publication: 2026. Author Moronkola R.; Babatunde A.; Oladimeji O.; Okeke M.; Ijaola E.O.; Oladimeji A.B.; Daniel F.; Ajibare A.; Adekoya A.; Emerole O. Institution (Moronkola, Babatunde, Oladimeji, Ijaola, Oladimeji, Daniel, Ajibare, Adekoya) Cardiology Unit, Department of Medicine, Lagos State University Teaching Hospital, Lagos State, Ikeja, Nigeria (Okeke) Cardiology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria (Emerole) Cardiology Unit, Department of Medicine, Cardiovascular Education Foundation, Macon, GA, United States Publisher Frontiers Media SA Abstract There is a growing burden of cardiovascular diseases (CVDs) in sub-Saharan Africa (SSA). CVDs such as coronary artery disease, valvular heart disease, heart block and others require procedures involving interventional cardiology. However, there is a huge unmet need for catheterization labs and expertise in health facilities in SSA. We highlight the gaps in equitable access, service delivery and the urgent need for strategic collaborations to increase equitable access to interventional cardiology in the content. This review will guide policy making and inspire innovation in SSA to bridge the existing gap in CVDs management. Copyright © 2026 Moronkola, Babatunde, Oladimeji, Okeke, Ijaola, Oladimeji, Daniel, Ajibare, Adekoya and Emerole. <61> Accession Number 2048298646 Title A Systematic Review to Assess the Diagnostic Performance and Clinical Utility of Intraoperative Neuromonitoring during Transcarotid Artery Revascularization. Source Annals of Vascular Surgery. 133 (pp 24-34), 2026. Date of Publication: 01 Dec 2026. Author Zil-E-Ali A.; Fatima N.; Ali I.Z.; Jawed H.; Gulzar H.; Sarfraz L.; Munir F.; Hakimi A.; Aziz F. Institution (Zil-E-Ali, Hakimi, Aziz) Division of Vascular Surgery, Heart and Vascular Institute, Pennsylvania State Milton S. Hershey Medical Center, Hershey, PA, United States (Fatima, Ali) Shifa College of Medicine, Islamabad, Pakistan (Jawed) Jinnah Postgraduate Medical Center, Karachi, Pakistan (Gulzar) Allama Iqbal Medical College, Lahore, Pakistan (Sarfraz) King Edward Medical University, Lahore, Pakistan (Munir) Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan Publisher Elsevier Inc. Abstract Background Intraoperative neuromonitoring (IONM), most commonly using electroencephalography (EEG) and somatosensory evoked potentials (SSEP), is increasingly used during carotid revascularization to detect cerebral hypoperfusion and acute neurologic compromise. However, evidence regarding its diagnostic accuracy, clinical utility, and impact on intraoperative decision-making, particularly during transcarotid artery revascularization (TCAR) remains limited. This systematic review evaluates the diagnostic performance and clinical relevance of IONM during carotid revascularization procedures. Methods A systematic literature search was conducted across PubMed, Scopus, and the Cochrane Central Register of Controlled Trials to identify studies reporting the use of IONM during carotid revascularization. Data extraction focused on neuromonitoring modality, incidence of monitoring alerts, correlation with neurologic outcomes, intraoperative interventions, and diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results Five retrospective studies encompassing 709 patients undergoing TCAR with IONM were included. Across studies, IONM demonstrated sensitivity up to 100% and NPV up to 100% for detecting immediate postoperative neurologic deficits. PPV varied by modality and alert definition but was highest when simultaneous EEG and SSEP changes were observed. The overall incidence of new neurologic deficits was low (0.4-3.4%). Unresolved perfusion-related IONM alerts were associated with a higher risk of immediate postoperative neurologic deficits, whereas most alerts resolved following intraoperative interventions such as blood pressure augmentation, clamp removal, or flow reversal adjustment. Studies employing transcranial Doppler and near-infrared spectroscopy consistently demonstrated transient reductions in cerebral blood flow and oxygenation during flow reversal, with recovery following restoration of antegrade flow. Conclusion IONM during carotid revascularization, particularly TCAR, demonstrates excellent sensitivity and NPV for detecting cerebral hypoperfusion and neurologic compromise. Although its PPV is limited by the low incidence of neurologic events, multimodal monitoring, especially combined EEG and SSEP, enhances diagnostic reliability and supports timely intraoperative intervention. Prospective studies with standardized monitoring protocols are needed to define the optimal role of IONM and its impact on clinical outcomes. Copyright © 2026 Elsevier Inc. <62> Accession Number 2048666692 Title Effect of salbutamol during one-lung ventilation in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Source Canadian Journal of Anesthesia. 73(7) (pp 671-680), 2026. Date of Publication: 01 Jul 2026. Author Oh Y.J.; Kim N.; Choo H.; Lee K. Institution (Oh, Kim, Choo, Lee) Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea (Oh, Kim, Choo, Lee) Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Publisher Springer Abstract Purpose: Ventilation-perfusion mismatch during one-lung ventilation (OLV) for thoracic surgery increases the risk of hypoxemia. Salbutamol may selectively dilate pulmonary vessels and enhance perfusion of the ventilated lung. We sought to investigate whether selective salbutamol nebulization to the ventilated lung during OLV improves gas exchange and respiratory mechanics in patients with chronic obstructive pulmonary disease (COPD). Method(s): In this prospective randomized controlled trial, we randomly allocated 90 patients scheduled for lung resection to receive salbutamol or placebo nebulization 30 min after OLV initiation and analyzed 82 patients (41 per group). The primary endpoint was the change in the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf>) after nebulization. Secondary outcomes included other gas exchange and respiratory mechanics indices, hemodynamic variables, and perioperative complications. Result(s): Compared with placebo, salbutamol increased PaO<inf>2</inf>/F<inf>I</inf>O<inf>2</inf> (mean difference, 26; 95% confidence interval [CI], 0 to 53; P = 0.03) and decreased alveolar dead space (mean difference, -1.7; 95% CI, -4.3 to -0.1; P = 0.04) as well as serum potassium (mean difference, -0.2; 95% CI, -0.4 to 0.0; P = 0.01). Heart rate rose transiently without arrhythmia. In a subgroup of patients who had received preoperative inhaler therapy, no between-group differences were observed. Conclusion(s): Selective salbutamol nebulization during OLV improved oxygenation and respiratory mechanics without serious adverse events, and it may be considered as an adjunctive option for the management of intraoperative hypoxemia in patients with COPD. The lack of benefit among patients who received preoperative inhaler therapy suggests that intraoperative selective one-lung nebulization may be more advantageous than preoperative two-lung nebulization. Study registration: ClinicalTrials.gov (NCT05914285); first submitted 13 June 2023. Copyright © Canadian Anesthesiologists' Society 2026. <63> Accession Number 2048856217 Title Response by Dong et al to Letter Regarding Article, "Transcatheter Closure of Patent Foramen Ovale With a Novel Biodegradable Device: A Prospective, Multicenter, Randomized Controlled Clinical Trial". Source Circulation. 154(8) (pp e297-e298), 2026. Date of Publication: 25 Aug 2026. Author Dong J.; Zhang F.; Pan X. Institution (Dong, Zhang, Pan) Department of Structural Heart Disease, Fuwai Hospital & National Center for Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Cardiovascular Diseases, Beijing, China (Pan) Department of Structural Heart Disease, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China (Pan) Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, China (Pan) Shenzhen Medical Academy of Research and Translation (SMART), Shenzhen, China Publisher Lippincott Williams and Wilkins Abstract We thank Hayek et al for their positive comments on our study. The preservation of future transseptal access and elimination of radiation exposure highlighted by Hayek et al were major motivations for this study and exemplify the emerging percutaneous and non-fluoroscopic (PAN) procedure, in which echocardiography alone is used to guide transcatheter interventions. We also appreciate their thoughtful comments on several important issues. Copyright © 2026 American Heart Association, Inc. <64> Accession Number 2047158448 Title Protection against postoperative atrial fibrillation via antiplatelet aggregation induced by remote ischemic preconditioning during off-pump coronary artery bypass grafting. Source Basic Research in Cardiology. 121(5) (pp 883-894), 2026. Date of Publication: 01 Oct 2026. Author Jiang Q.; Zheng Y.; Huang K.; Du J.; Yang Z.; Hu S. Institution (Jiang, Huang) Department of Cardiac Surgery, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China (Jiang, Zheng) School of Medicine, University of Electronic Science and Technology, Chengdu, China (Jiang) Ultrasound Medicine and Computational Cardiology Key Laboratory of Sichuan Province, Chengdu, China (Du) Department of Operating Room, Sichuan Provincial People's Hospital, Affiliated Hospital of University of Electronic Science and Technology, Chengdu, China (Yang) The Key Laboratory for Human Disease Gene Study of Sichuan Province, Department of Laboratory Medicine, Sichuan Provincial People's Hospital, Chengdu, China (Hu) Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Jiang) No.32, West Second Section First Ring Road, Chengdu, China Publisher Springer Science and Business Media Deutschland GmbH Abstract Off-pump coronary artery bypass grafting (OPCABG) is associated with increased platelet aggregation and a higher incidence of postoperative atrial fibrillation (POAF). Remote ischemic preconditioning (RIPC) has been reported as a promising intervention to mitigate these adverse outcomes. Consecutive patients with cytochrome P450 family 2 subfamily C member 19 (CYP2C19) loss-of-function (LOF) genotype who underwent isolated OPCABG were randomly assigned to receive intermittent ischemia-reperfusion applied to the arm (RIPC group) or not intervention (control group). RIPC was performed after induction of anesthesia using three cycles of 5-min inflation separated by 5-min deflation. The primary outcome was the cumulative incidence of POAF within the first postoperative week, assessed by the intention-to-treat analysis. Secondary outcomes included POAF burden, biochemical indicators, and clinical trajectory. Among the 220 patients available for the primary endpoint analysis, POAF occurred in 27 of 109 patients (24.8%) in the RIPC group versus 46 of 111 patients (41.4%) in the control group (hazard ratio [HR]: 0.542, 95% confidence interval [CI]: 0.342 to 0.858; P = 0.01). The RIPC group also showed significantly lower values than the control group for AF burden (5.1% [IQR 2.3-11.3%] vs. 8.3% [IQR 4.1-19.1%]; P = 0.019), arachidonic acid- and adenosine diphosphate-stimulated platelet aggregation, inflammatory and prothrombotic index, and intensive care unit length of stay. In CYP2C19 LoF carriers, administration of RIPC favorably reduced the incidence and burden of POAF within 1 week after OPCABG, attenuated platelet aggregation and systemic inflammation, and shortened the duration of intensive care unit stay. Copyright © Springer-Verlag GmbH Germany, part of Springer Nature 2026. <65> Accession Number 2038616411 Title Surgical Considerations for Kidney Transplant in Simultaneous Versus Sequential Heart-Kidney Transplant: A Systematic Review. Source Experimental and Clinical Transplantation. 24(8) (pp 579-588), 2026. Date of Publication: 01 Aug 2026. Author Sharma R.; Khan N. Institution (Sharma) Department of Surgery, West Virginia University School of Medicine, Morgantown, WV, United States (Khan) Department of Nephrology, West Virginia University School of Medicine, Morgantown, WV, United States Publisher Baskent University Abstract Objectives: We aimed to answer a key kidney-focused question in simultaneous heart-kidney transplant of whether the kidney should be implanted immediately, staged after short-term stabilization, or deferred to sequential kidney-after-heart transplant. Material(s) and Method(s): We used PRISMA to guide our systematic review using PubMed as the primary database, with supplementary Embase and Cochrane searches and separate review of current Organ Procurement and Transplant Network policies. PubMed was searched on March 21, 2026, using (((heart-kidney transplant) OR (sequential kidney transplant in heart transplant)) OR (simultaneous heart and kidney transplant)), limited to English, humans, adult: 19+ years, MEDLINE, and January 1, 2006, through March 21, 2026. Our review yielded 303 records; 62 abstracts underwent review, of which 26 were selected for full-text review. Embase search yielded 264 records across 7 targeted searches; 14 studies underwent review, of which 7 were duplicates and 7 unique studies underwent full-text review. No Cochrane record met final inclusion criteria. Two Organ Procurement and Transplant Network policy reports were reviewed separately. Final qualitative synthesis included 35 full-text records. Result(s): Simultaneous heart-kidney transplant was most consistently supported in dialysis-dependent recipients and in recipients with severe, likely irreversible renal dysfunction. Kidney delayed graft function occurred in approximately one-fourth to one-third of simultaneous heart-kidney transplant recipients and was associated with worse patient and kidney graft survival. Primary nonfunction, early kidney graft loss, and renal allograft futility were highly consequential, especially in hemodynamically fragile and surgically complex recipients. Comparative studies suggested that sequential kidney-after-heart transplant is a reasonable strategy when renal reversibility is uncertain or when the postsurgery heart transplant environment is hostile to renal graft perfusion. Conclusion(s): Simultaneous allocation should be distinguished from simultaneous implantation. In selected recipients, staged or sequential kidney transplant may better protect kidney outcomes and better align with utility, justice, and organ stewardship. Copyright © Baskent University 2026 Printed in Turkey. All Rights Reserved. <66> Accession Number 2049252045 Title Clopidogrel Versus Dual-Antiplatelet Therapy for Long-Term Maintenance After Coronary Stenting in Ischemic and Bleeding Birisk Patients With Acute Coronary Syndromes and Diabetes: A Prespecified Subgroup Analysis of the OPT-BIRISK Trial. Source Journal of the American Heart Association. 15(17) (no pagination), 2026. Article Number: e049178. Date of Publication: 2026. Author Zhang D.; Li Y.; Qiu M.; Zhou Y.; Chen S.; Pei H.; Liu J.; Xu B.; Han Y.; Stone G.W. Institution (Zhang, Li, Qiu, Han) State Key Laboratory of Frigid Zone Cardiovascular Diseases, Department of Cardiology, General Hospital of Northern Theater Command, Cardiovascular Research Institute, Shenyang, China (Zhou, Liu) Beijing Anzhen Hospital, Capital Medical University, Beijing, China (Chen) Nanjing First Hospital, Nanjing Medical University, Nanjing, China (Pei) The First Affiliated Hospital of Baotou Medical College, Baotou, China (Xu) Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China (Stone) Icahn School of Medicine at Mount Sinai, New York, NY, United States Publisher American Heart Association Inc. Abstract BACKGROUND: Among patients with acute coronary syndromes at both high bleeding and ischemic risk (birisk), extended clopidogrel monotherapy after 9 to 12months of dual-antiplatelet therapy reduces bleeding without increasing ischemia. Whether this benefit extends to birisk patients with diabetes is unknown. METHOD(S): This prespecified subgroup analysis of the OPT-BIRISK (Optimal Antiplatelet Therapy for High Bleeding and Ischemic Risk Patients) trial included birisk patients with acute coronary syndrome who had completed 9 to 12months of dual-antiplatelet therapy after percutaneous coronary intervention. Patients were then randomized 1:1 to 9months of clopidogrelplusplacebo versus clopidogrelplusaspirin. Outcomes were compared by diabetes status. The primary end point was Bleeding Academic Research Consortium type 2, 3, or 5 bleeding at 9 months after randomization. The key secondary end point was major adverse cardiac and cerebral events, defined as a composite outcome of all-cause death, myocardial infarction, stroke, or clinically driven revascularization. RESULT(S): Of 7758 patients, 4072 (52.5%) had diabetes. Clopidogrel monotherapy decreased Bleeding Academic Research Consortium type 2, 3, or 5 bleeding (2.1% versus 3.2%; hazard ratio [HR], 0.66 [95% CI, 0.45-0.97]) with no increase in major adverse cardiac and cerebral events (2.9% versus 3.6%; HR, 0.79 [95% CI, 0.56-1.12]) compared with clopidogrel plus aspirin in patients with diabetes. Outcomes were consistent in patients without diabetes, with no significant interactions by diabetes status. CONCLUSION(S): In birisk patients with acute coronary syndrome who were stable on dual-antiplatelet therapy with clopidogrel plus aspirin for 9 to 12 months after percutaneous coronary intervention, clopidogrel monotherapy for an additional 9 months reduced clinically relevant bleeding without increasing ischemic events compared with continued dual-antiplatelet therapy, irrespective of diabetes status. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT03431142. Copyright © 2026 The Author(s). Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. JAHA is available at: www.ahajournals.org/journal/jaha <67> Accession Number 2046955596 Title Perioperative Transfusion Trigger Score Versus Restrictive Transfusion in Older Non-Cardiac Surgery Patients: A Multicenter Randomized Controlled Trial. Source Journal of the American Geriatrics Society. 74(9) (pp 2564-2572), 2026. Date of Publication: 01 Sep 2026. Author Liang S.; Bai L.; Yang G.; Chen Z.; Wei Y.; Lv Y.; Huang Z.; Huang Y.; Lu K. Institution (Liang, Bai, Yang, Chen, Wei, Wei, Lv, Huang, Lu) Department of Anesthesiology, The Third Affiliated Hospital of Guangxi Medical University, Guangxi, Nanning, China (Liang, Bai, Yang, Chen, Wei, Wei, Lv, Huang, Lu) Department of Anesthesiology, The Second Naning People's Hospital, Guangxi, Nanning, China (Huang) Department of Anesthesiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Guangxi, Baise, China Publisher John Wiley and Sons Inc Abstract Background: Restrictive transfusion (Hb < 7 g/dL) is recommended for most perioperative patients, but the optimal threshold for those with cardiovascular disease or Hb 7-10 g/dL remains uncertain. The Perioperative Transfusion Trigger Score (POTTS), which integrates adrenaline requirement, FiO<inf>2</inf>, temperature, and angina history, may standardize decisions and safely reduce transfusions in older non-cardiac surgery patients. Method(s): This multicenter RCT in two Chinese hospitals randomized patients >= 60 years undergoing non-cardiac surgery 1:1 to POTTS or control. POTTS = 6 plus points for adrenaline, FiO<inf>2</inf> (to maintain SpO<inf>2</inf> >= 95%), core temperature, and angina; transfusion when Hb < POTTS. Control followed 2012 AABB guideline (Hb < 7 always transfuse; > 10 not; 7-10 physician discretion). Primary Outcome: proportion receiving allogeneic RBC transfusion during perioperative period (ITT population). Result(s): 253 patients (mean age 72.3 years; 67.6% women) were randomized (May 2023-Sept 2025). Baseline Hb similar (median 9.60 vs. 9.50 g/dL). In ITT, transfusion required in 24.00% (30/125) of POTTS vs. 35.94% (46/128) of control (p = 0.038). Transfusion volume did not differ significantly (median 2.50 vs. 3.00 units, p = 0.520). Overall complication rates: 12.80% vs. 8.59% (p = 0.279); one death in control group (0.85%). No significant differences in specific complications. Conclusion(s): In patients >= 60 years undergoing non-cardiac surgery, POTTS-guided transfusion significantly reduced the proportion of patients transfused without increasing complications. Trial Registration: This study was registered at http://www.chictr.org.cn (#ChiCTR2300071739). Copyright © 2026 The Author(s). Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society. <68> Accession Number 2048186020 Title Systematic Review Certainty of Evidence and Procedural Durability of Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: An Umbrella Review of Meta-Analyses. Source Cardiology (Switzerland). (pp 1-10), 2026. Date of Publication: 2026. Author Simao A.C.; de Oliveira M.B.G.; Menezes Junior A.D.S. Institution (Simao, de Oliveira, Menezes Junior) Faculty of Medicine, Federal University of Goias, Goiania, Brazil (Menezes Junior) Department of Medicine, School of Medical and Life Sciences, Pontifical Catholic University of Goias, Goiania, Brazil Publisher S. Karger AG Abstract Abstract - Introduction: This umbrella review aimed to evaluate the certainty and consistency of the available evidence rather than to provide a new procedural comparison. We synthesized systematic reviews comparing surgical septal myectomy (SM) versus alcohol septal ablation (ASA) for symptomatic obstructive hypertrophic cardiomyopathy (oHCM) to critically assess the certainty of findings. Method(s): An umbrella review of meta-analyses was conducted following Cochrane and PRISMA guidelines. A systematic search of four databases was performed. Methodological quality, risk of bias, and study overlap were assessed. Quantitative synthesis was performed using a random-effects model, and the certainty of evidence was classified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Result(s): Six meta-analyses comprising 31 unique primary studies and 12, 860 patients were included, demonstrating very high study overlap. ASA was associated with a significantly higher risk of reoperation compared to SM, supported by high-certainty evidence. Conversely, for all other outcomes, including mortality and permanent pacemaker implantation, the certainty of evidence was consistently classified as very low due to inconsistency and imprecision. Conclusion(s): High-certainty evidence supports SM as the more durable intervention for oHCM, demonstrated by a reduced need for reoperations. Notably, the evidence for mortality outcomes is of very low certainty, precluding definitive conclusions regarding clinical equivalence or technique superiority. This review identifies current knowledge gaps regarding survival benefits to inform clinical practice and future research. Plain Language Summary Hypertrophic cardiomyopathy is a genetic condition in which the heart muscle becomes abnormally thick. In many patients, this thickening blocks blood flow out of the heart, causing severe symptoms like shortness of breath and chest pain. When medication fails to relieve these symptoms, doctors recommend "septal reduction therapies" to reduce the muscle thickness. There are two main options: septal myectomy (an open-heart surgery to cut away excess muscle) and alcohol septal ablation (a minimally invasive procedure that injects alcohol into a specific artery to shrink the muscle). Patients and doctors often face a difficult choice between these two methods because previous research has shown conflicting results about which is safer or more effective. To address this uncertainty, our study conducted an "umbrella review, " which analyzes all existing systematic reviews to evaluate the quality and certainty of the available medical evidence. We found with high certainty that surgery (myectomy) provides a more durable solution than alcohol ablation. This means that patients who undergo surgery are significantly less likely to need a second procedure in the future. However, regarding safety risks, such as the risk of death or the need for a permanent pacemaker, we found that the current evidence is of low quality and does not definitively prove that one technique is superior to the other. Therefore, while surgery is the most reliable option for long-term relief, the choice of treatment should be individualized based on the patient's specific health needs and preferences. Copyright © 2026 S. Karger AG, Basel <69> Accession Number 2048901799 Title Pooled Efficacy and Safety of Left Atrial Appendage Occlusion Versus Direct Oral Anticoagulants or Antiplatelets: A Meta-Analysis of the Landmark Randomized Trials. Source Journal of Cardiovascular Electrophysiology. 37(9) (pp 2122-2123), 2026. Date of Publication: 01 Sep 2026. Author Knijnik L.M.; Rao B.; DeLurgio D.B. Institution (Knijnik, Rao, DeLurgio) Emory University, Atlanta, GA, United States Publisher John Wiley and Sons Inc Abstract Background: Landmark randomized controlled trials (RCTs) comparing left atrial appendage occlusion (LAAO) against direct oral anticoagulants (DOACs) are individually underpowered for small but clinically meaningful differences. We performed a pooled meta-analysis to provide more precise efficacy and safety data. Method(s): Utilizing random-effects models, we pooled data from 5890 patients across four landmark RCTs (PRAGUE-17, CLOSURE-AF, OPTION, and CHAMPION-AF) at their longest follow-up. Result(s): There were no significant differences between LAAO and antithrombotics in cardiovascular mortality (5.3% vs. 4.8%, p = 0.33), all-cause stroke (3.3% vs. 2.8%, p = 0.31), systemic embolism (0.2% vs. 0.1%, p = 0.68), or major bleeding (6.6% vs. 6.8%, p = 0.85). Non-procedural bleeding was significantly lower with LAAO (9.2% vs. 16.7%; RR 0.55; 95% CI 0.47-0.64; p < 0.0001), though there was a numerical trend toward more ischemic stroke events (2.7% vs. 2.0%; RR 1.35; 95% CI 0.97-1.88; p = 0.08). Conclusion(s): LAAO offers similar overall efficacy and safety to modern antithrombotics. It represents a clinical trade-off: accepting a known upfront procedural risk for a robust, long-term reduction in non-procedural bleeding, potentially at the cost of a slight numerical increase in ischemic stroke. Copyright © 2026 Wiley Periodicals LLC. <70> Accession Number 2048847085 Title "Left Atrial Appendage Closure Versus Medical Therapy in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials". Source Journal of Cardiovascular Electrophysiology. 37(9) (pp 2097-2111), 2026. Date of Publication: 01 Sep 2026. Author Al-Janabi A.A.H.; Al-Shammari A.S.; Hageen A.W.; Al-Tuaama A.Z.H.; Al-Ibraheem A.M.T.; Shahzaib M.; Rathi D.; Hamzah K.A.; shweliya M.A.; Kurmasha Y.H.; Wagdy M.; Refaat M.M. Institution (Al-Janabi, Al-Ibraheem, Hamzah) Department of Internal Medicine, ALkindy college of medicine/University of Baghdad, Baghdad, Iraq (Al-Shammari, shweliya) Department of Internal Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq (Hageen) Faculty of Medicine, Tanta University, Tanta, Egypt (Al-Tuaama) Department of Internal Medicine, Privolzhsky Research Medical University, Novgorod, Nizhny, Russian Federation (Shahzaib) Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan (Rathi) Dow University of Health Sciences, Karachi, Pakistan (Kurmasha) Department of Internal Medicine, College of Medicine, University of Kufa, Najaf, Iraq (Wagdy) Faculty of Medicine, Modern University for Technology and Information, Cairo, Egypt (Refaat) Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon Publisher John Wiley and Sons Inc Abstract We aim to compare the impact of left atrial appendage closure vs. medical therapy on clinical outcomes in patients with atrial fibrillation, focusing on key clinical outcomes relevant to thromboembolic prevention. We conducted a PRISMA-guided systematic review and meta-analysis of studies comparing LAAC with medical therapy in AF adults. PubMed, Embase, Scopus, ClinicalTrial. gov, and Cochrane Library were searched from inception to March 2026. Outcomes included all-cause mortality, any stroke, ischemic stroke, hemorrhagic stroke, major bleeding, systemic embolism and cardiac death. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Reconstructed individual patient-level survival data from published Kaplan-Meier curves were used for time-to-event analyses. Trial sequential analysis (TSA) assessed the conclusiveness of cumulative evidence. Six randomized controlled trials involving 7004 patients were included. LAAC demonstrated comparable outcomes to medical therapy for all-cause mortality, any stroke, major bleeding, systemic embolism, and cardiac death. There was a non-significant trend toward increased ischemic stroke and reduced hemorrhagic stroke with LAAC. Reconstructed time-to-event analyses showed similar cumulative incidence of stroke and bleeding outcomes over follow-up. TSA demonstrated that the required information size was not reached for any major endpoint, indicating that current evidence remains underpowered and additional randomized trials are needed. LAAC provides similar overall efficacy and safety compared with medical therapy for stroke prevention in AF but should currently remain reserved for selected patients rather than replacing oral anticoagulation broadly. Further adequately powered trials with longer follow-up are required. Copyright © 2026 Wiley Periodicals LLC. <71> Accession Number 365166770 Title Is a tricuspid annuloplasty ring significantly better than a de Vega's annuloplasty stitch when repairing severe tricuspid regurgitation?. Source Interactive Cardiovascular and Thoracic Surgery. 15(1) (pp 129-135), 2012. Date of Publication: July 2012. Author Khorsandia M.; Banerjeeb A.; Singh H.; Srivastava A.R. Institution (Khorsandia) Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom (Banerjeeb, Singh) Department of Cardiothoracic and Vascular Surgery, G B Pant Hospital, New Delhi, India (Srivastava) Department of Cardiothoracic Surgery, University of Pittsburgh, Medical Center, Pittsburgh, United States Publisher Oxford University Press Abstract A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether tricuspid valve (TV) repair with an annuloplasty ring leads to an improved outcome over a conventional suture annuloplasty for patients with severe tricuspid incompetence. Altogether, 306 papers were found using the reported search, of which 14 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. We found seven studies supporting the use of ring annuloplasty over De Vega's suture annuloplasty. Five studies found no significant difference in outcome between the two techniques. We found only two studies supporting the use of De Vega's suture annuloplasty over ring annuloplasty. Therefore, most of the tabulated studies show good evidence in support of ring annuloplasty compared with De Vega's suture repair for treatment of moderate to severe TV regurgitation. One cohort study identified a 20.4% postoperative failure rate for tricuspid regurgitation (TR) repair and concluded non-application of ring as a predictor for reoperation. One cohort study with a mean follow-up of 17 months reported success rates as high as 97% with ring annuloplasty for TV regurgitation. One large cohort study of 2277 patients with TR who had undergone repair reported a sustained reduction in TR and the rate of recurrence in a 5-year echocardiographic follow-up. One cohort study of 129 patients concluded that ring annuloplasty has the lowest rate of recurrence compared with De Vega's suture repair. An old randomized controlled trial (RCT) on the subject also reported a similar result to the mentioned studies. In contrast, we reviewed one recent study and four older studies and found no significant difference between the two techniques. We reviewed one study that reported De Vega's suture repair as a superior technique to ring annuloplasty. We conclude that there is good evidence supporting ring annuloplasty over conventional De Vega's suture annuloplasty. © The Author 2012. <72> [Use Link to view the full text] Accession Number 2045462719 Title Staged Versus Immediate Complete Revascularization in Patients With STEMI and Multivessel Disease: An Updated Meta-analysis of Randomized Controlled Trials With Trial Sequential Analysis. Source Critical Pathways in Cardiology. 25(2) (pp 1-10), 2026. Article Number: e0422. Date of Publication: 01 Jun 2026. Author Majeed M.W.; Humayun Z.; Joshi D.K.; Murtafa K.M.; Consoli L.; Arif M.S.; Khanday S.S.; Srinivasan R.V.; Ruelas M.G.; Waleed M.; Ratan P.; Wani S.A.; Ali B.A.; Zehra S.; Baqal O.; Mantoo M.R.; Changal K.H.; Vallabhajosyula S. Institution (Majeed) From the Department of Medicine, VMMC and Safdarjung Hospital, New Delhi, India (Humayun) Department of Medicine, University of Missouri, Kansas City, MO, United States (Joshi) Department of Medicine, Narendra Modi Medical College and Sheth L.G. Hospital, Ahmedabad, India (Murtafa, Arif, Khanday) Department of Medicine, Government Medical College, Srinagar, India (Consoli) Department of Medicine, Federal University of Bahia, Salvador, Brazil (Srinivasan) Department of Medicine, First Faculty of Medicine, Charles University, Prague, Czechia (Ruelas) Department of Medicine, Instituto de Investigacion Nutricional (IIN), Lima, Peru (Waleed) Department of Medicine, King Edward Medical University, Lahore, Pakistan (Ratan) Department of Medicine, Patna Medical College and Hospital, Patna, India (Wani) Department of Medicine, Wayne State University, Detroit, MI, United States (Ali) Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan (Zehra) Department of Medicine, Jawaharlal Nehru Medical College, Aligarh, India (Baqal) Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States (Mantoo) Department of Cardiology, AIIMS New Delhi, New Delhi, India (Changal) Department of Medicine, MercyOne Siouxland Medical Center, Sioux City, IA, United States (Vallabhajosyula) Department of Medicine, Warren Alpert Medical School of Brown University and Brown University Health Cardiovascular Institute, Providence, RI, United States Publisher Lippincott Williams and Wilkins Abstract Complete revascularization improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD); however, the optimal timing of noninfarct-related artery intervention during the index procedure, immediate revascularization (IR) versus a staged approach (SR), remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing SR and IR in patients with STEMI and MVD. The primary outcome was major adverse cardiovascular events. Secondary outcomes included all-cause and cardiovascular mortality, recurrent myocardial infarction, unplanned ischemia-driven revascularization, stent thrombosis, stroke, major bleeding, acute kidney injury, and heart failure hospitalization. Random-effects models with Hartung-Knapp adjustment were used. Trial sequential analysis assessed evidence conclusiveness, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation. Eight randomized trials, including 5077 patients (2556 SR; 2521 IR), were analyzed. No significant differences were observed between SR and IR for major adverse cardiovascular events [odds ratios (ORs), 1.07; 95% confidence intervals (CI), 0.76-1.49], recurrent myocardial infarction (OR, 1.30; 95% CI, 0.80-2.14), cardiovascular mortality (OR, 0.76; 95% CI, 0.51-1.13), or all-cause mortality (OR, 0.75; 95% CI, 0.54-1.06). Rates of stent thrombosis, stroke, unplanned ischemia-driven revascularization, major bleeding, acute kidney injury, and heart failure hospitalization were also comparable. Trial sequential analysis indicated insufficient information size to draw definitive conclusions, and the certainty of evidence ranged from very low to low. In patients with STEMI and MVD, staged and immediate complete revascularization provide comparable ischemic, safety, and mortality outcomes. Current evidence supports clinical equipoise, and revascularization timing should be individualized pending results from adequately powered trials. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. <73> Accession Number 2047985505 Title Management Algorithm for Vasoplegic Shock After Cardiac Surgery: An Interdisciplinary Collaboration. Source Annals of Thoracic Surgery. 122(4) (pp 909-920), 2026. Date of Publication: 01 Oct 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. <74> Accession Number 2048361777 Title Efficacy and safety of drinking ice-carbonated water and ice-purified water immediately after extubation in paediatric patients with congenital heart disease: A randomised, controlled three-arm trial. Source Australian Critical Care. 39(5) (no pagination), 2026. Article Number: 101663. Date of Publication: 01 Oct 2026. Author Zhang X.; Chen Y.; Peng Y.; Li S.; Chen L.; Lin Y. Institution (Zhang, Chen) School of Nursing, Fujian Medical University, Fujian, Fuzhou, China (Zhang) Department of Nursing, The Second Affiliated Hospital of Xiamen Medical College, China (Peng, Lin) Department of Nursing, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Li, Chen, Lin) Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fujian, Fuzhou, China (Chen) Fujian Provincial Special Reserve Talents Laboratory, Fujian, Fuzhou, China Publisher Elsevier Ireland Ltd Abstract Background: Children who undergo congenital heart disease (CHD) surgery face increased postoperative thirst, which can cause discomfort and lead to serious consequences. There is a lack of effective thirst management strategies for this vulnerable group. Objective(s): The aim of this study was to evaluate the efficacy and safety of ice-carbonated water and ice-purified water in alleviating thirst in children following CHD surgery. Result(s): A generalised estimating equation analysis demonstrated group-by-time interactions for both primary outcomes. At T5, the between-group difference in thirst NRS was -4.71 points (95% confidence interval [CI]: -5.12 to -4.30) for H<inf>2</inf>O-ice-carb group vs. control group and -3.86 points (95% CI: -4.36 to -3.35) for H<inf>2</inf>O-ice group vs. control group (both P < 0.001). The H<inf>2</inf>O-ice-carb group demonstrated greater improvement than the H<inf>2</inf>O-ice group (difference = -0.85; 95% CI: -1.26 to -0.44; P < 0.001), with the difference apparent from T1 (P = 0.009). For oral moisture, the H<inf>2</inf>O-ice-carb group showed the strongest effect (2.51% per hour), followed by the H<inf>2</inf>O-ice group (1.66% per hour; both P < 0.001). No differences in adverse events were found among the three groups (P = 0.364). Conclusion(s): Immediate consumption of ice-carbonated and ice-purified water following extubation effectively and safely alleviates postoperative thirst in children after CHD surgery, with ice-carbonated water showing better results. These findings may inform the development of postoperative fasting and fluid management protocols for paediatric patients. Copyright © 2026 The Author(s) <75> Accession Number 2049557268 Title Comparison of analgesic efficacy of dexamethasone and dexmedetomidine as an adjuvant to local anaesthetic in transversus thoracic muscle plane block in adult patients undergoing median sternotomy: A randomised controlled trial. Source Heart and Lung. 80 (no pagination), 2026. Article Number: 102955. Date of Publication: 01 Nov 2026. Author Kumari P.; Jha L.; Sinha C.; Kumar A.; Kumar S.; Kapoor P. Institution (Kumari, Kumar, Sinha, Kumar) Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India (Jha) Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India (Kumar, Kapoor) Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Patna, India Publisher Elsevier Inc. Abstract Background: Post-sternotomy pain contributes significantly to delayed recovery following cardiac surgery. The transversus thoracic muscle plane block (TTPB) is a recently described regional anaesthetic technique that provides analgesia to the anterior chest wall. The addition of adjuvants such as dexamethasone and dexmedetomidine may enhance the analgesic efficacy of TTPB. Objective(s): This study compared the analgesic efficacy of dexamethasone and dexmedetomidine as adjuvants to bupivacaine for TTPB in patients undergoing median sternotomy. Method(s): 66 adult patients (ASA I-III) scheduled for cardiac surgery via median sternotomy were recruited for this randomised trial. Following induction of anaesthesia, all patients received bilateral TTPB and were allocated to three groups: dexamethasone (0.25 % bupivacaine + 8 mg dexamethasone), dexmedetomidine (0.25 % bupivacaine + 1 microg/kg dexmedetomidine), and a control group (0.25 % bupivacaine alone). The primary outcome was the time to first rescue analgesia following extubation. Secondary outcomes included 24-hour postoperative fentanyl consumption, intraoperative fentanyl requirement, pain scores, extubation time, patient satisfaction, and adverse events. Result(s): Time to first rescue analgesia was significantly longer in the dexmedetomidine group than in the dexamethasone and control groups (P 0.001). Twenty-four-hour postoperative fentanyl consumption was significantly lower in both adjuvant groups than in the control group (P < 0.001). Pain scores were consistently lower with dexmedetomidine and dexamethasone groups. Extubation time and intraoperative fentanyl consumption were comparable among the three groups (P > 0.05). Conclusion(s): Both dexamethasone and dexmedetomidine improved TTPB analgesia. Dexmedetomidine significantly prolonged the duration of analgesia, whereas 24-hour postoperative opioid consumption was comparable between the adjuvant groups. Copyright © 2026 Elsevier Inc. <76> Accession Number 2048953952 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. 303 (no pagination), 2027. Article Number: 107546. Date of Publication: 01 Jan 2027. Author Mafham M.M.; Zayed M.G.; Collins R.; Sabatine M.S.; Armitage J.; Brittain D.; da Costa B.R.; Chen F.; Goonasekera M.A.; Hill M.; Hopewell J.C.; Landray M.J.; Lay M.D.; Lesogor A.; Maggioni A.P.; Morrow D.A.; Nunn M.; O'Donoghue M.L.; Ray K.K.; Rizkala A.; Schwartz G.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) Division of Cardiovascular Medicine, Brigham and Women's Hospital, Thrombolysis in Myocardial Infarction (TIMI) Study Group, Boston, MA, United States (Brittain, Lesogor) Novartis Pharma AG, Basel, Switzerland (Maggioni) ANMCO Research Center, HCF Fondazione ANMCO per il Tuo cuore ETS, Florence, Italy (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, Department of Cardiology, Mayo Clinic, Rochester, MN, United States (Landray) Protas, Manchester, United Kingdom Publisher Elsevier Inc. 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 to 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. Methods 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 nonfatal ischemic stroke, or urgent coronary revascularization. Participants will be followed until the median time since randomization is at least 5 years and at least 1,700 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 1 quarter, while also providing an opportunity to assess efficacy in different subgroups as well as on secondary outcomes of interest. Results 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) years and 30% were female. At baseline, 78% had a history of coronary heart disease, 22% of ischemic 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. Trial Registration The trial is registered at ClinicalTrials.gov (NCT03705234) and the EU Clinical Trials Register (EudraCT Number: 2017-005066-22). Copyright © 2026 The Author(s). <77> Accession Number 652258969 Title Stellate Ganglion Block Reduces the Incidence of Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting. Source JACC. Clinical electrophysiology. (no pagination), 2026. Date of Publication: 21 Sep 2026. Author Tian S.; Chen C.; Liang W.; Yin J.; Zhou W.; Wang M.; Feng S.; Pu X.; Xing Z.; Zhang J.; Zhang Z. Institution (Tian, Yin, Zhou, Wang, Feng, Pu, Xing, Zhang, Zhang) Department of Anesthesiology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China (Chen) Department of Anesthesiology, Gaoyou People's Hospital, Third Clinical Medical College of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, China (Liang) School of Public Health, Yangzhou University, Yangzhou, Jiangsu, China Abstract BACKGROUND: Postoperative atrial fibrillation (POAF) is associated with sympathetic overactivity. Stellate ganglion is a potential target for intervention. OBJECTIVE(S): The aim of this study was to examine the efficacy of preemptive left stellate ganglion block (SGB) in reducing POAF in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. METHOD(S): Patients were randomized to the SGB group or the control group. The primary endpoint was the incidence of POAF within 5 days postoperatively. Secondary endpoints included POAF-associated characteristics and recovery indicators. RESULT(S): A total of 124 patients underwent initial randomization, with 108 in modified intention-to-treat and 98 in per-protocol analysis. In modified intention-to-treat analysis, POAF occurred in 18.5% of the SGB group and 44.4% of the control group (OR: 0.288; 95% CI: 0.106-0.731; P = 0.007). Per-protocol analysis yielded consistent results. SGB group showed significantly lower POAF burden, shorter duration of first POAF episode, fewer POAF episodes and antiarrhythmic treatments, decreased C-reactive protein, interleukin-6, high-sensitivity cardiac troponin T, and creatine kinase-MB on certain postoperative time points, and decreased postoperative hospitalization than the control group (all P < 0.05). Exploratory subgroup analyses suggested that the association between SGB pretreatment and lower POAF incidence was more pronounced among patients without diabetes (OR: 0.10; 95% CI: 0.019-0.480; P = 0.004) and those at lower baseline risk of POAF (OR: 0.10; 95% CI: 0.005-0.642; P = 0.040). CONCLUSION(S): In patients undergoing coronary artery bypass grafting with cardiopulmonary bypass, preemptive left SGB was associated with a reduced incidence of POAF within 5 postoperative days. Exploratory subgroup analyses suggested a potentially greater association among patients without diabetes and those at lower risk of POAF. Copyright © 2026. Published by Elsevier Inc. <78> Accession Number 652260687 Title Clinical Outcomes of Left Atrial Appendage Occlusion During Cardiac Surgery in Patients Without Atrial Fibrillation: A Systematic Review and Meta-Analysis. Source Journal of the American Heart Association. (pp e049033), 2026. Date of Publication: 24 Sep 2026. Author Song Q.; Tu X.; Zheng Z.; Song L.; Fan C. Institution (Song, Tu, Zheng, Song, Fan) Department of Cardiovascular Surgery The Second Xiangya Hospital, Central South University Changsha Hunan China Abstract BACKGROUND: The left atrial appendage is the primary source of cardiac thrombi, and prophylactic exclusion during cardiac surgery may reduce thromboembolic risk. However, its benefit in patients without preoperative atrial fibrillation (AF) remains uncertain. METHOD(S): We searched PubMed, Web of Science, EMBASE, and the Cochrane Library for randomized controlled trials and observational studies comparing surgical left atrial appendage occlusion (LAAO) versus no LAAO in patients with sinus rhythm undergoing cardiac surgery. Primary outcomes were new-onset transient ischemic attack (TIA)/stroke, postoperative AF, and all-cause death. Dichotomous outcomes were pooled as odds ratios and continuous outcomes as mean differences, with 95% CIs. RESULT(S): Eleven studies involving 12 145 participants were included. Compared with no LAAO, surgical LAAO reduced new-onset TIA/stroke (odds ratio, 0.75 [95% CI, 0.62-0.90]) and bleeding (odds ratio, 0.78 [95% CI, 0.60-1.00]) but increased postoperative AF (odds ratio, 1.27 [95% CI, 1.06-1.53]). No significant differences were detected between the 2 groups in all-cause death, 30-day death, and length of stay. Subgroup analyses showed some variation in effect estimates across study design, type of surgery, and LAAO technique. CONCLUSION(S): In patients with sinus rhythm undergoing cardiac surgery, surgical LAAO was associated with a lower risk of new-onset TIA/stroke and bleeding but a higher incidence of postoperative AF, with no significant differences in all-cause death, 30-day death, or length of hospital stay. Study design, type of cardiac surgery, and LAAO technique may influence these associations. These findings should be interpreted cautiously given low to moderate certainty of evidence. <79> Accession Number 652258066 Title Star-Crossed Valve: Late STARFlex Fracture Causing Severe Tricuspid Regurgitation and Symptomatic Right Heart Failure. Source Pediatric Cardiology. Conference: PICS Society Symposium 2026. San Diego United States. 47(Supplement 1) (pp S46-S47), 2026. Date of Publication: 01 Aug 2026. Author Wu M.; Ang S.P.; Beauti W.; Rathore S.; Acharya D.; Seckeler M. Institution (Wu, Ang, Beauti, Rathore, Acharya, Seckeler) University of Arizona, Tucson, United States Publisher Springer Abstract Background: The STARFlex septal occluder (NMT Medical, Inc., Boston, MA) was used for transcatheter closure of secundum atrial septal defects (ASDs) and patent foramen ovales (PFOs) during the late 1990s and early 2000s. The device was subsequently withdrawn from clinical use following the failure of the CLOSURE I randomized controlled trial to demonstrate superiority in stroke prevention compared to best medical therapy. While the CardioSEAL/STARFlex platform carried risk for stress-mediated device arm fractures due to its metallic framework and Dacron fiber, these were largely considered clinically inconsequential. We present a case of delayed, symptomatic STARFlex wire fracture with mechanical impingement of the tricuspid valve septal leaflet, producing severe tricuspid regurgitation and right heart failure. Case Presentation: A 38-year-old woman with a history of ASD transcatheter closure at three years of age with a STARFlex device presented with a several month history of abdominal pain and fatigue. She was found to have hepatic steatosis, intrahepatic biliary ductal dilatation, and persistent transaminitis. Transthoracic echocardiography demonstrated no residual atrial shunt, severe tricuspid regurgitation, moderate right ventricular dilation, and a normal predicted right ventricular systolic pressure. An echodense structure was noted near the tricuspid valve (Figure 1). Cardiac CT identified an atrial septal closure device with a linear hypoattenuating projection extending from the device to the region of the tricuspid valve, as well as hyperattenuating foci within the left atrium (Figure 2). Transesophageal echocardiography confirmed the presence of a STARFlex device with wire fracture; the fractured wire crossed the tricuspid annulus and impinged the tricuspid septal leaflet, resulting in severe tricuspid regurgitation (Figure 3). An additional fracture was visualized on the left atrial side adjacent to the base of the mitral leaflet without associated valvular dysfunction. The patient was medically optimized with diuretics and planned surgical explantation of the device and tricuspid valve repair. Discussion(s): The STARFlex device was among the earliest transcatheter ASD closure systems to receive regulatory approval in the United States. Despite acute procedural success rates exceeding 85%, the device's metallic framework and Dacron fabric were recognized as susceptible to stress-mediated mechanical failure (up to 35% with no clinical sequelae in one report). There has been a reported a case of late-onset device fracture five years after implantation, but still with no clinical consequence. Our case is due to delayed frame fracture, and the progressive worsening of her symptoms and hepatic injury suggest long-term tricuspid regurgitation. This appears to be the latest reported occurrence of a symptomatic STARFlex complication and highlights the importance of lifelong surveillance of patients with ASD closure devices and having a low threshold for further evaluation of symptoms.(Figure presented) <80> Accession Number 2049280250 Title Endocardial Left Atrial Appendage Occlusion in Atrial Fibrillation: Device Design, Clinical Evidence, and Postprocedural Antithrombotic Management. Source Medicina (Lithuania). 62(9) (no pagination), 2026. Article Number: 1644. Date of Publication: 01 Sep 2026. Author Matvienko G.; Rimkiene M.A.; Bajoras V.; Drasutiene A.; Masiuliene R.; Gabartaite D.; Salaseviciene M.; Mataciunas M.; Sudaviciene D.; Marinskis G.; Aidietis A.; Rackauskas G. Institution (Matvienko, Rimkiene, Bajoras, Drasutiene, Salaseviciene, Sudaviciene, Marinskis, Aidietis, Rackauskas) Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania (Masiuliene, Gabartaite) Center of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (Mataciunas) Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background and Objectives: Atrial fibrillation is a major cause of ischemic stroke, and in patients with non-valvular atrial fibrillation the left atrial appendage is the predominant site of thrombus formation. Although oral anticoagulation remains the standard strategy for stroke prevention, long-term therapy may be limited by bleeding risk, prior major bleeding, contraindications, intolerance, or difficulty maintaining stable anticoagulation. Endocardial left atrial appendage occlusion (LAAO) has therefore emerged as an alternative strategy in selected patients. Its role continues to evolve with expanding device technologies, contemporary direct oral anticoagulant therapy, and ongoing randomized evidence. Material(s) and Method(s): This narrative literature review summarizes current evidence on endocardial LAAO, focusing on device design, anatomical considerations, clinical outcomes, postprocedural antithrombotic therapy, and ongoing research directions. Result(s): Available devices differ substantially in sealing mechanism, fixation strategy, conformability, surface properties, and suitability for complex appendage anatomy. The Watchman and Amulet platforms remain the most extensively studied systems, whereas several CE-marked and investigational devices aim to improve anatomical adaptability, reduce peri-device leak and device-related thrombus, and simplify implantation. Randomized evidence supports LAAO as a non-inferior alternative to oral anticoagulation in selected populations, with potential reduction in late bleeding but persistent concerns regarding procedural risk, frailty, comorbidity burden, and patient selection. The optimal postprocedural antithrombotic regimen remains uncertain, with increasing interest in individualized strategies and short-term direct oral anticoagulant therapy when feasible. Current research is shifting toward next-generation devices, combined ablation-closure strategies, simplified imaging guidance, and evaluation of LAAO as both an alternative and an adjunct to oral anticoagulation. Conclusion(s): LAAO should currently be considered a selective rather than a universal strategy, requiring individualized assessment of thromboembolic risk, bleeding risk, anatomy, procedural safety, and comorbidity burden. Copyright © 2026 by the authors. <81> Accession Number 652261072 Title Racial Differences in the Incidence and Outcomes of Postoperative Atrial Fibrillation After Isolated Coronary Artery Bypass Grafting: A Systematic Review. Source Journal of cardiothoracic and vascular anesthesia. (no pagination), 2026. Date of Publication: 18 Aug 2026. Author Fields A.; Vo J.; Elsherbini A.; Hasheminia A.; Barzegar N.S.; Rodriguez M.; Abu-Omar Y.; El-Diasty M. Institution (Fields, Vo) College of Arts & Sciences, Case Western Reserve University, Cleveland, OH, United States (Elsherbini) Temerty Faculty of Medicine, University of Toronto, Toronto, Canada (Hasheminia) McGill Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada (Barzegar) Faculty of Health Sciences, Queen's University, Kingston, Canada (Rodriguez) School of Applied Life Sciences, Keck Graduate Institute, Claremont, CA, United States (Abu-Omar) Cardiac Surgery Department, University Hospitals Cleveland Medical Center, Cleveland, OH, United States (El-Diasty) Cardiac Surgery Department, University Hospitals Cleveland Medical Center, Cleveland, OH, United States Abstract Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG), with an estimated incidence of up to 20% to 40%. Existing evidence suggests that inequities in access to health care may impact clinical outcomes following POAF. This systematic review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines across the Cochrane, MEDLINE, and Embase databases to retrieve potential studies. Studies reporting racial and/or socioeconomic differences in the incidence or outcomes of new-onset POAF after isolated CABG were included. Title and abstract screening and full-text review were performed using Covidence software for systematic reviews. The risk of bias was assessed using the JBI Critical Appraisal Tool. The search strategy retrieved 1,155 studies. After duplicate removal, 1,149 studies underwent the screening process. Eventually, 6 studies were included for data extraction. The results showed a higher reported incidence of POAF among White patients than among African American and other racial and ethnic groups. However, African American patients appear to have worse survival after developing POAF. Income, education, insurance status, and other socioeconomic or access-to-care variables were not consistently reported or adjusted for in the included studies. Racial differences can impact the incidence and clinical outcomes in patients who develop POAF after CABG. Future work could investigate the role of other socioeconomic factors. Copyright © 2026 Elsevier Inc. All rights reserved. <82> Accession Number 2049900216 Title Decompressive craniectomy in patients with aortic dissection and ischemic stroke. Source Brain and Spine. Conference: Abstracts of the EANS2026. Hamburg Germany. 6(Supplement 2) (no pagination), 2026. Article Number: 107128. Date of Publication: 01 Jan 2026. Author Hautmann X.; Mielke D.; Lilla N. Institution (Hautmann, Mielke, Lilla) University Hospital Augsburg, Germany Publisher Elsevier B.V. Abstract Ischemic stroke may result from local vascular occlusions, thromboembolic events, or vascular dissections. Stroke associated with aortic dissection (AD) represents a particularly challenging clinical entity. Randomized controlled trials (HAMLET, DESTINY, and DECIMAL) have demonstrated a beneficial effect of early decompressive hemicraniectomy (DHC) on functional outcome in patients with malignant cerebral infarction. Although patients with carotid artery dissections were included, individuals with severe acute systemic comorbidities beyond stroke, were excluded from these trials. Consequently, the existing literature on DHC in patients with AD is limited to few case reports. The aim of the present study is to evaluate the potential benefit of DHC in this particularly vulnerable patient population. Method(s): We conducted a retrospective analysis of all patients admitted to our center with a diagnosis of AD Stanford Type A. Using ICD codes, AD cases complicated by ischemic events were identified and screened for neurosurgical interventions. Neurological deficits, CCT findings, cardiac surgical parameters, and functional outcome (mRS) were analyzed. Result(s): From January 2015 to January 2026, a total of 69 patients were identified who had been diagnosed with cerebral ischemia in addition to AD. Of these, 6 patients underwent neurosurgical treatment. In 2 cases, DHC was performed, and in 4 cases, an ICP probe or ventricular drainage was implanted. One patient who underwent implantation of a ICP probe was transferred to rehabilitation with an mRS of 5. All other patients died in hospital (mRS 6) due to circulatory failure. Conclusion(s): Both AD and malignant cerebral infarction are associated with high mortality, especially when both occur simultaneously. In our cohort, mortality was 83%, and 100% in patients who received DHC. Whether selected patients can still benefit from DHC will now be examined in a multicenter study. Copyright © 2026, Elsevier B.V. <83> Accession Number 2049340381 Title Comparing Transcatheter Mitral Valve Replacement to Transcatheter Edge-to-Edge Repair in Mitral Regurgitation: A Systematic Review. Source Cardiovascular Therapeutics. 2026(1) (no pagination), 2026. Article Number: 7522199. Date of Publication: 2026. Author Safadi R.A.; Esmail A.D.A.; DeProfio L.E.; Elsayed A.A.R.; Basson M.D. Institution (Safadi, Esmail, DeProfio, Elsayed, Basson) College of Medicine, Northeast Ohio Medical University, Rootstown, OH, United States (Elsayed, Basson) Department of Surgery, Northeast Ohio Medical University, Rootstown, OH, United States (Elsayed, Basson) Department of Biomedical Sciences, Northeast Ohio Medical University, Rootstown, OH, United States Publisher John Wiley and Sons Inc Abstract Background: Mitral regurgitation affects 2% of the population globally, with a widely increasing prevalence. Although mitral regurgitation is most commonly corrected by open surgery, there has been a recent shift toward less invasive transcatheter approaches, including both transcatheter edge-to-edge repair (TEER) and transcatheter mitral valve replacement (TMVR). Method(s): A comprehensive literature search was conducted using four databases: PubMed, Cochrane Library, Virtual Health Library (VHL), and Web of Science (WOS), following the PRISMA guidelines. Relevant observational studies were assessed for reporting using STROBE guidelines, whereas case reports were assessed using CARE guidelines. Independent reviewers evaluated studies based on eligibility criteria and analyzed relevant studies. Result(s): Postoperative complications observed in patients undergoing either technique (TMVR or TEER) included acute kidney injury, stroke, access site complications, and postoperative bleeding. These complications were generally more frequent in patients after TMVR. Myocardial infarction, prosthesis malposition, and valve migration were reported exclusively after TMVR, whereas ischemic cardiomyopathy was associated with TEER. Regarding hemodynamic outcomes, TMVR patients were associated with greater MR reduction to <= 1, frequently observed complete MR resolution, near-laminar blood flow, and marked improvement in left ventricular function (assessed using LVEDVI and LVESVI). TMVR was associated with significantly higher 30-day mortality, whereas pooled 1-year mortality did not differ significantly between TMVR and TEER. Conclusion(s): Although TEER remains the safer option in appropriately selected patients, TMVR offers greater efficacy in MR resolution at the cost of higher procedural risk. However, findings should be interpreted with caution, given that patient selection between TMVR and TEER patients may influence observed outcomes. Copyright © 2026 Rama A. Safadi et al. Cardiovascular Therapeutics published by John Wiley & Sons Ltd. <84> Accession Number 2049234104 Title Drug-Coated Balloon Angioplasty: A Novel Approach for the Revascularization of High-Bleeding Risk Patients. Source Journal of the Society for Cardiovascular Angiography and Interventions. (no pagination), 2026. Article Number: 105631. Date of Publication: 2026. Author Kumar S.; Rissanen T. Institution (Kumar) Department of Cardiology, Creighton University School of Medicine, Phoenix, AZ, United States (Rissanen) Heart Center, North Karelia Central Hospital, Siunsote, Finland (Rissanen) Division of Cardiovascular Medicine, University of Eastern Finland, Kuopio, Finland Publisher Elsevier B.V. Abstract Bleeding is one of the most clinically significant complications after percutaneous coronary intervention (PCI) and markedly increases the risk of death. Almost half of contemporary patients undergoing PCI for chronic coronary syndrome or acute coronary syndrome have been reported to be at high bleeding risk (HBR) according to the Academic Research Consortium-High Bleeding Risk definition. Although modern drug-eluting stent PCI may allow for 1 month of dual antiplatelet therapy (DAPT) in patients at HBR, bleeding after drug-eluting stent implantation continues to be a significant clinical issue causing morbidity and mortality. In patients with chronic coronary syndrome, the current evidence supports 1-month DAPT after drug-coated balloon (DCB)-only PCI. Because DCB angioplasty leaves no permanent scaffold, it may provide greater flexibility for earlier DAPT de-escalation, single antiplatelet therapy, or antiplatelet treatment interruption in selected patients at HBR or after a bleeding event. Although registry trials suggest the potential of this approach, randomized clinical trials are essential to inform changes to current guidelines for the management of patients at HBR requiring coronary revascularization. This review outlines the clinical issue of bleeding following PCI, its prognostic implications, and the reasoning for using DCBs in this group of patients. It also discusses evidence supporting shorter antiplatelet therapy and highlights ongoing trials that are redefining the role of stentless PCI in managing patients at HBR in the catheterization lab. Copyright © 2026 The Author(s). <85> Accession Number 652263930 Title Application of an AI-enabled personalized medical education model for improving clinical thinking among cardiovascular surgery trainees. Source BMC medical education. 26(1) (no pagination), 2026. Date of Publication: 25 Jul 2026. Author Yang Y.; Sheng L.; Huang L.; Guo Q.; Hu Y.; Shi J. Institution (Yang, Sheng, Huang, Guo, Hu) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China (Shi) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei, China Abstract OBJECTIVE: Cardiovascular surgery involves complex clinical scenarios and high demands on clinical judgment. This study aimed to evaluate the effectiveness of an artificial intelligence (AI)-enabled personalized teaching model in cardiovascular surgery training. METHOD(S): From February to June 2025, 158 trainees in the department of cardiovascular surgery at our hospital were randomly assigned to an experimental group (n = 79) or a control group (n = 79). The control group received conventional teaching, including lectures, bedside teaching, and case discussions. The experimental group received a personalized teaching model integrating an intelligent question bank, staged case-based teaching, and AI-based standardized patient training. Outcomes included theoretical examination scores, the Chinese version of the California Critical Thinking Disposition Inventory (CTDI-CV), clinical interview performance, and teaching satisfaction. RESULT(S): The experimental group achieved significantly higher theoretical examination scores than the control group (84.56 +/- 5.07 vs. 77.95 +/- 9.04, P < 0.001). CTDI-CV results showed significantly higher total scores and higher scores in truth-seeking, open-mindedness, analyticity, systematicity, and inquisitiveness in the experimental group (all P < 0.05). In the clinical interview assessment, the experimental group scored significantly higher in completeness of information collection, communication skills, diagnostic reasoning, and overall performance (all P < 0.001), while the between-group difference in empathy was not significant (P = 0.328). Teaching satisfaction in the experimental group was high, with an overall satisfaction score of 4.68 +/- 0.39. CONCLUSION(S): The AI-enabled personalized teaching model may represent a feasible and effective approach for cardiovascular surgery education. It was associated with higher theoretical examination scores, better critical thinking disposition, higher scores in several dimensions of simulated clinical interview performance, and high learner satisfaction. Further studies are needed to confirm its broader applicability and long-term educational value. Copyright © 2026. The Author(s). <86> Accession Number 2049937206 Title Covered Stents for Transfemoral Transcatheter Aortic Valve Replacement-Associated Vascular Access Complications: A Systematic Review and Meta-Analysis. Source CJC Open. (no pagination), 2026. Date of Publication: 2026. Author Mahmoud M.; Jessula S.; Liu H.; Tremblay P.; Elkhateeb O.; Cote C. Institution (Mahmoud) Centre de Formation Medicale du Nouveau-Brunswick, Universite de Sherbrooke, Moncton, NB, Canada (Jessula) Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada (Liu) Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada (Tremblay, Cote) Division of Cardiac Surgery, Dalhousie University, Halifax, NS, Canada (Elkhateeb) Division of Cardiology, Department of Cardiology, Dalhousie University, Halifax, NS, Canada Publisher Elsevier Inc. Abstract Background: Iliofemoral vascular access complications (VACs) after transfemoral transcatheter aortic valve replacements (TAVRs) are common, with reported rates of 10%-20%. Historically, TAVR was intended for high-risk patients, making percutaneous management of VACs with covered stents appealing, although their long-term safety and efficacy remain unclear. This study aims to evaluate the safety and efficacy of covered stents for managing VACs after transfemoral TAVR. Method(s): We conducted a systematic review and meta-analysis of observational studies. Fourteen studies met eligibility criteria. Primary outcomes were technical success and primary patency. Secondary outcomes included stent-related complications, procedure-related complications, and survival. Result(s): Short-term outcomes were favourable, with a pooled technical success rate of 96.92% and a pooled primary patency rate at 30 days of 99.78%. Pooled short-term survival was 97.18%. Pooled stent-related complications at 30 days were 1.00%, and procedure-related complications were 1.32%. Follow-up outcomes reported after 30 days were heterogeneous. Pooled 1-year survival across 5 studies was 79.32%. Median cumulative incidence of post-30-day stent-related complications was 1.72% (interquartile range, 0%-4.00%) across 11 studies. Pooled primary patency was 97.20% at 1 year across 4 studies. Conclusion(s): Based on short-term outcomes, covered stents appear to be a safe and effective intervention for TAVR vascular access complications in the intermediate- to high-risk population, as demonstrated by high patency rates, technical success, and short- and post-30-day complication rates. The absence of comparative data, heterogeneous outcome reporting, and limited post-30-day follow-up imaging surveillance limit conclusions regarding long-term outcomes. Copyright © 2026 The Authors <87> Accession Number 2038654663 Title A COMPARATIVE STUDY BETWEEN THE EFFECTS OF CISATRACURIUM AND ATRACURIUM FOR ABDOMINAL SURGERIES IN TERTIARY CARE HOSPITAL. Source International Journal of Medicine and Public Health. 16(3) (pp 5051-5058), 2026. Date of Publication: 01 Jul 2026. Author G G.V.; Kamala L.; Naik R.P. Institution (G, Naik) Department of Anesthesia, Osmania Medical College, Koti, Telangana, Hyderabad, India (Kamala) Department of Chemistry, GDC Shadnagar, Telangana, Shadnagar, India Publisher Pink Petals Publications Pvt Ltd Abstract Background: Neuromuscular blocking agents are an essential component of general anaesthesia for abdominal surgery, providing optimal conditions for tracheal intubation and surgical exposure. Atracurium and cisatracurium are intermediate-acting, non-depolarizing neuromuscular blocking agents with organ-independent elimination. However, differences in onset of action, surgical-site relaxation, haemodynamic effects, and histamine-related adverse effects may influence their clinical utility. Aim(s): To compare the clinical effects of cisatracurium 0.1 mg/kg and atracurium 0.5 mg/kg, corresponding to approximately 2 x ED95, in patients undergoing elective abdominal surgery under general anaesthesia, with particular emphasis on intubating conditions, surgical-site muscle relaxation, haemodynamic changes, and clinically apparent adverse effects. Material(s) and Method(s): This randomized comparative study included 60 adult patients aged 16-60 years, classified as American Society of Anesthesiologists (ASA) physical status I or II, undergoing elective abdominal surgery under general anaesthesia. Patients were randomly allocated into two groups of 30 each. Group I received atracurium 0.5 mg/kg intravenously, while Group II received cisatracurium 0.1 mg/kg intravenously. Standardized anaesthetic management and perioperative monitoring were used. Ease of tracheal intubation, quality of surgical-site relaxation, heart rate, systolic, diastolic and mean arterial blood pressure, end-tidal carbon dioxide, and clinically apparent features suggestive of histamine release were assessed. Result(s): Good intubating conditions were observed in 80.0% of patients receiving atracurium and 70.0% receiving cisatracurium. Excellent surgical-site relaxation was observed significantly more frequently with cisatracurium (73.3%) than with atracurium (20.0%) (chi2=17.14, p=0.000104). Heart rate increased in both groups, with the maximum increase occurring at intubation, followed by a gradual decline toward baseline. Similar peri-intubation changes were observed in blood pressure. Baseline heart rate and systolic blood pressure differed significantly between the groups, whereas baseline diastolic blood pressure and end-tidal carbon dioxide were comparable. No clinically apparent flushing, bronchospasm, or hypotension attributable to histamine release was observed in either group. Conclusion(s): Haemodynamic changes were observed predominantly around tracheal intubation and subsequently tended toward baseline values. No clinically apparent histamine-related adverse reactions were observed with either agent. The findings should be interpreted considering the small sample size and baseline differences in heart rate and systolic blood pressure between the groups. Copyright © 2026, Pink Petals Publications Pvt Ltd. All rights reserved. <88> Accession Number 652240335 Title Approach to Distal Left Main Coronary Artery Bifurcation Lesions. Source Anatolian journal of cardiology. (no pagination), 2026. Date of Publication: 22 Sep 2026. Author Esenboga K.; Ozerdem M.E. Institution (Esenboga) Department of Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey (Ozerdem) Department of Cardiology, Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, Turkey Abstract Distal left main coronary artery (LMCA) bifurcation lesions are associated with a worse prognosis than other coronary bifurcation lesions. Although coronary artery bypass grafting remains a safe and effective treatment option in this patient population, percutaneous coronary intervention (PCI) has been increasingly adopted in patients with low-to-intermediate anatomical complexity due to its less invasive nature and the favorable long-term outcomes demonstrated in major randomized clinical trials. Given the substantial impact of LMCA revascularization on patient prognosis, meticulous procedural planning and optimization are of paramount importance. The use of intravascular imaging has proven to be of significant value both in making revascularization decisions and in optimizing PCI outcomes. Since the side branch in distal LMCA bifurcation lesions is the left circumflex artery, which supplies a significant portion of the myocardium, accurately predicting and preventing damage to this side branch is of vital importance. Intravascular imaging plays a key role in predicting side branch compromise and in determining the most appropriate stenting strategy, including provisional stenting or an upfront 2-stent approach. Regardless of the stenting strategy employed, achieving optimal minimal stent area targets is essential for improving long-term clinical outcomes. Adverse events following distal LMCA PCI most frequently occur at the left circumflex ostium, highlighting the importance of maintaining long-term side branch patency. Drug-coated balloons, which have demonstrated favorable results in bifurcation interventions, may represent a promising adjunctive therapy for side branch treatment during provisional stenting. However, further large-scale randomized studies are required to establish their role in distal LMCA bifurcation. <89> Accession Number 2049255676 Title Effect of Bilateral Ultrasound-Guided Deep Parasternal Intercostal Plane Block Before Extubation on Early Recovery After Cardiac Surgery via Median Sternotomy: A Randomized Controlled Trial. Source Pain and Therapy. (no pagination), 2026. Date of Publication: 2026. Author Jin Z.; Sun J.; Zha Y.; Ji S.; Deng S.; Qiang Y.; Chen H. Institution (Jin, Zha, Ji, Qiang) Department of Anesthesiology, The First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China (Sun, Deng) Department of Anesthesiology, RuiAn TangXia People's Hospital, Zhejiang, China (Chen) Department of Pain Medicine, The First Affiliated Hospital, Wenzhou Medical University, Zhejiang, China Publisher Adis Abstract Introduction: Postoperative pain remains a major concern after cardiac surgery via median sternotomy and may impair early recovery. Deep parasternal intercostal plane (DPIP) block is a regional analgesic technique targeting the parasternal intercostal nerves, but the effect of DPIP block performed before extubation on postoperative recovery has not been well defined. We therefore evaluated whether bilateral ultrasound-guided DPIP block administered before extubation could improve early recovery after median sternotomy cardiac surgery. Method(s): In this single-center, prospective, randomized, single-blind, controlled trial, 64 adults undergoing elective cardiac surgery via median sternotomy were randomly assigned in a 1:1 ratio to receive either a bilateral ultrasound-guided DPIP block with 0.375% ropivacaine or a saline placebo nerve block (control group) before extubation. The primary outcome was the Quality of Recovery-15 (QoR-15) score at 24 h after extubation. Secondary outcomes included the QoR-15 score at 48 h after extubation, cumulative sufentanil consumption during the first 24 h after extubation, rescue analgesia requirement, time to first ambulation, and postoperative adverse events. Result(s): Of the 64 randomized patients, 61 were included in the final analysis (30 in the DPIP group and 31 in the control group). Total QoR-15 scores were higher in the DPIP group than in the control group at both 24 h (112.83 +/- 13.13 vs. 101.83 +/- 13.50; P = 0.002) and 48 h (127.93 +/- 9.65 vs. 121.53 +/- 8.83; P = 0.01) after extubation. Cumulative sufentanil consumption during the first 24 h after extubation was lower in the DPIP group (50.00 [21.26-57.60] mug vs. 60.10 [48.00-63.40] mug; P = 0.016), and postoperative nausea and vomiting occurred less frequently (13.3% vs. 38.7%; P = 0.024). No significant between-group differences were observed in rescue analgesia requirement or time to first ambulation. Conclusion(s): Bilateral ultrasound-guided DPIP block performed before extubation was associated with improved early recovery after median sternotomy cardiac surgery, reflected by higher QoR-15 score, lower postoperative sufentanil consumption, and less postoperative nausea and vomiting. These findings suggest that the timing of DPIP block administration may be important in optimizing recovery after cardiac surgery. Future multicenter studies or studies with extended follow-up may be conducted to validate the generalizability of these findings. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2400092616. Copyright © The Author(s) 2026. <90> Accession Number 2038662228 Title Prognostic value of the New York Heart Association classification for cardiovascular events and mortality in Chagas cardiomyopathy: a systematic review and meta-analysis with GRADE recommendations. Source Revista da Sociedade Brasileira de Medicina Tropical. 59 (no pagination), 2026. Article Number: e0104-2026. Date of Publication: 2026. Author Silva W.T.; Costa H.S.; Silva H.J.; Avila M.R.; Oliveira L.F.F.; Silva J.P.; Gomes S.M.B.; Hasslocher-Moreno A.M.; Figueiredo P.H.S.; Mediano M.F.F. Institution (Silva, Silva, Hasslocher-Moreno, Mediano) Fundacao Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, RJ, Rio de Janeiro, Brazil (Silva, Costa, Avila, Oliveira, Silva, Figueiredo) Universidade Federal dos Vales do Jequitinhonha e Mucuri, Departamento de Fisioterapia, MG, Diamantina, Brazil (Avila, Oliveira) Universidade Federal de Minas Gerais, Faculdade de Medicina, MG, Belo Horizonte, Brazil (Gomes) Fundacao Oswaldo Cruz, Instituto Oswaldo Cruz, RJ, Rio de Janeiro, Brazil Publisher Sociedade Brasileira de Medicina Tropical Abstract Chagas cardiomyopathy is associated with a higher risk of severe cardiovascular events and increased mortality. Among the factors associated with Chagas cardiomyopathy, impairment in functional capacity-commonly assessed using the New York Heart Association (NYHA) functional classification-is notable and may contribute to risk stratification. In this review, we assessed the prognostic value of the NYHA classification on cardiovascular events and mortality in patients with Chagas cardiomyopathy. The search was performed across EMBASE, LILACS, MEDLINE, and Web of Science databases. Prospective and retrospective cohort studies in which the prognostic value of the NYHA classification was assessed were eligible. Risk of bias was assessed using the Quality in Prognostic Studies tool. Evidence was classified using the adapted GRADE system. Eighteen studies were included in the systematic review. The meta-analysis results indicate that the NYHA classification is an important prognostic factor for mortality. Patients with NYHA class III and IV showed a higher risk of death than those with class I and II (hazard ratio, 2.63; 95% confidence interval: 2.00-3.45; moderate GRADE evidence). Patients with NYHA class IV had a higher risk of death than those with class I, II, and III (hazard ratio, 2.80; 95% confidence interval: 1.06-7.43; low GRADE evidence). Very low evidence suggests that the NYHA classification does not predict heart transplantation or stroke, but may predict cardiac pacemaker implantation. Overall, the NYHA classification is a key prognostic indicator of mortality in Chagas cardiomyopathy, although its ability to predict stroke, heart transplantation, and pacemaker implantation is inconsistent. Copyright © 2026, Sociedade Brasileira de Medicina Tropical. All rights reserved. <91> Accession Number 2049205645 Title Risk Factors for Myocardial Injury During Cardio-Pulmonary Bypass-Assisted Heart Surgery: A Retrospective Single-Center Study. Source Acta Anaesthesiologica Scandinavica. 70(10) (no pagination), 2026. Article Number: e70330. Date of Publication: 01 Nov 2026. Author Holm J.T.; Wiberg S.C.; Gronlykke L.; Busch S.E.; Moller-Sorensen P.H.; Hassager C.; Itenov T.S. Institution (Holm, Wiberg, Gronlykke, Busch, Moller-Sorensen, Itenov) Department of Cardiothoracic Anesthesiology and Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark (Holm) Department of Anesthesia and Intensive Care, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark (Wiberg, Gronlykke, Hassager, Itenov) Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Hassager) Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark Publisher John Wiley and Sons Inc Abstract Introduction: Myocardial injury is a significant contributor to 30-day mortality after cardiac surgery with cardiopulmonary bypass. We aimed to investigate the association between mean arterial pressure, norepinephrine use during the aorta cross-clamp period, and aorta cross-clamp duration with myocardial injury during cardiopulmonary bypass-assisted open-heart surgery. Method(s): We identified all adults (>= 18 years) undergoing coronary artery bypass grafting on cardiopulmonary bypass at Rigshospitalet, Copenhagen, between January 1st 2018 and December 31st 2019. The primary outcome was the change from baseline in creatine kinase myocardial band during the first 18 postoperative hours. Exposures included mean arterial pressure, norepinephrine use during the aorta cross-clamp period, and aorta cross-clamp duration. Associations were investigated using linear mixed-effect models. Result(s): A total of 1443 patients were included in the analysis. Patients treated with norepinephrine during the aortic cross-clamp period had 19% (95% CI: 9.0%-29%; p < 0.001) higher creatine kinase myocardial band postoperatively compared with those not treated with norepinephrine. Higher mean arterial pressure was not significantly associated with creatine kinase myocardial band (3.0%, 95% CI: -2.0% to 9%; p = 0.20). Patients treated with norepinephrine with a mean arterial pressure above the median (39 mmHg) had similar creatine kinase myocardial band levels compared to patients not treated with norepinephrine with a mean arterial pressure below the median, with a difference of 2% (95% CI: -0.18% to 0.22%, p = 0.80). Creatine kinase myocardial band increased by 12% (95% CI: 10%-14%; p < 0.001) for each 15-min increase in aortic cross-clamp duration. Conclusion(s): This retrospective observational study suggested a possible link between norepinephrine use and myocardial injury during cardiopulmonary bypass-assisted open-heart surgery, while mean arterial pressure appeared to have no impact. Further randomized controlled trials are necessary. Editorial Comment: In this single center retrospective cohort analysis, intraoperative cardiac surgery management factors were analyzed along with postoperative cardiac injury marker levels. Associations for aortic cross-clamp time, noradrenaline use during this, and mean arterial pressures are presented for post-op creatine kinase MB levels. Copyright © 2026 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. <92> Accession Number 2049259757 Title Expectation-related effects of fascial plane blocks in cardiac surgery: A hypothesis-generating network meta-analysis of randomized controlled trials. Source Journal of Clinical Anesthesia. 115 (no pagination), 2026. Article Number: 112328. Date of Publication: 01 Nov 2026. Author De Cassai A.; Karapinar Y.E.; Turunc E.; Boscolo A.; Dost B. Institution (De Cassai, Boscolo) Department of Medicine (DIMED), University of Padua, Padua, Italy (De Cassai, Boscolo) Institute of Anesthesia and Intensive Care Unit, University Hospital of Padua, Padua, Italy (Karapinar) Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey (Turunc, Dost) Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey Publisher Elsevier Inc. <93> Accession Number 652242151 Title Transcatheter vs. Surgical Aortic Valve Replacement in Low- to Intermediate-Risk Patients: Do DEDICATE trial outcomes translate to real-world populations?. Source The Journal of thoracic and cardiovascular surgery. (no pagination), 2026. Date of Publication: 22 Sep 2026. Author Daeter E.; Roefs M.M.; Post R.A.J.; Berg J.T.; Tonino P.A.L.; Van Veghel D.; Klautz R.; Takkenberg J.J.M.; Veen K.M. Institution (Daeter, Berg) Department of Cardiothoracic Surgery and Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands (Roefs, Van Veghel) UtrechtNetherlands (Post) Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands (Tonino) Catharina Hospital, Eindhoven, Netherlands (Klautz) Leiden University Medical Centre, Leiden, The Netherlands; Amsterdam University Medical Center, The Netherlands (Takkenberg, Veen) Thorax Center, Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands Abstract OBJECTIVE: To assess the transportability of the randomized DEDICATE trial results, comparing SAVR with TAVR in low- to intermediate-risk patients, to an external Dutch population derived from the Netherlands Heart Registration (NHR). METHOD(S): Data sources included the DEDICATE-RCT data (TAVR-trial, SAVR-trial) and the NHR (SAVR-registry). The primary endpoint was composite of all-cause mortality or stroke at one year; secondary endpoints were mortality and stroke. As-treated TAVR-trial and SAVR-trial patients were propensity-score (PS) matched to SAVR-registry patients. Model-based and weighting-based transportability analyses were performed. RESULT(S): After applying trial criteria, 3,389 SAVR-registry patients were eligible and 1,211 trial patients were included (654 TAVR; 557 SAVR). Trial-eligible SAVR-registry patients were younger and had fewer comorbidities. PS-matching of TAVR-trial to SAVR-registry yielded 1,150 patients, and matching of SAVR-trial to SAVR-registry yielded 892 patients. In PS-matched cohorts, SAVR-trial patients experienced more composite events (HR 1.63 [1.02-2.62],p=0.04) and strokes (HR 2.96 [1.37-6.37],p=0.01) than SAVR-registry patients, with comparable mortality (HR 1.15 [0.65-2.02], p=0.63). TAVR-trial (vs. SAVR-registry) patients had lower 1-year mortality (HR 0.46 [0.24-0.87], p=0.02). Transported absolute risk reduction (ARR) of 1-year mortality of TAVR was attenuated when the trial was reweighted to resemble the registry (ARRtransported: 2.2% [0.1-4.2]; ARRtrial: 3.7% [1.4-6.7]). CONCLUSION(S): In PS-matched analyses, SAVR-registry patients showed lower combined mortality/stroke and stroke rates than SAVR-trial participants, suggesting caution in transporting trial-derived relative effects to this population. For mortality the relative trial-effects could be reproduced, but absolute benefit of TAVR was diminished in the registry population. Copyright © 2026. Published by Elsevier Inc. <94> Accession Number 652247351 Title Colchicine Use After Coronary Artery Stenting: One-Year Follow-Up Results. Source European Research Journal. Conference: 6th Uludag Cardiology Summit. Bursa Turkey. 12(Supplement 1) (pp S42-S43), 2026. Date of Publication: 01 Mar 2026. Author Akhmedov S.; Akhrorov J.; Ilkhom J.; Abdullajonov A.; Asror N.; Maxmudov B. Institution (Akhmedov) Department of Cardiology, Ezgu Niyat Tashkent, Carmen+, Bukhara, Uzbekistan (Akhrorov, Ilkhom) Department of Cardiology, Carmen+, Bukhara, Uzbekistan (Abdullajonov) Department of Cardiology, American Hospital, Uzbekistan (Asror) Department of Cardiology, Ezgu Niyat Tashkent, Uzbekistan (Maxmudov) Department of Cardiology, Neurocenter Tashkent, Uzbekistan Publisher Association of Health Research and Strategy Abstract Objectives: Restenosis following coronary artery stenting remains a significant clinical problem, particularly in patients with ischemic heart disease. Despite the widespread use of drug-eluting stents (DES), certain high-risk subgroups, such as those with diabetes mellitus and vascular calcification, continue to experience elevated restenosis rates. Inflammation plays a key role in this process. Colchicine, an anti-inflammatory agent known to inhibit the NLRP3 inflammasome and reduce systemic inflammatory markers, may help mitigate this risk. This study aimed to evaluate the efficacy of colchicine in reducing the incidence of in-stent restenosis one year after coronary stenting and to assess its impact on inflammatory biomarkers and clinical outcomes. Method(s): This prospective, randomized, controlled trial was conducted at Ezgu Niyat Cardiology Center and Carmen+ Clinic (Uzbekistan) between January 2021 and December 2024. A total of 120 patients with stable coronary artery disease undergoing successful elective percutaneous coronary intervention (PCI) with DES implantation were enrolled and randomized (1:1) into: Group 1 (Colchicine Group): 60 patients received colchicine 0.5 mg once daily for 12 months. Group 2 (Placebo Group): 60 patients received a matching placebo. The primary endpoint was the rate of angiographically confirmed in-stent restenosis (>=50% luminal narrowing) at 12 months. Secondary endpoints included major adverse cardiovascular events (MACE) and changes in inflammatory biomarkers (CRP, IL-6, TNF-alpha) from baseline to 12 months. Result(s): At one-year follow-up, restenosis was significantly lower in the colchicine group compared to the placebo group (6.7% vs. 18.3%, P=0.02). Colchicine group (n=60): *LAD: 0/25 (0%) *RCA: 3/20 (15%) *LCX: 1/15 (6.7%) *Diabetic patients: 7.3%; non-diabetic: 5.3% *With calcification: 7.7% Placebo group (n=60): *LAD: 2/30 (6.7%) *RCA: 5/20 (25%) *LCX: 4/10 (40%) *Diabetic patients: 16.7%; non-diabetic: 22.2% *With calcification: 15.4% Inflammatory markers significantly decreased in the colchicine group (all P < 0.01): *CRP: 4.2 -> 1.8 mg/L *IL-6: 6.5 -> 3.1 pg/mL *TNF-alpha: 12.7 -> 6.2 pg/mL No significant changes were observed in the placebo group (P>0.05). Discussion(s): Colchicine significantly reduced restenosis rates and systemic inflammation in patients undergoing coronary stenting. Its anti-inflammatory mechanism, targeting the NLRP3 inflammasome, may explain the observed vascular protection. The absence of restenosis in LAD and LCX territories further supports colchicine's beneficial effect on critical vascular segments. The drug's efficacy extended to patients with diabetes and vascular calcification-populations at inherently higher restenosis risk. Conclusion(s): Daily colchicine (0.5 mg) therapy significantly reduced in-stent restenosis and inflammatory biomarkers at one-year follow-up compared with placebo. These findings support the inclusion of colchicine as an adjunct to standard post-PCI therapy, especially in high-risk patients. Larger multicenter studies are warranted to confirm these results and refine patient selection criteria. <95> Accession Number 2049163384 Title Colchicine for cardiovascular secondary prevention: evidence from recent trials and meta-analyses. Source Current Opinion in Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Muroke V.; Samuel M.; Pierre R.; Tardif J.-C. Institution (Muroke, Pierre, Tardif) Montreal Heart Institute, Canada (Muroke, Pierre, Tardif) Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada (Samuel) Faculty of Medicine, Drexel University, Canada (Samuel) Mario Lemieux Center for Heart Rhythm Care, Allegheny Health Network, Pittsburgh, PA, United States (Samuel) Faculty of Medicine, Dalhousie University, Halifax, Canada Publisher Lippincott Williams and Wilkins Abstract Purpose of review - Residual inflammatory risk remains an important driver of recurrent vascular events despite contemporary lipid-lowering and antithrombotic therapies. Low-dose colchicine is the first widely available anti-inflammatory therapy to be incorporated into contemporary guidelines for secondary prevention in coronary artery disease. This review summarizes contemporary evidence on the efficacy and safety of low-dose colchicine for secondary prevention. Recent findings - Large randomized trials have demonstrated that colchicine reduces recurrent ischemic events in patients with chronic coronary disease and after myocardial infarction. Recent trials in acute myocardial infarction and stroke populations, however, have produced heterogeneous results. Nevertheless, contemporary meta-analyses consistently demonstrate reductions in major adverse cardiovascular events (MACE), driven mainly by fewer myocardial infarctions, strokes, and coronary revascularizations. Safety data are reassuring, with no consistent excess in serious infection, cancer, pneumonia, or noncardiovascular death, although gastrointestinal intolerance remains the most common adverse effect. Summary - Low-dose colchicine has established residual inflammation as an actionable target in secondary prevention of vascular events in patients with chronic coronary disease or recent myocardial infarction. Ongoing trials will clarify colchicine's role across broader vascular indications. Future work should also focus on implementing the use of colchicine for prevention of clinical events in patients with coronary artery disease in clinical practice. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <96> Accession Number 2049239224 Title Computational modeling of thrombosis after transcatheter aortic valve implantation: A systematic review of hemodynamic and mechanical risk metrics. Source Computer Methods and Programs in Biomedicine. 287 (no pagination), 2026. Article Number: 109644. Date of Publication: 01 Dec 2026. Author Erina Y.; Kuchumov A.G. Institution (Erina, Kuchumov) Scientific Center of Genetics and Life Sciences, Sirius University of Science and Technology, Olympic Avenue 1, Sirius, Russian Federation (Kuchumov) Biofluids Laboratory, Perm National Research Polytechnic University, Professor Pozdeev Street 11, Perm, Russian Federation Publisher Elsevier Ireland Ltd Abstract Background and objective Although transcatheter aortic valve implantation (TAVI) generally provides favorable procedural outcomes, thrombotic complications remain an important concern for the long-term performance and durability of transcatheter heart valves. A subset of patients develops hypo-attenuated leaflet thickening (HALT), reduced leaflet mobility, or late thrombotic complications, often in the absence of overt clinical manifestations. This has motivated the use of computational modeling to investigate post-TAVI hemodynamics and valve mechanics and to identify flow- and device-related factors associated with thrombus formation. Methods In this review, we systematically analyze 68 computational studies focused on post-TAVI hemodynamics and thrombosis. The literature is organized into three categories based on their relevance to thrombogenic risk modeling: Peripheral (31 studies), Intermediate (21 studies), and Core (16 studies). This classification reflects the presence of hemodynamic modeling, the use of dedicated proxy metrics of thrombogenicity, and the extent to which thrombosis constitutes the primary focus of the investigation. We further examine the methodological spectrum of existing approaches, including computational fluid dynamics, fluid-structure interaction, and finite element analysis; the use of patient-specific versus idealized geometries; and the application of thrombogenicity-related metrics, such as residence time and washout indices, wall shear stress-based measures, and stress-history-based indicators of mechanical platelet activation. Results Our study shows that while direct simulation of thrombus formation is still mostly lacking, most published studies use indirect hemodynamic and mechanical proxies to evaluate thrombogenic risk. The existence and geometry of paravalvular leaks, valve implantation depth, asymmetric stent expansion, and patient-specific characteristics of aortic root architecture are the risk factors that are most frequently reported across studies. Notably, research in the Core category shows a distinct move away from descriptive flow analyzes and toward a more mechanistic understanding of thrombogenic risk, connecting the cumulative mechanical exposure of blood constituents, unstable neo-sinus hemodynamics, and implantation parameters. Conclusions Overall, this analysis shows that modern in silico methods already make it possible to compare implantation techniques and valve design elements quantitatively in terms of thrombogenic risk. Simultaneously, a shift from exclusively proxy-based evaluations to hybrid and multiscale modeling frameworks that incorporate geometry, hemodynamics, and a minimally adequate description of the biological mechanisms behind thrombus formation will be necessary for future advancements in the field. Copyright © 2026 Elsevier B.V. <97> Accession Number 2049265509 Title Balloon-Expandable Versus Self-Expandable Transcatheter Aortic Valve Implantation Devices: A Contemporary Systematic Review. Source Journal of Clinical Medicine. 15(18) (no pagination), 2026. Article Number: 7224. Date of Publication: 01 Sep 2026. Author Apergis I.; Georghiou G.P.; Georghiou P.; Chrisofos E.E.; Triposkiadis F.; Lampropoulos K. Institution (Apergis, Georghiou, Chrisofos, Triposkiadis, Lampropoulos) School of Medicine, European University Cyprus, Nicosia, Cyprus (Georghiou) Department of Surgery, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel (Georghiou) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Turner St, London, United Kingdom Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis. Prosthesis selection is increasingly important because balloon-expandable valves (BEVs) and self-expandable valves (SEVs) differ in deployment, hemodynamics, and lifetime-management implications. This systematic review synthesized contemporary evidence comparing BEVs and SEVs, while platform-, generation-, and subgroup-specific studies provided contextual evidence. Method(s): A PubMed-only systematic search was performed on 25 January 2026 for studies published between 1 January 2020 and 31 December 2025. Eligible human studies evaluated contemporary balloon or self-expandable systems. Randomized and observational studies, including single-arm cohorts, were included. Risk of bias was assessed using the revised Cochrane Risk of Bias tool (RoB 2) and the Methodological Index for Non-Randomized Studies (MINORS). Because of heterogeneity, findings were synthesized narratively without meta-analysis. Direct randomized and adjusted comparative evidence received greatest weight, whereas single-arm and within-platform studies were not interpreted as establishing comparative superiority. Result(s): Fifty studies met the eligibility criteria. No consistent mortality advantage was identified for either expansion mechanism. The most reproducible differences concerned hemodynamics, paravalvular regurgitation, and conduction outcomes. Supra-annular SEVs were more consistently associated with lower residual gradients and less prosthesis-patient mismatch, whereas BEVs showed lower paravalvular regurgitation or permanent pacemaker implantation in selected comparative settings. These signals varied by valve generation, implantation technique, anatomy, and study design. Evidence on coronary reaccess, durability, thrombosis, and reintervention was less extensive. Conclusion(s): Contemporary evidence does not support a universal BEV-versus-SEV hierarchy. Prosthesis selection should be individualized according to anatomy, conduction risk, hemodynamic priorities, and lifetime-management considerations. Comparative conclusions should remain generation-specific and distinguish direct comparative evidence from single-arm or anatomically selected cohorts. The review was not prospectively registered and received no external funding. Copyright © 2026 by the authors. <98> Accession Number 2038654271 Title Surgical and transcatheter pulmonary valve replacement in patients with congenital heart disease, who have a history of right ventricular outflow tract remodeling, Indonesia: A model-based economic evaluation. Source Thai Journal of Pharmaceutical Sciences. 50(3) (no pagination), 2026. Article Number: e5. Date of Publication: 2026. Author Annisa A.N.; Anantachoti P.; Prakoso R.; Juzar D.A.; Nerapusee O. Institution (Annisa, Anantachoti) Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand (Prakoso, Juzar) Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas, Central Jakarta, Indonesia (Prakoso, Juzar) National Cardiovascular Centre, Harapan Kita, Jakarta, Indonesia (Nerapusee) Industrial Pharmacy Division, School of Pharmacy, Eastern Asia University, Pathumthani, Thailand Publisher Faculty of Pharmaceutical Sciences, Chulalongkorn University Abstract Background: Patients with congenital heart disease who have previously undergone right ventricular outflow tract (RVOT) surgery frequently require repeat valve replacement later in life. While transcatheter pulmonary valve replacement (TPVR) offers less invasive reintervention compared with surgery, its high device cost raises concerns about affordability under Indonesia's National Health Insurance Program (Jaminan Kesehatan Nasional). Objective(s): To compare the cost-effectiveness of surgical pulmonary valve replacement (SPVR) versus TPVR in post-RVOT surgery patients, and to estimate the TPVR price threshold for cost-effectiveness from a societal perspective. Method(s): A Markov model simulated a hypothetical cohort of 15-year-old patients with prior RVOT surgery over their lifetime. Two strategies were evaluated: SPVR repeated every 15 years and TPVR repeated every 10 years. Probability input and costs included procedures and complications, were retrieved from a meta-analysis, hospital data, and published literature. Outcomes included quality-adjusted life-years (QALYs), life-years (LYs), and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. Deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) sensitivity analyses assessed parameter uncertainty. Result(s): Compared with SPVR, TPVR increased costs by USD 49,765.81, gained 1.47 QALYs and 2.41 LYs, yielding an ICER of USD 33,790.96/QALY. Using a cost-effectiveness threshold of one-time gross domestic product per capita (USD 4,925.40), TPVR was not cost-effective. DSA indicated that the initial SPVR and TPVR utility values had the greatest influence on ICER, while PSA showed TPVR was more effective but substantially more costly. Price-threshold analysis suggested the TPVR valve device cost would need to fall by ~70% (to USD 10,000) to meet the threshold. Conclusion(s): Under current pricing, TPVR is not cost-effective in Indonesia. These findings support price-negotiation strategies to improve TPVR affordability and advance universal health coverage goals. Copyright © 2026, Faculty of Pharmaceutical Sciences, Chulalongkorn University. All rights reserved. <99> Accession Number 652248500 Title Heterogeneity in MACE Definitions and Its Impact on Treatment Effect Estimates in Coronary Stent Trials: A Meta-Epidemiological Study. Source Journal of evidence-based medicine. (pp e70192), 2026. Date of Publication: 23 Sep 2026. Author Wang X.; Yang J.; Long Y.; Ran J.; Li S.; Xu Z.; Jiang Z.; Wan X.; Li Y.; Fang K.; Huang S.; Gu R.; Zhang N.; He W.; Huang J.; Li Z.; Du L. Institution (Wang, Long, Ran, Li, Zhang, Huang, Li, Du) Department of Cardiac Surgery, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China (Wang, Long, Ran, Li, Xu, Zhang, He, Huang, Du) Innovation Institute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, China (Yang, Li, Fang, Huang) West China School of Public Health, Sichuan University, Chengdu, China (Jiang) Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China (Wan) Department of Nursing, West China Second Hospital of Sichuan University, Chengdu, China (Gu) School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, Chengdu, China (Li, Du) Center for Education of Medical Humanities, West China Hospital, Sichuan University, Chengdu, China Abstract BACKGROUND: Major adverse cardiac events (MACE) are widely used composite endpoints in cardiovascular trials. However, heterogeneity in MACE definitions may influence treatment effect estimates, with potential implications for clinical decision-making. This study explored variability in MACE definitions across coronary stent trials and assessed the influence of individual components on effect estimates. METHOD(S): We systematically searched PubMed and Embase (via Ovid) from inception to March 5, 2026, for meta-analyses and extracted eligible coronary stent randomized controlled trials (RCTs) from their forest plots. Data on MACE definitions, outcomes, and trial characteristics were extracted. Consistency between MACE outcomes and individual component outcomes was assessed. Meta-regression analyses assessed the associations between MACE components and treatment effect estimates. RESULT(S): Among 301 included RCTs, 62.79% reported individual component results, and substantial heterogeneity was observed in MACE definitions. Among trials with comparable MACE and component results, 8.96% had non-significant MACE results despite significant mortality differences, whereas 14.81% had significant MACE results despite no significant differences in any individual component. In addition, 52.72% showed opposite effect directions between MACE and at least one component. Meta-regression further showed that inclusion of mortality, myocardial infarction, stent thrombosis, target lesion revascularization, coronary artery bypass grafting, and overall revascularization was associated with lower estimated effects, whereas inclusion of stroke was associated with higher estimated effects. CONCLUSION(S): Substantial heterogeneity exists in MACE definitions, impacting treatment effect estimates in coronary stent trials. Standardized reporting of composite and individual component outcomes is essential to improve the interpretation of trial findings and reliability of evidence synthesis. Copyright © 2026 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd. <100> Accession Number 2038654255 Title Non-Ultrasound-Guided Versus Ultrasound-Guided Femoral Venous Puncture in the Interventional Pulmonary Embolism Era: Does Ultrasound Guidance Improve Safety and Feasibility?. Source Reviews in Cardiovascular Medicine. 27(9) (no pagination), 2026. Article Number: 46795. Date of Publication: 01 Sep 2026. Author Elhakim A.; Abdelatti D.; Elhakim M.; Bisht O.; Yassin I.; Mosaad M.A.; Hassaan A.M.; Radke P.W.; Saad M. Institution (Elhakim, Radke) Cardiology Department, Schoen Clinic Neustadt, Neustadt in Holstein, Germany (Abdelatti) Pulmonology Department, University Wuppertal, Wuppertal, Germany (Elhakim) Intensive Care Medicine Department, The Royal Prince Alfred Hospital, Sydney, NSW, Australia (Bisht) Cardiology Department, Coswig Heart Center, Sachsen-Anhalt, Coswig, Germany (Yassin, Mosaad, Hassaan) Cardiology Department, Faculty of Medicine, Alazhar University, Cairo, Egypt (Saad) Cardiology Department, Sana Klinikum Coburg, Coburg, Germany Publisher IMR Press Limited Abstract Background: The use of interventional endovascular therapy for pulmonary embolism (PE) has become increasingly important over the last decade. In contrast to other cardiovascular interventions, these procedures carry a higher risk of access-related bleeding due to the acute clinical setting, elevated body mass index, and the frequent need for high-dose anticoagulation. However, there is still no clear consensus regarding the optimal vascular access site for endovascular PE therapy or the impact of ultrasound (US)-guided puncture on access-related complications. Method(s): We treated 89 patients with intermediate-to high-risk PE using the Ekosonic endovascular system (EKOS). Group A (n = 39) underwent femoral venous puncture without US guidance, and Group B (n = 50) underwent US-guided femoral venous puncture. Result(s): Intraprocedural complications differed significantly between the two groups, with a higher incidence of vascular access complications in the non-US-guided group. Access-site pseudoaneurysms and retroperitoneal bleeding events occurred exclusively in the non-US-guided group (n = 6). Major (n = 3) and moderate (n = 5) bleeding events were also observed only in the non-US-guided group (p < 0.001). However, the total length of stay in the intermediate care unit and in the hospital did not differ between the groups. These findings are consistent with prior reports from other interventional settings that demonstrate fewer bleeding events among patients undergoing US-guided procedures. Conclusion(s): Widespread adoption of US-guided puncture in interventional PE therapy could reduce access-related complications, increase first-pass success, and reduce the number of puncture attempts, inadvertent arterial punctures, and unsuccessful access-site cannulations, particularly in patients with unfavorable access anatomy, obesity, or anatomical variations. Further education and implementation of US-guided access into training programs could improve the adoption of this technique. Copyright © 2026 The Author(s). <101> Accession Number 2049202700 Title The role of antifactor Xa monitoring in the dosing and administration of low-molecular-weight heparins in pregnancy: a systematic review and meta-analysis. Source Journal of Thrombosis and Haemostasis. (no pagination), 2026. Date of Publication: 2026. Author Ashraf R.; Mohamed D.; Sayfi S.; Bowen J.M.; Steinberg I.; Shehata N.; Hwang M.; D'Souza R. Institution (Ashraf, Sayfi, D'Souza) Department of Obstetrics & Gynaecology, McMaster University, Hamilton, ON, Canada (Ashraf, Sayfi, Bowen, D'Souza) Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada (Mohamed) Department of Obstetrics & Gynaecology, McGill University, Montreal, QC, Canada (Bowen) Program for Health System and Technology Evaluation, Ted Rogers Centre for Heart Research at Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada (Bowen) Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Steinberg) Department of Pediatrics, University of Southern California (USC) Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States (Shehata) Division of Haematology, Departments of Medicine and Laboratory Medicine and Pathobiology, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, ON, Canada (Hwang) Library & Knowledge Services, Trillium Health Partners, Toronto, ON, Canada Publisher Elsevier B.V. Abstract Background Low-molecular-weight heparins (LMWHs) are widely used in pregnancy for prevention and treatment of venous thromboembolism (VTE) and in individuals with mechanical heart valves (MHVs). Objectives Our aim was to determine the risk of thromboembolic complications (TECs) and major bleeding with weight-based, fixed, and anti-Xa-monitored dosing of LMWHs during pregnancy. Methods We conducted a systematic review and searched 6 databases for articles published before August 2024 that reported on LMWH dosing and monitoring during pregnancy. We calculated event rates and 95% confidence intervals (95% CIs) for maternal death, TECs, and major bleeding using a random-effects meta-analysis. We assessed risk of bias using the Quality In Prognosis Studies tool and evaluated the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results We identified 5007 studies, of which 94 (53 case series, 30 cohort studies, and 11 randomized trials) were eligible. For thromboprophylaxis and VTE treatment, fixed, weight-based, and anti-Xa-monitored LMWH doses had overlapping pooled event rates and 95% CIs for TECs and major bleeding. For MHVs, the risk of maternal death, TECs, and major bleeding was 2.7% (95% CI, 0.3%-6.5%), 7.9% (95% CI, 2.8%-14.6%), and 8.4% (95% CI, 2.0%-17.2%), respectively with overlapping pooled single-arm event rates and 95% CIs across different anti-Xa-monitored LMWH dosing regimens. The CoE for all estimates was low to very low, mainly due to imprecision, risk of bias, and publication bias. Conclusion Pooled single-arm event rates and 95% CIs for the main outcomes overlapped across LMWH dosing regimens currently used in pregnancy for thromboprophylaxis, VTE treatment, and anticoagulation in individuals with MHVs. These findings should be interpreted in light of small sample sizes, wide 95% CIs, and low CoE; and not as evidence of comparable effectiveness or safety. Copyright © 2026 The Author(s). <102> Accession Number 2049265518 Title Recurrent Stroke Following Left Atrial Appendage Closure in Patients with Breakthrough Stroke: A Systematic Review and Meta-Analysis. Source Journal of Clinical Medicine. 15(18) (no pagination), 2026. Article Number: 7320. Date of Publication: 01 Sep 2026. Author Bini T.; Gamardella M.; Gasys A.; Galea R.; Roten L.; Seiffge D.; Raber L.; Siontis G.C.M. Institution (Bini, Gamardella, Gasys, Galea, Roten, Raber, Siontis) Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (Bini, Gasys) Graduate School for Health Sciences, University of Bern, Bern, Switzerland (Galea) Department of Cardiology, Hospital Centre of Biel, Biel, Switzerland (Seiffge) Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (Siontis) Institute of Social and Preventive Medicine (ISPM, University of Bern, 3012 Bern, Switzerland Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Objective: To determine the incidence of recurrent ischemic stroke following percutaneous left atrial appendage closure in patients with previous thromboembolic events despite oral anticoagulation. Method(s): We conducted a systematic review and meta-analysis of studies of any design reporting ischemic stroke recurrence after left atrial appendage closure in patients with prior ischemic stroke despite oral anticoagulation therapy. The literature search was conducted in MEDLINE, Embase, and the Cochrane Library for studies published between 1 January 2010 and 31 December 2025. Data on study design, population characteristics, indexed intervention, and outcomes were extracted from each included report. The primary outcome was ischemic stroke occurring after left atrial appendage closure, as defined by each individual study. A pooled incidence rate was estimated using a random-effects model to account for anticipated between-study heterogeneity. The study is registered in Open Science Framework. The Risk of Bias in Non-randomized Studies of Interventions assessment tool was used to assess the risk of bias. Result(s): Overall, eight studies of a total of 1091 patients met the eligibility criteria. Patients were elderly (mean age range 71.8 to 78.1 years), 33% to 53% were women, and thromboembolic risk was consistently high (mean CHA<inf>2</inf>DS<inf>2</inf>-VASc scores >= 5.0). The risk of bias across the included studies was either moderate or serious. Antithrombotic therapy after left atrial appendage closure varied considerably across the included studies. In one study, all patients were discharged on dual antiplatelet therapy, whereas in five studies >70% received oral anticoagulation alone or in combination with antiplatelet therapy at discharge. In six studies, antithrombotic therapy at follow-up was reported, with the proportion of patients on oral anticoagulation alone or in combination with antiplatelet therapy at follow-up ranging from 8.1% to 100% in individual studies. Follow-up duration ranged from 1.0 to 3.1 years. At a mean follow-up of 17.7 months the pooled incidence of the ischemic stroke recurrence rate following left atrial appendage closure was 3.1% per year (95% confidence interval 2.35-4.20%). Conclusion(s): Among elderly patients with prior ischemic stroke despite oral anticoagulation, the recurrence rate of ischemic stroke following left atrial appendage closure was 3.1% per year. Given the residual risk of stroke recurrence and the substantial heterogeneity in post-procedural antithrombotic management observed across studies, prospective randomized trials are urgently needed to define both the protective impact of left atrial appendage closure and the optimal antithrombotic strategy in this high-risk population. Copyright © 2026 by the authors. <103> Accession Number 2049725256 Title Prior percutaneous coronary intervention versus deferral in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis of randomized controlled trials. Source Coronary Artery Disease. (no pagination), 2026. Date of Publication: 2026. Author Mata E.; Barbosa C.; Morais I.; Ribeiro S.; Alberto Rodrigues J.; Lourenco A.; Fontes-Carvalho R. Institution (Mata, Ribeiro, Lourenco) Servico de Cardiologia, Unidade Local de Saude Alto Ave, Guimaraes, Portugal (Barbosa, Morais, Alberto Rodrigues, Fontes-Carvalho) Servico de Cardiologia, Unidade Local de Saude de Gaia/Espinho, Gaia, Portugal Publisher Lippincott Williams and Wilkins Abstract Background - Coronary artery disease (CAD) is highly prevalent among patients undergoing transcatheter aortic valve implantation (TAVI), yet the optimal management of concomitant coronary lesions remains uncertain. While routine percutaneous coronary intervention (PCI) prior to TAVI may reduce ischemic complications, it may also increase bleeding risk and procedural burden. Methods - We systematically searched Cochrane Central Register of Controlled Trials, Scopus, and PubMed for randomized controlled trials (RCTs) comparing routine PCI versus PCI deferral in patients undergoing TAVI with CAD. Primary outcomes were all-cause mortality and myocardial infarction. Secondary outcomes included major bleeding, any bleeding, stroke, hospitalizations, and cardiovascular mortality. Random-effects meta-analysis was performed using hazard ratios with 95% confidence intervals (CIs). Results - Three multicenter RCTs (2021-2026), including 1132 patients (563 PCI deferral, 569 routine PCI), were analyzed. Routine PCI was not associated with differences in all-cause mortality (hazard ratio = 0.88; 95% CI = 0.67-1.17) or myocardial infarction (hazard ratio = 0.84; 95% CI = 0.44-1.58). Similarly, no significant differences were observed in stroke, hospitalizations, or cardiovascular mortality. However, routine PCI was associated with a higher risk of major bleeding (hazard ratio = 1.61; 95% CI = 1.05-2.49) and any bleeding (hazard ratio = 1.96; 95% CI = 1.28-3.00). Conclusion - In patients undergoing TAVI with concomitant CAD, PCI deferral appears safe and is associated with a significantly lower bleeding risk, without increasing ischemic events. These findings support a deferral approach to coronary revascularization rather than routine PCI prior to TAVI. However, longer-term follow-up is warranted to better define the impact of this strategy on late ischemic outcomes, particularly as TAVI is increasingly performed in younger patients with longer life expectancy. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <104> Accession Number 2049263378 Title Remimazolam Versus Dexmedetomidine for Monitored Anesthesia Care in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation: A Randomized Clinical Trial. Source Journal of Clinical Medicine. 15(18) (no pagination), 2026. Article Number: 7182. Date of Publication: 01 Sep 2026. Author Hyung S.-W.; Choi M.; Chung M.Y.; Hwang W. Institution (Hyung, Chung) Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Anesthesiology and Pain Medicine, Seoul, South Korea (Choi) Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Department of Anesthesiology and Pain Medicine, Bucheon, South Korea (Hwang) Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Monitored anesthesia care is increasingly used for transfemoral transcatheter aortic valve implantation (tf-TAVI), but the optimal sedative regimen remains uncertain. We compared remimazolam with dexmedetomidine during tf-TAVI. Method(s): In this single-center randomized trial, 34 patients were assigned 1:1 to remimazolam or dexmedetomidine. Primary outcomes were the number of intraoperative hypotensive episodes, defined as mean arterial pressure <65 mmHg requiring vasopressor treatment, and cumulative phenylephrine and norepinephrine doses. Secondary outcomes included hemodynamic and physiological variables, regional cerebral oxygen saturation (rSO<inf>2</inf>), arterial blood gases, recovery time, surgeon requests for deeper sedation, and procedural outcomes. Longitudinal variables were analyzed using generalized estimating equations with Holm adjustment for time-specific comparisons. Result(s): No significant between-group differences were detected in intraoperative hypotensive episodes or cumulative phenylephrine and norepinephrine doses, and no significant group-by-time interactions were observed for blood pressure. Both left and right rSO<inf>2</inf> showed significant group-by-time interactions, with higher remimazolam values at selected time points after Holm adjustment. Arterial carbon dioxide tension was higher and arterial pH lower with remimazolam immediately before rapid ventricular pacing and at procedure completion. Recovery was faster with remimazolam (mean +/- standard deviation, 13.5 +/- 7.2 vs. 32.4 +/- 12.5 min; p < 0.001), and surgeon requests for deeper sedation were less frequent (11.8% vs. 76.5%; p < 0.001). Conclusion(s): Remimazolam was associated with faster recovery and fewer surgeon requests for deeper sedation; however, the trial was not designed or powered to establish equivalence for hypotensive episodes, vasopressor requirements or hemodynamic outcomes. Copyright © 2026 by the authors. <105> Accession Number 2049262965 Title Temporary Mechanical Circulatory Support in Patients in Cardiogenic Shock Requiring Cardiac Surgery: Protected Cardiac Surgery Concept. Source Journal of Clinical Medicine. 15(18) (no pagination), 2026. Article Number: 7158. Date of Publication: 01 Sep 2026. Author Nagel A.; Geiger D.; Nersesian G.; Lewin D.; Hrytsyna Y.; Stegmann A.; Pitts L.; Kaemmel J.; Lanmueller P.; Falk V.; Potapov E. Institution (Nagel, Geiger, Nersesian, Lewin, Hrytsyna, Stegmann, Pitts, Kaemmel, Lanmueller, Falk, Potapov) Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite, Augustenburger Platz 1, Berlin, Germany (Nagel, Geiger, Nersesian, Lewin, Hrytsyna, Stegmann, Pitts, Kaemmel, Lanmueller, Falk, Potapov) Charite-Universitatsmedizin Berlin, Corporate Member of Freie Universitat Berlin and Humboldt-Universitat zu Berlin, Chariteplatz 1, Berlin, Germany (Nersesian, Hrytsyna, Stegmann, Pitts, Kaemmel, Lanmueller, Falk, Potapov) DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Temporary mechanical circulatory support (tMCS) has evolved as a first-line treatment of cardiogenic shock refractory to medical therapy. In recent years, tMCS has been applied to bridge and precondition end-stage heart failure patients with structural heart disease for surgery or intervention. This review describes three clinical scenarios: preoperative stabilization and bridge-to-surgery (Type 1), planned intraoperative support in patients at high risk of perioperative low cardiac output (Type 2), and rescue support for failure to wean from cardiopulmonary bypass or postoperative heart failure (Type 3). PubMed/MEDLINE was searched for publications from January 2017 onward. It discusses microaxial flow pumps (mAFP), intra-aortic balloon pumps (IABP), veno-arterial extracorporeal life support (VA-ECLS), and combined strategies, including left ventricular unloading during VA-ECLS. Clinical applications include acute myocardial infarction-related cardiogenic shock, acute mitral regurgitation, post-infarction ventricular septal defect and advanced heart failure therapy. Current European and American recommendations support early, individualized and Heart Team-guided use in selected patients. In this review, we aim to summarize the important aspects of protected tMCS implementation in cardiac surgery and highlight some recent evidence in this field. Copyright © 2026 by the authors. <106> Accession Number 2049883756 Title Coronary Revascularization of Ischemic Territories Improves Myocardial Perfusion, Increases Submaximal Aerobic Capacity and Reduces Exercise-induced Angina in Patients With Chronic Coronary Syndrome. Source American Journal of Cardiology. 278 (pp 30-37), 2026. Date of Publication: 01 Nov 2026. Author Mosen H.; Szekely A.; Steding-Ehrenborg K.; Akil Engblom S.; Hedeer F.; Arheden H.; Erlinge D.; Engblom H. Institution (Mosen, Szekely, Steding-Ehrenborg, Akil Engblom, Hedeer, Arheden, Engblom) Department of Clinical Physiology, Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden (Erlinge) Department of Cardiology, Clinical Sciences Lund, Lund University and Skane University Hospital, Lund, Sweden Publisher Elsevier Inc. Abstract Chronic coronary syndrome (CCS) is associated with reduced stress perfusion, a predictor of adverse cardiovascular outcome. To what extent myocardial perfusion is related to cardiorespiratory fitness is not completely known. The aim was to investigate if change in myocardial perfusion correlates to change in aerobic capacity after revascularization. Sixty-two patients with suspected or established CCS underwent cardiopulmonary exercise testing (CPET) and [13N]NH<inf>3</inf> positron emission tomography (PET) before and after elective invasive coronary angiography. Thirty-six patients were revascularized and 26 were not. The angiographer was blinded to the results from CPET and PET. Myocardial perfusion was defined as decreased when below 2 ml/min/g and as myocardial perfusion reserve (MPR) <2. Change in oxygen uptake at submaximal effort (VO<inf>2</inf> at AT) correlated positively to change in MPR in revascularized patients (r = 0.36, p = 0.04), but not in conservatively treated patients (r = 0.03, p = 0.90). Change in VO<inf>2</inf> peak, however, did not correlate to change in myocardial perfusion in any of the groups. Myocardial perfusion at stress and MPR increased significantly after revascularization, when baseline perfusion was decreased (p = 0.01 stress and p = 0.001 MPR, respectively). Furthermore, the number of patients with exercise-induced angina decreased significantly for the revascularized patients (42% (14/33) at baseline versus 3% (1/33) at follow-up, p <0.001) whereas half of the conservatively treated patients still had exercise-induced angina at follow-up (42% (10/24) at baseline versus 21% (5/24) at follow-up, p = 0.12). In conclusion, change in myocardial perfusion correlates with change in submaximal aerobic capacity after revascularization and revascularization reduces exercise-induced angina. 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/ <107> Accession Number 2049591255 Title Pediatric dilated cardiomyopathy and the progression to heart failure: mechanisms and interventions focusing on the "gene-inflammation-metabolism" axis. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1888470. Date of Publication: 01 Sep 2026. Author Jiang J.; Luo D.; Gu Y.; Wang Z.; Xiao Y.; Hu A. Institution (Jiang, Luo, Wang, Hu) Department of Non-Communicable Disease Management, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China (Gu, Xiao) Department of Cardiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China Publisher Frontiers Media SA Abstract Dilated cardiomyopathy (DCM) is the most common cardiomyopathy in children and a leading indication for heart transplantation. Despite considerable progress in understanding its genetic architecture, translating these insights into improved outcomes for children remains challenging. The pathophysiology of pediatric dilated cardiomyopathy is highly complex, extending beyond a simple monogenic model to encompass intricate interactions between genetic predisposition, inflammatory triggers, and metabolic dysregulation. This review systematically synthesizes current evidence on the mechanisms driving heart failure progression in pediatric dilated cardiomyopathy, focusing on the integrated framework of the "gene-inflammation-metabolism" axis. We begin by outlining the genetic landscape of pediatric dilated cardiomyopathy, highlighting key pathogenic genes and their associated phenotypes, with particular emphasis on features distinct from adult disease. We then explore how environmental "second hits" (such as viral infection and autoimmune responses) trigger excessive inflammatory reactions, and discuss the significance of special clinical phenomena such as "hot phase" myocarditis in genetically susceptible children. Concurrently, we systematically examine the metabolic reprogramming of the failing heart, including mitochondrial dysfunction, substrate utilization shifts, insulin resistance, and iron metabolism disturbances, analyzing how these processes further compromise energy-starved cardiomyocytes. By integrating these three interconnected domains, this review presents a pediatric-specific triaxial framework that unifies known DCM pathways into a single actionable model for precision risk stratification and targeted therapy. This framework supports the development of novel biomarkers, multi-dimensional risk stratification strategies, and targeted interventions-ranging from anti-inflammatory agents and metabolic modulators to gene therapy, psychological support, and AI-assisted risk prediction. This review aims to provide a novel theoretical framework and practical roadmap for the clinical management and future research of pediatric dilated cardiomyopathy. Copyright © 2026 Jiang, Luo, Gu, Wang, Xiao and Hu. <108> Accession Number 2049894338 Title Beyond catecholamine escalation: Receptor desensitization and endogenous vasopressor failure, and extracorporeal circuit biocompatibility after cardiopulmonary bypass-A narrative review. Source Vascular Pharmacology. 165 (no pagination), 2026. Article Number: 107707. Date of Publication: 01 Dec 2026. Author Condello I.; Dell'Aquila M.; Condello S.; Totaro A.; El Dsouki Y.; Prapas S.; Katsavrias K.; D'Onofrio A.; Newman J.; Patel N.; Kalimi R.; Gaudino M.; Calafiore A.M. Institution (Condello) School of Medicine and Surgery, University of Insubria, Varese, Italy (Dell'Aquila, Newman, Patel, Kalimi) Northwell Health, Cardiovascular Institute, New York, NY, United States (Condello) Neuromotor Rehabilitation Unit, Istituti Clinici Scientifici, Maugeri SPA, Ribera, Italy (Totaro) Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy (El Dsouki) Faculty of Health, Medicine and Life Sciences, CARIM, Maastricht University, Maastricht, Netherlands (Prapas, Katsavrias) 1st Division of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece (D'Onofrio, Calafiore) Division of Cardiac Surgery, University of Rome "Tor Vergata", Rome, Italy (Gaudino) Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States Publisher Elsevier Inc. Abstract Background: Vasoplegic syndrome following cardiopulmonary bypass (CPB) is a major cause of postoperative circulatory failure in cardiac surgery and is associated with increased morbidity and mortality. Traditionally, vasoplegia has been attributed to systemic inflammation, endothelial dysfunction, excessive nitric oxide production, and pathological vasodilation. However, these mechanisms alone do not fully explain the marked variability in vasopressor responsiveness observed in clinical practice. Increasing evidence suggests that vasoplegia may result not only from depletion of endogenous vasopressors, but also from receptor desensitization and impaired intracellular signaling involving catecholamines, arginine vasopressin (AVP), and angiotensin II (Ang II). Evidence Synthesis: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science, supplemented by citation tracking and manual cross-referencing. Literature was selected qualitatively according to its relevance to endogenous vasopressor physiology, GPCR signaling and desensitization, endothelial and glycocalyx dysfunction, extracorporeal circuit biocompatibility, and vasoplegic syndrome after cardiac surgery. Fifty-one publications representing the key clinical, experimental, translational, and physiological evidence informing these themes were included in the final narrative synthesis; this number represents the literature selected for qualitative discussion rather than the yield of a systematic-review screening process. Result(s): The available evidence suggests that CPB profoundly alters endogenous vasopressor pathways through systemic inflammation, oxidative stress, endothelial activation, ischemia-reperfusion injury, and prolonged adrenergic stimulation. These mechanisms may contribute to depletion of endogenous vasopressors as well as receptor downregulation, desensitization, and uncoupling of intracellular signaling pathways. Alterations involving vasopressin V1/V2 receptors, beta-adrenergic receptors, and the renin-angiotensin system may all participate in vasopressor refractoriness. Increased activation of the ACE2/Ang-(1-7) counter-regulatory axis may further promote vasodilatory pathways, particularly in patients with obesity, diabetes mellitus, and heart failure. Emerging evidence also suggests that multimodal vasopressor strategies, including vasopressin and Ang II supplementation, may be more effective than isolated catecholamine escalation in refractory vasoplegia. In severe cases, non-conventional therapies such as Methylene Blue may restore vascular tone independently of classic vasopressor receptor pathways. Conclusion(s): Vasoplegia after CPB may represent a complex endocrine and receptor-mediated disorder rather than a purely vasodilatory state. The interaction between endogenous vasopressor depletion, receptor dysfunction, and altered intracellular signaling may explain the development of catecholamine-refractory shock after cardiac surgery. A better understanding of these mechanisms could support more individualized and physiologically guided vasopressor strategies aimed at preventing receptor exhaustion and improving hemodynamic management in cardiac surgical patients. Copyright © 2026 Elsevier Inc. <109> Accession Number 2049262929 Title Left Atrial Appendage Occlusion vs. Oral Anticoagulants: Current Evidence and Debates. Source Journal of Clinical Medicine. 15(18) (no pagination), 2026. Article Number: 7015. Date of Publication: 01 Sep 2026. Author Baskovski E.; Gulyigit H.; Akyurek O.; Altin T.; Tutar E. Institution (Baskovski, Gulyigit, Akyurek, Altin, Tutar) Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey (Gulyigit) Department of Cardiology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Atrial fibrillation (AF) is a major cause of cardioembolic stroke, and oral anticoagulation (OAC) remains the standard of care for thromboembolic prophylaxis. Because the left atrial appendage (LAA) is the dominant source of thrombus in AF, percutaneous LAA occlusion (LAAO) has been developed as a mechanical alternative for patients in whom long-term anticoagulation is problematic. Randomized trials against warfarin established non-inferiority for the composite endpoint, though not consistently across coprimary endpoints, and more recent trials against direct oral anticoagulants (DOACs) have extended this comparison to post-ablation and lower-risk populations. Across these studies a consistent pattern emerges: the clinical advantage of LAAO derives largely from a reduction in non-procedural bleeding rather than from superior ischemic protection, and recent meta-analyses diverge mainly according to how the thromboembolic endpoint is composed. At the extreme of stroke and bleeding risk, LAAO failed to demonstrate non-inferiority to physician-directed medical care. This review synthesizes the randomized evidence, examines methodological differences in endpoint construction and patient selection that complicate cross-trial comparison, and discusses determinants of procedural success including peridevice leak, device endothelialization, and device-related thrombus. Remaining evidence gaps are outlined, particularly for patients who experience ischemic stroke despite adequate anticoagulation. Copyright © 2026 by the authors. <110> Accession Number 2049262968 Title Effects of Pulsatile and Non-Pulsatile Cardiopulmonary Bypass on Early Inflammatory Response After Cardiac Surgery: A Secondary Biomarker Analysis of a Multicentric Randomized Controlled Trial. Source Journal of Clinical Medicine. 15(18) (no pagination), 2026. Article Number: 7228. Date of Publication: 01 Sep 2026. Author Ljubacev A.; Grcic A.; Baticic L.; Jenko M.; Taleska Stupica G.; Curko-Cofek B.; Sestan M.; Laskarin G.; Knezevic D.; Damic M.; Vujnovic Dukic V.; Medved I.; Sostaric M.; Antonic M.; Zdravkovic M.; Sotosek V. Institution (Ljubacev, Medved) Department of Surgery, Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia (Grcic, Baticic) Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia (Jenko, Taleska Stupica, Sostaric) Clinical Department of Anesthesiology and Surgical Intensive Care, University Medical Centre Ljubljana, Zaloska Cesta 7, Ljubljana, Slovenia (Jenko, Taleska Stupica, Sostaric, Zdravkovic) Department of Anesthesiology and Reanimatology, Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, Ljubljana, Slovenia (Curko-Cofek, Laskarin) Department of Physiology, Immunology and Pathophysiology, Faculty of Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia (Sestan, Knezevic, Damic, Vujnovic Dukic, Sotosek) Clinic of Anesthesiology, Intensive Medicine and Pain Management, Clinical Hospital Centre Rijeka, Kresimirova 42, Rijeka, Croatia (Laskarin) Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism "Thalassotherapia-Opatija", M. Tita 188, Opatija, Croatia (Knezevic, Sotosek) Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, University of Rijeka, Brace Branchetta 20, Rijeka, Croatia (Antonic) Department for Cardiac Surgery, University Medical Centre Maribor, Ljubljanska Ulica 5, Maribor, Slovenia (Antonic, Zdravkovic) University of Maribor, Taborska 8, Maribor, Slovenia (Zdravkovic) Department of Anesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska Ulica 5, Maribor, Slovenia (Sotosek) Department of Clinical Medical Sciences II, Faculty of Health Studies, University of Rijeka, Viktora Cara Emina 2, Rijeka, Croatia Publisher Multidisciplinary Digital Publishing Institute (MDPI) Abstract Background/Objectives: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response that may contribute to postoperative organ dysfunction. However, the effects of pulsatile and non-pulsatile CPB on the inflammatory response remain incompletely understood. This study investigated the perioperative dynamics of interleukin (IL)-1beta, IL-18, and IL-18 binding protein (IL-18BP), as pre-specified secondary inflammatory biomarker analysis of a prospective, multicentric, randomized trial (ISRCTN11243508), in patients undergoing cardiac surgery with pulsatile or non-pulsatile CPB and evaluated their relationships with routine inflammatory and myocardial injury biomarkers. Method(s): In this study 142 patients undergoing elective cardiac surgery were randomized to pulsatile (Group P) or non-pulsatile (Group NP) CPB, and 129 were analyzed (pulsatile, n = 63; non-pulsatile, n = 66). Blood samples were collected before surgery and at five postoperative time points. Plasma concentrations of IL-1beta, IL-18, and IL-18BP were measured by ELISA. Leukocyte count, C-reactive protein (CRP), procalcitonin (PCT), high-sensitivity cardiac troponin I (hsTnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were also analyzed. The trial was powered for its primary outcome; for these secondary outcomes the achieved sample size had 80% power to detect between-group ratios of geometric means of approximately 1.27 (IL-18), 1.41 (IL-18BP) and 1.38 (IL-1beta). Result(s): Cardiac surgery with CPB induced a marked postoperative inflammatory response in both groups: leukocyte count, CRP, PCT, IL-18, IL-18BP, hsTnI and NT-proBNP increased significantly after surgery, whereas IL-1beta remained essentially unchanged. In the pre-specified confirmatory comparison of postoperative peak concentrations, no biomarker differed significantly between groups. The 95% confidence intervals of this comparison exclude a pulsatile-flow effect on peak IL-18 larger than a 15% reduction or 19% increase, and on peak IL-18BP larger than a 26% reduction or 20% increase. A supporting mixed model for repeated measures showed no differential trajectory over time for any biomarker; its confidence intervals for the average postoperative effect were narrower (approximately +/-10% for IL-18 and -9% to +15% for IL-18BP). The only exception was the leukocyte count, which was approximately 10% higher throughout the postoperative period in Group NP, without a differential trajectory shape. Conclusion(s): This pre-specified secondary analysis of a randomized trial found no evidence that pulsatile CPB reduces the early postoperative inflammatory or myocardial-injury response compared with non-pulsatile CPB for any of the eight biomarkers studied, apart from a modest difference in leukocyte count that did not survive correction for multiple comparisons. The confidence intervals obtained exclude only moderate-to-large between-group differences in IL-18 and IL-18BP; smaller true differences remain compatible with the data and cannot be ruled out at this sample size. These findings should not be interpreted as evidence of biochemical equivalence between pulsatile and non-pulsatile CPB, but they do not support a clinically important early anti-inflammatory advantage of pulsatile perfusion in this population. Copyright © 2026 by the authors. <111> Accession Number 2049794363 Title Routine versus deferred percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation: a frequentist and Bayesian meta-analysis of randomized trials with trial sequential analysis. Source IJC Heart and Vasculature. 66 (no pagination), 2026. Article Number: 102017. Date of Publication: 01 Oct 2026. Author Ibrahim A.; Shalabi L.; Giamundo D.M.; Aboueisha H.; Enani A.; Assi M.; Mojahed A.; Granata L.G.; Meyer D.M.; Sabouret P.; Ando G. Institution (Ibrahim, Enani, Mojahed) Faculty of Medicine, Alexandria University, Alexandria, Egypt (Shalabi) Faculty of Medicine, Gharyan University, Gharyan, Libyan Arab Jamahiriya (Giamundo) Division of Cardiology, Policlinico Casilino, Rome, Italy (Aboueisha) Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Groningen, Netherlands (Aboueisha) College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates (Assi) Faculty of Medicine, Al Najah National University, Nablus, Palestine (Granata) Cardiology Division, Garibaldi-Nesima Hospital, ARNAS Garibaldi, Catania, Italy (Meyer) Department of Cardiothoracic Surgery, Baylor Scott & White Health, Baylor University Medical Center, Dallas, TX, United States (Sabouret) Heart Institute and Action Group, Pitie-Salpetriere, Sorbonne University, Paris, France (Ando) Azienda Ospedaliera Papardo, Messina, Italy (Ando) Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy Publisher Elsevier Ireland Ltd Abstract Background: The optimal management of concomitant coronary artery disease (CAD) in patients undergoing transcatheter aortic valve implantation (TAVI) remains debated. Therefore, we performed this meta-analysis of randomized controlled trials (RCTs) to compare routine percutaneous coronary intervention (PCI) versus deferred PCI in patients with severe aortic stenosis and significant coronary artery disease undergoing TAVI. Method(s): We systematically searched major electronic databases for eligible RCTs. The primary efficacy outcome was spontaneous myocardial infarction (MI); the primary safety outcome was major bleeding. Bayesian random-effects meta-analysis models were fitted using weakly informative prior distributions. Effect estimates are reported as posterior median risk ratios (RR) with 95% credible intervals (CrI). The posterior probability of benefit (PPB) for efficacy outcomes or harm (PPH) for safety outcomes was calculated (RR < 1 or RR > 1, respectively). Result(s): Three RCTs comprising 1156 patients were included. Routine PCI did not demonstrate a convincing posterior probability of benefit for spontaneous MI (posterior median RR 0.84, 95% CrI 0.43-1.73; PPB: 70.2%) or all-cause mortality (posterior median RR 0.91, 95% CrI 0.60-1.43; PPB: 69.6%). However, routine PCI was associated with a reduced risk of urgent revascularization (posterior median RR 0.37, 95% CrI 0.15-0.91; PPB: 98.1%). For safety outcomes, routine PCI was associated with an increased posterior probability of harm for major bleeding (posterior median RR 1.56, 95% CrI 0.91-2.71; PPH: 95.6%) and life-threatening or disabling bleeding (posterior median RR 1.74, 95% CrI 1.00-3.07; PPH: 97.4%). Conclusion(s): Among patients undergoing TAVI with concomitant CAD, routine PCI did not reduce ischemic events or mortality but increased bleeding complications. These findings suggest that a selective revascularization strategy, rather than a routine one, may be preferable. PROSPERO registration: CRD420261386909. Copyright © 2026 <112> Accession Number 2049591231 Title Linking clinical trial data with real-world data for enhanced clinical evidence generation: methodological considerations and recommendations. Source Frontiers in Pharmacology. 17 (no pagination), 2026. Article Number: 1887249. Date of Publication: 01 Sep 2026. Author Meinecke A.-K.; Diaz-Decaro J.; Gavin K.M.; Sun T.; Strom J.B.; Soriano Gabarro M.; Li H.; Teltsch D.Y.; Najafzadeh M.; Panozzo C.A.; Vora P.; Burcu M. Institution (Meinecke, Vora) Bayer AG, Berlin, Germany (Diaz-Decaro, Sun, Panozzo) ModernaTX, Inc., Cambridge, MA, United States (Gavin) Datavant, Inc., Phoenix, AZ, United States (Strom) Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States (Soriano Gabarro) Independent Researcher, Potsdam, Germany (Li) Neurocrine Biosciences, San Diego, CA, United States (Teltsch) EviDT LLC, Lexington, MA, United States (Najafzadeh) UCB, Inc, Cambridge, MA, United States (Burcu) Merck & Co., Inc., Rahway, NJ, United States Publisher Frontiers Media SA Abstract Randomized controlled trials (RCTs) remain the cornerstone of causal inference on the safety and efficacy of medicinal products. But their limited follow-up, controlled settings, and narrowly defined data collection to balance the burden to patients and maintain study feasibility often results in unaddressed important questions for health authorities and other clinical decision makers. Linkage of RCT data to routinely collected health data [real-world data (RWD)] offers a mechanism for addressing these gaps by extending observations and outcomes assessment into routine practice. This paper synthesizes methodological and operational considerations for RCTs with RWD linkage, drawing on deterministic, probabilistic, referential, and privacy-preserving record linkage methodologies and on four case studies that span different indications and regional settings: a long-term follow-up of a human papillomavirus vaccine trial using deterministic linkage via universal Personal Identity Numbers; a U.S. linkage of a respiratory syncytial virus vaccine trial to administrative health claims using privacy-preserving tokenization; and two transcatheter aortic valve replacement trials linked to Medicare claims to reproduce randomized treatment-effect estimates and to assess transportability to the broader Medicare population. We offer actionable methodological considerations and recommendations, drawing on the case studies and the broader linkage literature. Progress beyond the current state will require global health authority guidance specific to linking clinical trials with routinely collected data, shared benchmarks for evaluating linkage approaches, routine reporting and assessments of impact of use cases on regulatory and reimbursement decisions. Linkage of clinical trial data with routinely collected data sources can meaningfully accelerate clinical development and inform health authority and other clinical decision making. Copyright © 2026 Meinecke, Diaz-Decaro, Gavin, Sun, Strom, Soriano Gabarro, Li, Teltsch, Najafzadeh, Panozzo, Vora and Burcu. <113> Accession Number 2049545265 Title Prevention of postoperative delirium with transcranial alternating current stimulation: study protocol for a randomised controlled trial. Source Frontiers in Psychiatry. 17 (no pagination), 2026. Article Number: 1907287. Date of Publication: 2026. Author Zeng L.; Yu X.; Yang T.; Liao J.; Ouyang Y.; Zhou J. Institution (Zeng, Yu, Yang, Liao, Ouyang) Department of Anesthesiology, Shifang People's Hospital, Sichuan, Shifang, China (Zhou) Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Sichuan, Luzhou, China Publisher Frontiers Media SA Abstract Introduction - Postoperative delirium (POD), a common and serious neurological complication in elderly patients following non-cardiac surgery, is associated with increased risk of complications, cognitive decline, prolonged hospital stay, and higher mortality. Current prevention strategies are limited and unsatisfactory. As a non-invasive neuromodulation technique that modulates cortical oscillations and may improve age-related cognitive impairment, transcranial alternating current stimulation (tACS) emerges as a promising intervention for POD. Methods and analysis - This two-stage, randomized, double-blind, sham-controlled trial will enroll elderly patients aged >=65 years undergoing non-cardiac surgery. In Stage 1, In Stage 1, 268 patients will be randomized to physiologically matched theta-tACS, alpha-tACS, gamma-tACS (all 2 mA) or sham stimulation to identify the optimal frequency-plus-montage tACS protocol for POD prevention. In Stage 2, another 268 patients will receive optimal-frequency-plus-montage tACS at 1 mA, 1.5 mA, 2 mA or sham stimulation to determine the optimal intensity. Primary outcome is POD incidence (3D-CAM). Secondary outcomes include pain, cognition, sleep, anxiety and depression. Electroencephalography and blood biomarkers will be assessed. Data will be analyzed using SPSS 26.0. This study aims to develop an optimal tACS protocol for POD prevention in elderly surgical patients. Ethics and dissemination - This study was approved by the Ethics Committee of Shifang people's hospital (202634). The results of the trial will be presented at national and international meetings relevant to the topic area and submitted to international peer-reviewed journals. Clinical trial registration - https://www.chictr.org.cn/showproj.html?proj=317411, identifier ChiCTR2600123512. Copyright © 2026 Zeng, Yu, Yang, Liao, Ouyang and Zhou. <114> Accession Number 2049200117 Title Impact of persistent left bundle branch block on ventricular function and clinical outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis. Source Cardiothoracic Surgeon. 34(1) (no pagination), 2026. Article Number: 41. Date of Publication: 01 Dec 2026. Author de Aquino R.G.F.; Lobo Filho H.G.; Campane R.Z.; Figueiredo Gurgel B.T.; Kilic A. Institution (de Aquino, Lobo Filho) Department of Cardiac Surgery, Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Av. Frei Cirilo, 3480, CE, Fortaleza, Brazil (Lobo Filho) Department of Surgery, Universidade Federal do Ceara, Fortaleza, Brazil (Campane) Department of Medicine, Hospital Regional Hans Dieter Schimitd, Joinville, Brazil (Figueiredo Gurgel) Hospital Universitario Walter Cantidio, Universidade Federal do Ceara, Fortaleza, Brazil (Kilic) Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Background: New-onset persistent left bundle branch block (NOP-LBBB) is a frequent complication after transcatheter aortic valve implantation (TAVI), but its long-term prognostic impact remains controversial. This meta-analysis aimed to evaluate the impact of NOP-LBBB on changes in left ventricular ejection fraction (LVEF) and clinical outcomes after TAVI. Method(s): PubMed, Embase, and Cochrane Library were searched through May 2026 for studies comparing outcomes between patients with and without NOP-LBBB after TAVI. Random-effects models were used to calculate pooled mean differences (MD) for continuous outcomes and risk ratios (RR) for binary endpoints, with 95% confidence intervals (CIs). Result(s): Thirty observational studies comprising 223,419 patients were included (37,856 with NOP-LBBB). NOP-LBBB was associated with a significant reduction in LVEF (MD, - 4.65%; 95% CI, - 6.03 to - 3.27), a higher risk of all-cause mortality (RR, 1.19; 95% CI, 1.05 to 1.35), heart failure hospitalization (RR, 1.48; 95% CI, 1.10 to 1.98), and permanent pacemaker implantation (RR, 2.24; 95% CI, 1.75 to 2.86). No significant difference was observed in cardiovascular mortality (RR, 1.29; 95% CI, 0.93 to 1.81). Conclusion(s): NOP-LBBB after TAVI was associated with impaired LVEF recovery, a modest increase in all-cause mortality, and higher rates of HF hospitalization and permanent pacemaker implantation. The association with all-cause mortality remained statistically significant when restricted to studies at moderate risk of bias (RR, 1.23; 95% CI, 1.02 to 1.49) and after exclusion of the large registry cohort (RR, 1.19; 95% CI, 1.03 to 1.36); the HF hospitalization association remained statistically significant, albeit borderline, in the moderate risk-of-bias analysis (RR, 1.56; 95% CI, 1.01 to 2.42). Given the observational design of the included studies and the low-to-very-low certainty of the evidence, these findings should be regarded as hypothesis-generating and warrant confirmation in prospective studies. Copyright © The Author(s) 2026. <115> Accession Number 2049371334 Title Machine Learning for Mortality Prediction in Infective Endocarditis: A Systematic Review and Meta-Analysis. Source Cardiology in Review. (no pagination), 2026. Date of Publication: 2026. Author Choudhary V.; Jain M.; Tamanna F.; Gohil R.; Mandalapu N.; Gara S.; Vadiyala M.R.; Chilingarashvili G.; Popat A.; Desai R.; Sharma S. Institution (Choudhary) From the Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, United States (Jain) Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, United States (Tamanna) Department of Internal Medicine, St. John's Episcopal Hospital, Far Rockaway, NY, United States (Gohil) Department of Internal Medicine, Kasturba Medical College, Manipal, Udupi, Karnataka, India (Mandalapu) Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, United States (Gara) Department of Primary Care and Behavioral Health, Aspire Indiana Health, Indianapolis, IN, United States (Gara) Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States (Vadiyala) Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, United States (Chilingarashvili) Department of Critical Care Medicine, Cooper University Hospital, Camden, NJ, United States (Popat) Department of Cardiology, Sanford Health, Marshfield Clinic, WI (Desai) Independent Researcher, Outcomes Research, Atlanta, GA, United States (Sharma) Department of Cardiology, Guthrie Robert Packer Hospital, Sayre, PA, United States Publisher Lippincott Williams and Wilkins Abstract Infective endocarditis (IE) continues to be an often fatal condition despite improvements in cardiac surgical procedures and antibiotic therapy, and conventional scoring tools show poor generalizability. Machine learning (ML) addresses these limitations by capturing complex, nonlinear clinical relationships, outperforming conventional scores in predictive accuracy, though prior ML work in IE has focused on diagnosis. A PRISMA-compliant systematic review and meta-analysis of PubMed (Supplemental Digital Content, https://links.lww.com/CIR/A251) and Scopus (through April 2026) evaluated supervised ML models predicting all-cause mortality in adult IE patients; study quality and reporting were appraised using PROBAST and TRIPOD. Eight studies (5503 patients, mean age 53.85) were included in qualitative synthesis, of which 5 contributed area under the receiver operating characteristic curve (AUC) or C-index estimates for pooling via random-effects models, stratified into in-hospital/early and 6-month mortality subgroups. Seven studies were retrospective, and 1 was prospective. ML models, especially ensemble approaches such as Random Forest and gradient boosting, demonstrated strong discriminative performance across all cohorts, with AUC reflecting the ability to distinguish patients who died from those who survived, and outperformed conventional models. Pooled AUC was 0.85 (95% confidence interval [CI], 0.81-0.89) for in-hospital/early mortality (I2 = 35.3%) and 0.85 (95% CI, 0.82-0.88) for 6-month mortality (I2 = 0%). Dominant predictor domains varied by clinical context; multisystem physiologic markers characterized general IE cohorts, dynamic and laboratory variables enhanced intensive care unit-based predictions, and procedural and anatomical factors defined surgical and transcatheter aortic valve replacement model performance. Risk of bias was identified in 4 studies. ML models showed strong discriminative performance for IE mortality prediction, with ensemble methods outperforming conventional approaches by capturing its multivariate heterogeneity. Clinical adoption remains limited; future efforts should prioritize multicenter prospective validation, longitudinal data integration, and development of interpretable frameworks for bedside adoption. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. <116> Accession Number 652234672 Title A multicenter randomized, double-blinded placebo-controlled phase 2 trial to evaluate safety and efficacy of ilofotase alfa in patients at risk for kidney injury following open heart surgery. Source Intensive care medicine. (no pagination), 2026. Date of Publication: 21 Sep 2026. Author Mourisse L.; Ostermann M.; Thiessen S.; Dumoulin A.; Vlaar A.P.J.; Hoste E.; Mosbahi S.; Schneider A.; Zarbock A.; Boehm J.; Rosenberger P.; Thielmann M.; Dubois E.; Powell-Tuck J.; Baig K.; Renette W.; Meex I.; Klop-Rhiel M.; Opschoor K.; Vandenberghe W.; Siepe M.; Strauss C.; Wirth F.; Winkel M.; Hof L.; Kraan M.; Bernholz J.; Pickkers P. Institution (Mourisse, Pickkers) Department of Intensive Care, Radboud University Medical Centre, Nijmegen, Netherlands (Ostermann, Powell-Tuck, Baig, Klop-Rhiel) Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (Thiessen, Meex) Department of Anaesthesiology and Intensive Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium (Thiessen) Faculty of Medicine and Life Sciences, Department of Neurosciences, UHasselt, Hasselt, Belgium (Thiessen, Renette) Department of Cardiovascular Sciences, Anesthesiology and Algology, KULeuven, Leuven, Belgium (Dumoulin) Department of Intensive Care AZ Delta Roeselare, Roeselare, Belgium (Vlaar) Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.) Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands (Hoste, Vandenberghe) Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium (Mosbahi, Siepe) Department of Cardiac Surgery, Inselspital, University Hospital Bern, Bern, Switzerland (Schneider) Adult Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland (Zarbock, Strauss) Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Munster, Munster, Germany (Boehm, Wirth) Department of Cardiovascular Surgery, TUM University Hospital - German Heart Center, TUM School of Medicine & Health, Technical University of Munich, Munich, Germany (Rosenberger) Department of Anesthesiology and Intensive Care Medicine, University Hospital Tubingen, Eberhard Karls University Tubingen, Tubingen, Germany (Thielmann) Department of Thoracic and Cardiovascular Surgery, West-German Heart & Vascular Center Essen at University Duisburg-Essen, Essen, Germany (Dubois) Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, Netherlands (Dubois) Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, Netherlands (Renette) Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium (Renette) Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium (Renette, Opschoor) Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands (Opschoor) Department of Anaesthesiology Amsterdam UMC, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands (Winkel, Hof, Kraan, Bernholz) UtrechtNetherlands Abstract INTRODUCTION: Acute impairment of kidney function after cardiac surgery is common and associated with an increased morbidity and mortality. Ilofotase alfa has demonstrated potential to attenuate renal injury through its immunomodulatory effects. We evaluated the safety and efficacy of ilofotase alfa in preventing renal functional impairment in cardiac surgery patients. METHOD(S): This phase 2, multi-center, randomized, double-blinded, placebo-controlled trial employing a two-arm, parallel-group design randomized adult patients at a high risk of renal functional impairment after on-pump cardiac surgery. Patients with a pre-existent estimated glomerular filtration rate of 25-65 ml/min/1.73m2 scheduled to undergo complex cardiac surgery were eligible. Patients received two intravenous doses (128 mg) of ilofotase alfa or placebo perioperatively. The primary endpoint was the ratio between the highest serum creatinine levels within five days postoperative relative to the pre-operative level (sCrRatio). The secondary endpoint was major adverse kidney events up to day 60 (MAKE60). RESULT(S): In total, 244 patients were randomized of whom 204 received two doses and were included in the trial analysis: 109 patients were treated with ilofotase alfa and 95 received placebo. The mean+/-SD sCrRatio in the ilofotase alfa group was 1.21+/-0.42, compared to 1.27+/-0.50 for placebo (p=0.31). MAKE60 incidence was 15.9% in the ilofotase alfa group and 15.4% in the placebo group (p=0.87). No safety concerns were raised. CONCLUSION(S): Administration of ilofotase alfa did not attenuate short- and longer-term renal function loss in patients at a high risk of renal functional impairment after on-pump cardiac surgery. No safety concerns of ilofotase alfa emerged. TRIAL REGISTRATION: EUCT Number: 2023-505859-45 US IND Number: 117 605 ClinicalTrials.gov ID: NCT06168799. Copyright © 2026. The Author(s). <117> Accession Number 652231233 Title MACE Outcome Definition Heterogeneity and Associated Incidence Rate Variability in Populations with Chronic Diseases: A Test Case based on Patients with Moderately to Severely Active IBD. Source Pharmacoepidemiology and Drug Safety. Conference: ISPEs 2026. Milan Italy. 35(Supplement 3) (no pagination), 2026. Article Number: e70409. Date of Publication: 01 Aug 2026. Author Tesfaye H.; McGrath L.; Wegrzyn L.R.; Pinheiro S.; Patorno E. Institution (Tesfaye, McGrath, Wegrzyn, Pinheiro) AbbVie Inc., North Chicago, IL, United States (Patorno) Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States Publisher John Wiley and Sons Ltd Abstract Background: Major adverse cardiovascular events (MACE) are clinically relevant endpoints used in safety assessment and regulatory decision-making, with trials typically using a 3-point (3P) definition (non-fatal myocardial infarction (MI), non-fatal stroke, cardiovascular death). However, observational studies use non-standardized MACE definitions that may include different outcome events, care settings, and code algorithms, creating substantial variability that complicates cross-study aggregation, comparisons and regulatory and clinical interpretation. Objective(s): To assess MACE incidence rate variability resulting from heterogenous endpoint definitions in published real-world evidence studies compared to a modified 3P MACE definition mimicking the 3P MACE definition used in trials, using a test case based on adult patients with moderately to severely active inflammatory bowel disease (IBD). Method(s): Using Optum's de-identified Market Clarity Data (2021-2025), we identified patients with IBD based on the presence of a prevalent advanced (biologic or small molecule) therapy for IBD plus a prior code for Crohn's disease or ulcerative colitis. We calculated incidence rates (IR) per 1000 person-years (PY) with 95% confidence intervals (CI) for a modified 3P MACE (MI, stroke, or all-cause mortality) reference definition and six alternative definitions from published observational studies: (1) MI, stroke, or heart failure hospitalization (HHF)primary diagnosis position; (2) MI, stroke, or HHF-any diagnosis position; (3) MI, stroke, or unstable angina hospitalization (UA); (4) MI or stroke; (5) MI or UA, and (6) MI, stroke, (UA), coronary revascularization (CR), or transient ischemic attack (TIA). Result(s): Among 73,909 patients with IBD, the MACE IR/1000 PY varied substantially compared to the modified 3P MACE reference [6.51 (95% CI: 6.11-6.91)]. Most alternative definitions resulted in lower IR, ranging from 2.07 (1.80-2.30) for MI or UA to 4.78 (4.43-5.12) for MI, stroke, UA, CR, or TIA. Incidence rates for the other alternative definitions were 2.81 (2.55-3.07) for MI or stroke, 3.34 (3.05-3.62) for MI, stroke, or UA, and 4.24 (3.92-4.56) for MI, stroke, HHF-primary. Notably, the definition using HHF-any position resulted in the highest IR of 7.78 (7.34-8.22). Conclusion(s): In a test case based on IBD patients, MACE incidence was primarily driven by outcome event types and diagnosis position selection. These findings underscore the need for standardized MACE definitions in pharmacoepidemiologic research, as current inconsistencies can lead to disparate safety conclusions and compromise the utility of real-world evidence in regulatory assessments when used to complement RCT data. <118> Accession Number 652230958 Title A Principled Framework for Constructing an External Control Arm Using Real-World Data to Support Long-Term Treatment Effect Estimation in Open-Label Extension Studies. Source Pharmacoepidemiology and Drug Safety. Conference: ISPEs 2026. Milan Italy. 35(Supplement 3) (no pagination), 2026. Article Number: e70409. Date of Publication: 01 Aug 2026. Author Sakhuja S.; Walsh E.; Ke H.; Gehringer C.; Neasham D.E.; Giorgianni F.; Brookhart M.A.; Lash T.L.; da Silva Lima G.P.; Kent S.; Accortt N.; Liu L.; Dhalwani N. Institution (Sakhuja, Walsh, Ke, da Silva Lima, Kent, Accortt, Liu, Dhalwani) Amgen Inc., Thousand Oaks, CA, United States (Gehringer, Neasham, Giorgianni) Amgen Ltd, Uxbridge, United Kingdom (Brookhart) Duke University, Durham, NC, United States (Lash) Emory University, Atlanta, GA, United States Publisher John Wiley and Sons Ltd Abstract Background: In open-label extension (OLE) studies, estimation of long-term treatment effects is often not feasible due to the absence of a concurrent placebo arm. Objective(s): To use a principled framework to construct an external control arm (ECA) from real-world data comparable to a trial placebo arm, enabling estimation of long-term treatment effects using OLE data. Method(s): A framework with two checkpoints was designed to assess the comparability of the ECA with phase 3 trial data: first, by evaluating concordance of baseline characteristics in the ECA with trial data after applying standardized mortality ratio weights and using standardized mean differences (SMDs; criterion: SMD < 0.15) and, second, comparing endpoint event rates over the trial period between the placebo arm and ECA (criterion: overlapping 95% confidence interval for both event rates and hazard ratios). Endpoints meeting both criteria were deemed comparable and therefore eligible for estimating long-term treatment effects. This framework was evaluated using data from the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) trial and ECAs were created in two real-world data sources (UK Clinical Practice Research Datalink Aurum and US Komodo Healthcare claims database) by closely applying the trial eligibility criteria and enrollment period. Long-term treatment effectiveness outcomes included 4-point (4P) major adverse cardiovascular event (MACE; myocardial infarction [MI], stroke, coronary revascularization, and cardiovascular [CV] death), 3-point (3P) MACE (MI, stroke, and CV death), MI, stroke, coronary revascularization, CV death (UK data only), and all-cause death. All-cause death was used in place of CV death for both composite endpoints in US data. Result(s): There were 56,490 and 111,017 patients in UK and US databases, respectively, who met the trial eligibility criteria. After weighting, all SMDs for baseline characteristics were < 0.15 for both ECAs vs trial placebo and treatment arms, separately, establishing baseline comparability. Over the trial time period (median follow-up, 2.2 years), 4P MACE, 3P MACE, MI, stroke, and CV death endpoints were comparable between the trial placebo arm and weighted ECA from UK data, whereas only 3P MACE and MI were comparable between the trial placebo arm and weighted ECA from US data. Conclusion(s): These results suggest that a principled framework can be used to create a trial-like cohort from real-world data to evaluate long-term treatment benefits beyond the trial duration. Data source characteristics, routine clinical practices, endpoint ascertainment, and clinical granularity are critical considerations and may affect comparability as well as final estimation of treatment effects. <119> Accession Number 2049571910 Title Efficacy of serratus anterior plane block on postoperative nausea and vomiting: a meta-analysis of randomized controlled trial. Source Frontiers in Medicine. 13 (no pagination), 2026. Date of Publication: 12 Aug 2026. Author Zeng J.; Li Z.; Gao H.; Ye Y.; Hua J.; Huang D. Institution (Zeng, Li, Gao, Ye, Hua, Huang) Department of Anaesthesiology and Pain Medicine, Jiangnan University Medical Center, No. 2 People's Hospital, Wuxi, China (Zeng, Li, Gao, Hua, Huang) Jiangsu Province Key Laboratory of Anesthesiology and Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, China (Ye) Wuxi School of Medicine, Jiangnan University, Wuxi, China Publisher Frontiers Media SA Abstract Background - Postoperative nausea and vomiting (PONV) still often occurs after surgery, which adversely affects recovery and patient satisfaction. Serratus anterior plane block (SAPB) has been proposed as a regional anesthesia technique that may reduce PONV indirectly by improving postoperative analgesia and decreasing perioperative opioid requirements. Methods - A systematic review and meta-analysis of the randomized controlled trial (RCT) was conducted to evaluate the impact of SAPB on PONV. From its establishment to April 20, 2026, the central register of PubMed, Embase, CNKI and Cochrane controlled trials was searched. Eligible studies include adults who underwent surgery under general anesthesia with a control group (placebo or no intervention). The main results are the incidence of postoperative nausea and vomiting; the secondary results include postoperative opioid consumption, pain score (visual analog scale, VAS), hospitalization time, the time of first rescue analgesia, and the incidence of headache or hypotension. Random effect element analysis was carried out to gather risk differences (RD) and standardized mean differences (SMD) with 95% confidence intervals (CI). Use GRADE to evaluate the certainty of evidence and apply test sequence analysis (TSA) to evaluate robustness. Results - Twenty RCTs involving 1, 651 patients were included. Compared with control treatment, SAPB was associated with a reduced incidence of postoperative nausea (RD = -0.17; 95% CI: -0.23 to -0.11; I2 = 67%; moderate-certainty evidence). SAPB may also reduce postoperative vomiting, although this finding was borderline and should be interpreted cautiously (RD = -0.13; 95% CI: -0.25 to -0.00; I2 = 79%; moderate-certainty evidence). SAPB reduced fentanyl consumption (SMD = -1.08; 95% CI: -1.86 to -0.31) and remifentanil consumption (SMD = -2.14; 95% CI: -3.25 to -1.03), whereas sufentanil consumption was not significantly reduced. SAPB also improved postoperative pain scores, shortened hospital stay, prolonged the time to first rescue analgesia, and reduced headache incidence. Funnel plot inspection and Egger's and Begg's tests did not suggest significant small-study effects for postoperative nausea. Risk-of-bias concerns were mainly related to insufficient reporting of allocation concealment and blinding procedures. Conclusion - SAPB appears to reduce postoperative opioid requirements and improve analgesia in patients undergoing breast and thoracic surgery. These benefits are associated with a reduced incidence of postoperative nausea and may contribute to enhanced recovery. However, the current evidence does not establish an independent direct antiemetic effect of SAPB, and the effect on postoperative vomiting should be interpreted cautiously. Further high-quality RCTs with standardized opioid and antiemetic protocols are needed to clarify the causal pathway between SAPB, opioid reduction, and PONV. Systematic review registration - https://www.crd.york.ac.uk/prospero/CRD420261373467, identifier CRD420261373467. Copyright © 2026 Zeng, Li, Gao, Ye, Hua and Huang. <120> Accession Number 2038654251 Title Single-Stage Computed Tomography Angiography, Percutaneous Coronary Intervention, and Transcatheter Aortic Valve Replacement in an Octogenarian With Femoral Neck Fracture, Non-ST-Elevation Myocardial Infarction, and Severe Aortic Stenosis: A Case Report and Literature Review of Multidisciplinary Approaches. Source Reviews in Cardiovascular Medicine. 27(9) (no pagination), 2026. Article Number: 50145. Date of Publication: 01 Sep 2026. Author Zhang M.; Pan X.; Yang L.; Mu Y.; Jiang B.; Chen T.; Wang J.; Wang L.; Li J.; Liu J.; Zhang Z.; Liu C. Institution (Zhang, Yang) Senior Department of Cardiology, The First Medical Center of PLA General Hospital, Beijing, China (Pan, Mu, Jiang, Chen, Wang, Wang, Li, Liu) Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, Beijing, China (Liu) Senior Department of Anesthesiology, The First Medical Center of PLA General Hospital, Beijing, China (Zhang) Senior Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, China Publisher IMR Press Limited Abstract Geriatric femoral neck fractures are associated with high mortality. Early surgery within 48 hours improves survival, whereas delayed arthroplasty is associated with a 41% increase in mortality. Multimorbidity in this population often prolongs preoperative optimization, thereby exacerbating perioperative risk. Current evidence indicates that 5%-10% of patients with hip fractures have concomitant severe aortic stenosis (AS), which independently increases the risk of anesthesia-related complications. Perioperative acute myocardial infarction further increases mortality risk, making cardiac management a critical challenge. The advent of transcatheter aortic valve replacement (TAVR) has revolutionized care paradigms. Nonetheless, this situation requires multidisciplinary consensus on optimizing the fracture-to-surgery interval, antithrombotic bridging strategies, and concomitant coronary revascularization. Here, we present a case of single-stage aorta-coronary computed tomography angiography (CTA), percutaneous coronary intervention (PCI), and TAVR in an octogenarian with femoral neck fracture, severe AS, and non-ST-elevation myocardial infarction (NSTEMI). This pioneering case is accompanied by a systematic review of contemporary management strategies. Copyright © 2026 The Author(s). <121> Accession Number 2049095687 Title Metabolic syndrome severity and the effects of intensive blood pressure lowering: Results from the STEP randomized trial. Source Hypertension Research. (no pagination), 2026. Date of Publication: 2026. Author Zhao J.; Dong X.; Song Q.; Cai J. Institution (Zhao, Dong) Anzhen Hospital, Capital Medical University, Beijing, China (Song) Hypertension Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease of China, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Cai) Capital Medical University, Beijing, China Publisher Springer Nature Abstract Several clinical trials have shown that intensive systolic blood pressure (SBP) lowering confers cardiovascular benefits. However, whether baseline metabolic syndrome (MetS) severity modifies these benefits and risks remains unclear. This post hoc analysis of the STEP trial included 8231 participants with complete MetS severity data. Baseline MetS severity was quantified using an age-, sex-, and ethnicity-specific MetS scoring model and analyzed as tertiles and continuously. The primary outcome was a composite of stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularization, atrial fibrillation, and cardiovascular death. Cox models and restricted cubic spline analyses were used to assess treatment-effect heterogeneity. During a median follow-up of 3.32 years, intensive SBP lowering reduced the risk of the primary outcome compared with standard treatment. The absolute incidence of the primary outcome and major adverse cardiac events was highest in the highest MetS tertile. Across MetS tertiles, event rates were lower in the intensive-treatment group, with the largest reduction in the middle tertile for the primary outcome (Q2: HR, 0.66; 95% CI, 0.44-0.99). No significant treatment-by-MetS interaction was observed in tertile-based or spline analyses. For safety outcomes, no significant treatment-by-MetS tertile interaction was observed, although hypotension was numerically more frequent with intensive treatment among participants in the highest MetS tertile. These findings suggest that baseline MetS severity identifies patients with higher absolute cardiovascular risk but does not significantly modify the relative efficacy of intensive SBP lowering. Careful monitoring for treatment-related hypotension may be warranted, particularly among patients with higher metabolic burden. (Figure presented.) Copyright © The Author(s), under exclusive licence to The Japanese Society of Hypertension 2026. <122> Accession Number 2049573335 Title The effect of ultrasound-guided lung recruitment maneuvers on postoperative atelectasis: a systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Cardiovascular Medicine. 13 (no pagination), 2026. Article Number: 1890372. Date of Publication: 12 Aug 2026. Author Bao Y.; Lin H.; Tang B.; Zhang K.; Chen B. Institution (Bao, Tang, Chen) Department of Ultrasound Medicine, The First People's Hospital of Taizhou, Taizhou, China (Lin) Department of Emergency Medicine, The First People's Hospital of Taizhou, Taizhou, China (Zhang) Department of Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China Publisher Frontiers Media SA Abstract Background - Postoperative atelectasis is common after general anesthesia. Lung ultrasound may help individualize recruitment maneuvers, but the certainty and generalizability of the evidence remain uncertain. Methods - We searched PubMed, Embase, Scopus, and the Cochrane Library through March 25, 2026 for randomized controlled trials (RCTs) of intraoperative ultrasound-guided lung recruitment maneuvers in adults undergoing elective surgery. The primary outcome was postoperative atelectasis assessed by lung ultrasound. Secondary outcomes were postoperative pulmonary complications (PPCs) and length of hospital stay. A random-effects model was used to calculate pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results - Ten RCTs involving 1, 076 patients were included. Ultrasound-guided lung recruitment maneuvers were associated with a lower incidence of postoperative atelectasis (RR, 0.64, 95% CI, 0.52 to 0.77, P < 0.0001, I2 = 50.8%). The effect appeared clearer in abdominal surgery than in thoracic surgery. PPCs were not significantly reduced in the primary analysis (RR, 0.70, 95% CI, 0.48 to 1.01, P = 0.0571, I2 = 59.2%), and length of hospital stay was statistically but modestly shorter (MD -0.56 days, 95% CI -0.94 to -0.18, P = 0.0039, I2 = 67.7%). Conclusion - Ultrasound-guided lung recruitment maneuvers may reduce postoperative atelectasis, especially in abdominal surgery, but the certainty of evidence is limited by the small evidence base, residual clinical and statistical heterogeneity, operator dependency of lung ultrasound, and inconsistent outcome definitions. The modest reduction in hospital stay should be interpreted cautiously. Larger standardized trials are needed before broad clinical implementation can be recommended. Copyright © 2026 Bao, Lin, Tang, Zhang and Chen. <123> Accession Number 2049155701 Title Tailoring Pediatric Cardiac Rehabilitation to the Underlying Cardiac Disease. Source Current Treatment Options in Pediatrics. 12(1) (no pagination), 2026. Article Number: 31. Date of Publication: 01 Dec 2026. Author Ward K.; McMahon M.; Vogel C.; Shekaran M.; Gambetta K.; McNulty D.C.; Peters K.; Allen K.Y.; Hauck A.L. Institution (Ward, McMahon, Vogel, Shekaran, Gambetta, McNulty, Peters, Allen, Hauck) Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Cardiology, 225 E Chicago Ave, Chicago, IL, United States Publisher Springer Science and Business Media Deutschland GmbH Abstract Purpose of Review: Pediatric cardiac rehabilitation (PCR) is an increasingly important component of care for children and adolescents with congenital, inherited, and acquired cardiac disease. Advances in medical and surgical therapies have improved survival, creating a growing population with chronic cardiovascular morbidity, including exercise intolerance, frailty, neurodevelopmental challenges, and impaired quality of life. This review summarizes the principles of PCR and highlights disease-specific approaches. Recent Findings: Contemporary evidence supports the safety and efficacy of structured exercise interventions in most pediatric cardiac populations when appropriately prescribed and monitored. Exercise training improves cardiovascular fitness, vascular function, skeletal muscle health, metabolic outcomes, and quality of life. Emerging data demonstrate benefits of PCR in congenital heart disease, including single ventricle physiology and repaired tetralogy of Fallot, as well as cardiomyopathy, heart failure, heart transplantation, and pulmonary hypertension. Recent studies have challenged historical exercise restrictions in conditions such as hypertrophic cardiomyopathy and channelopathies, supporting individualized risk assessment and shared decision-making. Increasing recognition of frailty, neurodevelopmental impairment, psychosocial comorbidity, and family influences have expanded the scope of PCR. Hybrid and home-based rehabilitation models may improve access and participation. Summary: PCR is a safe, effective, and underutilized therapy that addresses the complex physical, developmental, and psychosocial needs of children with cardiac disease. Programs should be individualized based on cardiac physiology, functional limitations, and developmental stage, incorporating aerobic and resistance training, psychosocial support, family engagement, and lifelong physical activity promotion. Despite growing evidence of improvements in exercise capacity, function, frailty, and quality of life, barriers to implementation remain. Expansion of access, development of disease-specific guidelines, and multicenter outcomes research are needed to establish PCR as a standard component of pediatric cardiovascular care. Copyright © The Author(s) 2026. <124> Accession Number 2049758282 Title Cardiovascular and renal outcomes of GLP-1 receptor agonists in type 2 diabetes mellitus: a systematic review and meta-analysis. Source European Heart Journal - Quality of Care and Clinical Outcomes. 12(6) (pp 980-994), 2026. Date of Publication: 01 Sep 2026. Author Ahmed M.; Hashmi T.M.; Shahzad M.; Zia R.; Ashraf H.; Ahmed R.; Rashid M.; Greene S.J.; Mentz R.J.; Fudim M.; Fonarow G.C.; Rana J.S. Institution (Ahmed, Hashmi, Zia, Ashraf) Department of Cardiology, Rawalpindi Medical University, Rawalpindi, Pakistan (Shahzad) Department of Cardiology, Dow University of Health Sciences, Karachi, Pakistan (Ahmed) Department of Cardiology, Royal Brompton Hospital, London, United Kingdom (Ahmed) National Heart and Lung Institute, Imperial College London, London, United Kingdom (Rashid) Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, David Weatherall building, University Road, Keele, United Kingdom (Greene, Mentz, Fudim) Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, United States (Greene, Mentz, Fudim) Division of Research, Duke Clinical Research Institute, 2301 Erwin Road, Durham, NC, United States (Fonarow) Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, United States (Rana) Division of Cardiology, Kaiser Permanente Northern California, 1 Kaiser Plaza, Oakland, CA, United States (Rana) Division of Research, Kaiser Permanente Northern California, 1 Kaiser Plaza, Oakland, CA, United States Publisher Oxford University Press Abstract Aims: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a foundational therapeutic option for type 2 diabetes mellitus (T2DM), offering glycaemic control and cardiovascular benefits. This systematic review and meta-analysis evaluate the impact of GLP-1RAs on cardiovascular outcomes in patients with T2DM. Methods and Results: We conducted a comprehensive search of PubMed, Embase, and Cochrane Library up to 31 March 2025, for randomized controlled trials (RCTs) comparing GLP-1RAs with placebo in T2DM patients. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Twenty RCTs involving 83 004 patients were included. GLP-1RAs significantly reduced the risk of major adverse cardiovascular events (RR 0.87, 95% CI 0.83-0.92), all-cause death (RR 0.89, 95% CI 0.84-0.93), cardiovascular death (RR 0.88, 95% CI 0.81-0.94), myocardial infarction (RR 0.87, 95% CI 0.79-0.96), stroke (RR 0.88, 95% CI 0.81-0.96) and composite renal outcome (RR 0.80, 95% CI 0.73-0.88) compared to placebo. In addition, a trend of reduction in heart failure hospitalizations (RR 0.93, 95% CI 0.85-1.01), and coronary revascularization (RR = 0.87, 95% CI 0.74 to 1.01) was observed with GLP-1 RAs without reaching statistical significance. Conclusion(s): GLP-1RAs are associated with improved cardiovascular outcomes in patients with T2DM. These findings support current guideline recommendations and highlight their cardioprotective benefits beyond glycaemic control in patients with T2DM. 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 journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) <125> Accession Number 2049587514 Title Efficacy and safety of intravenous methadone for pain management in cardiac surgery: a systematic review and meta-analysis. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1785811. Date of Publication: 10 Aug 2026. Author Li W.; Ye Y.; Zhou J.; Ji Y.; Gong Z. Institution (Li) School of Basic Medical Sciences & School of Nursing, Chengdu University, Chengdu, China (Ye) Anesthesia Surgery Center, Affiliated Hospital of Chengdu University, Chengdu, China (Zhou, Ji, Gong) Department of Pain Medicine, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, China Publisher Frontiers Media SA Abstract Objectives - To evaluate the analgesic efficacy and safety of intraoperative intravenous methadone compared with conventional opioid-based analgesic regimens in adult patients undergoing cardiac surgery, using data derived from randomized controlled trials and retrospective cohort studies. Methods - A comprehensive retrieval of scholarly literature was implemented in Embase, MEDLINE, PubMed, Web of Science, and the Cochrane Library until November 28, 2025. Randomized controlled trials and retrospective cohort studies comparing intraoperative methadone with other opioid analgesics for pain management in patients undergoing cardiac surgical procedures were eligible for inclusion in this meta-analysis. Quality of included studies was independently evaluated by two reviewers, with randomized controlled trials assessed using the Cochrane Risk of Bias tool (version 2.0) and cohort studies appraised using the Newcastle-Ottawa Scale. The primary outcome was postoperative pain intensity at 24 h. Secondary outcomes included postoperative 24-h opioid consumption, time to first rescue morphine administration, time to extubation, ICU length of stay, hospital length of stay, and reported adverse outcomes, including postoperative nausea, vomiting, and postoperative reintubation. Results - Eight studies, including 4 randomized controlled trials and 4 retrospective cohort studies, involving 10, 203 patients were included. Compared with conventional opioid analgesics, intraoperative methadone was associated with lower postoperative 24-h pain intensity (SMD, -0.44; 95% CI - 0.71 to -0.17; p = 0.001, I2 = 77%). Methadone was also associated with lower postoperative 24-h opioid consumption in the primary analysis (SMD, -0.72; 95% CI, -1.35 to -0.23; p = 0.02; I2 = 97%), No statistically significant differences were observed for overall time to first rescue morphine administration, time to extubation, ICU length of stay, or hospital length of stay. In randomized controlled trials, methadone was not associated with significant differences in postoperative nausea or vomiting, whereas reintubation was less frequent in the methadone group (RR, 0.75; 95% CI, 0.58 to 0.96; p = 0.02). In retrospective cohort studies, postoperative nausea and vomiting were slightly less frequent with methadone (RR, 0.96; 95% CI, 0.93 to 1.00; p = 0.04), but the magnitude of this association was small. Conclusion - In adult patients undergoing cardiac surgery, intraoperative intravenous methadone may be associated with lower pain intensity and reduced opioid consumption during the first 24 h after surgery. However, substantial heterogeneity, inconsistent findings between randomized and retrospective studies, and incomplete reporting of key safety outcomes limit the certainty of the evidence. These findings should be interpreted cautiously, and further adequately powered randomized trials with standardized analgesic protocols and safety monitoring are needed. Systematic review registration - https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251237093, identifier (CRD420251237093). Copyright © 2026 Li, Ye, Zhou, Ji and Gong. <126> Accession Number 2049758593 Title Validating national registry data for randomized trials: comparison of registry-derived cardiovascular events with and without adjudication in the BETAMI-DANBLOCK trial. Source European Heart Journal - Quality of Care and Clinical Outcomes. 12(6) (pp 903-911), 2026. Date of Publication: 01 Sep 2026. Author Holmager T.L.F.; Kristensen A.M.D.; Fagerland M.W.; Atar D.; Hecht Olsen M.; Bakken A.; Munkhaugen J.; Prescott E. Institution (Holmager, Kristensen, Prescott) Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, Copenhagen, Denmark (Fagerland) Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway (Atar, Bakken) Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway (Atar) Faculty of Medicine, University of Oslo, Oslo, Norway (Hecht Olsen) Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Hecht Olsen) Department of Internal Medicine 1, Holbaek Hospital, Holbaek, Denmark (Munkhaugen) Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway (Munkhaugen) Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway Publisher Oxford University Press Abstract Aims: Registry-based randomized clinical trials are increasingly applied in clinical research, providing advantages in feasibility and data capture. However, registry-based data may introduce bias through misclassification or missing information. Methods and Results: In the BETAMI-DANBLOCK trial, 5574 patients with myocardial infarction (MI) and no heart failure were randomized to beta-blocker or no beta-blocker therapy. The primary endpoint events (all-cause mortality, MI, ischemic stroke, heart failure, unplanned coronary revascularization, and malignant ventricular arrhythmias) were identified from the Danish/Norwegian national patient registries, self-reported questionnaires, and medical records. All registry-identified events, except all-cause mortality, underwent blinded adjudication. We compared non-adjudicated and adjudicated events by calculating incidence rates and hazard ratios (HRs) for beta-blocker therapy vs. controls. National registries captured 99.7% of primary endpoint events registered by self-report and medical records. Of the primary endpoint events identified through the registries, 75% were confirmed by adjudication (incidence rate 6.23 vs. 4.43/100 person-years). The confirmation rate was lower during the first 6 months and varied by event type (from 92% for ischaemic stroke to 45% for unplanned coronary revascularizations and heart failure). Estimated treatment effects were consistent for the primary endpoint with non-adjudicated and adjudicated events (HR 0.88, 95% confidence interval (CI): 0.78-0.98 and HR 0.85, 95% CI: 0.75-0.98, respectively), with no apparent differences across event types except for heart failure and revascularization. Conclusion(s): Registry data provided effect estimates of beta-blockers comparable to adjudicated data. However, adjudication substantially reduced the number of cardiovascular endpoint events and event-specific misclassification appeared, particularly during the first months after the index event. Trial registration number: BETAMI-DANBLOCK ClinicalTrials.gov numbers, NCT03646357 and NCT03778554 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 journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) <127> Accession Number 2049592248 Title Preoperative and postoperative ultrasound guided intercostal nerve blockade on postoperative analgesia in patients undergoing video assisted thoracic surgery (VATS): a prospective randomized comparative study. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1825123. Date of Publication: 2026. Author Xie N.; Luo L.; Zhu Y.; Zhu M.; Wang X. Institution (Xie, Zhu, Zhu, Wang) Fudan University Shanghai Cancer Center, Shanghai, China (Luo) Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China Publisher Frontiers Media SA Abstract Objectives - Ultrasound-guided intercostal nerve block (ICNB) is an effective modality for alleviating pain after video-assisted thoracic surgery (VATS). However, the optimal timing for its administration remains controversial. This study aimed to compare the analgesic efficacy of preoperative versus postoperative ICNB in patients undergoing VATS. Methods - A total of 172 adult patients undergoing VATS were randomized into two parallel groups: the pre-ICNB group (preoperative ultrasound-guided ICNB, n = 88) and the post-ICNB group (postoperative ultrasound-guided ICNB, n = 84). The primary outcome was the incidence of at least one episode of moderate-to-severe pain at rest (Numeric Rating Scale [NRS] score > 4) during the first 24 h postoperatively. Secondary outcomes included NRS scores during coughing, perioperative opioid consumption, sleep quality, and the incidence of postoperative complications. Results - The incidence of moderate-to-severe resting pain during the first 24 h postoperatively was significantly lower in the post-ICNB group than in the pre-ICNB group (11.9% vs. 28.4%, P < 0.05). Both static (at rest) and dynamic (during coughing) NRS scores were significantly lower in the post-ICNB group at 4, 6 and 8 h postoperatively (P < 0.05); however, comparable pain scores were observed upon admission to the post-anesthesia care unit (PACU) and at 2, 24, and 48 h postoperatively (P > 0.05). Cumulative postoperative opioid consumption at 24 and 48 h was significantly lower in the post-ICNB group (P < 0.01). Furthermore, patients in the post-ICNB group exhibited superior sleep quality during the first two postoperative nights (P < 0.01). No significant differences were observed in total (intraoperative + postoperative) opioid consumption, overall recovery quality, or surgical/anesthetic complications. Conclusion - Postoperative ICNB provides superior early postoperative analgesia, reduces postoperative opioid requirements, and improves sleep quality compared with preoperative ICNB. These findings suggest that postoperative administration is a more effective strategy for acute pain management following VATS. Clinical trial registration - https://www.chictr.org.cn/showproj.aspx?proj=183278, identifier ChiCTR2300079183. Copyright © 2026 Xie, Luo, Zhu, Zhu and Wang. <128> Accession Number 652233769 Title External wrapping of the ascending aorta versus ascending aorta replacement: Systematic review and meta-analysis. Source Surgery. (pp 110538), 2026. Date of Publication: 15 Aug 2026. Author Dell'Aquila M.; Sherman N.; O'Connor K.; Baudo M.; Tejada B.; Falco G.; Kola I.; Ali A.; Vovsha M.; Kiridly A.; Tohme S.; Lester J.; Calafiore A.M.; Katsavrias K.; Prapas S.; Manetta F.; Iribarne A.; Newman J.; Patel N.; Kalimi R.; Pupovac S.; Jarral O.A.; Brinster D.R. Institution (Dell'Aquila, Sherman, O'Connor, Tejada, Kola, Ali, Vovsha, Kiridly, Tohme, Manetta, Iribarne, Newman, Patel, Kalimi, Pupovac, Jarral, Brinster) Northwell Health, Cardiovascular Institute, New York, NY (Baudo) Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA, United States (Falco) Cardiology Unit, University Hospital Consortium Polyclinic of Bari, Bari, Italy (Lester) Health Sciences Library, Long Island Jewish Medical Center, Northwell Health, New York, NY (Calafiore, Katsavrias, Prapas) 1st Department of Cardiac Surgery, Henry Dunant Hospital, Athens, Greece Abstract BACKGROUND: In the treatment of a moderately dilated ascending aorta, external wrapping of the ascending aorta may represent an alternative to the gold standard ascending aorta replacement. Concerns regarding the safety and long-term durability of external wrapping of the ascending aorta have limited its widespread adoption. METHOD(S): We conducted a systematic review and meta-analysis comparing external wrapping of the ascending aorta with ascending aorta replacement. The primary outcome was 30-day mortality, defined as 30-day and/or in-hospital mortality, and midterm mortality, as reported by the source studies. Secondary outcomes included intensive care unit and hospital length of stay, cardiopulmonary bypass time, cardiac crossclamp time, reoperation for bleeding, stroke, acute kidney injury, wound infection, concomitant surgeries, and midterm outcomes. Between-group differences were quantified using standardized mean difference. Effect estimates were expressed as odds ratios for binary outcomes, incidence rate ratios for time-dependent mortality, and standardized mean differences for continuous outcomes, each with 95% confidence intervals. RESULT(S): Eight comparative studies comprising 851 patients were identified. A total of 433 patients (50.9%) underwent external wrapping of the ascending aorta, and 418 (49.1%) underwent ascending aorta replacement. The mean follow-up duration was 3.9 years (95% confidence interval, 1.8-8.4 years). No statistically significant differences were observed in 30-day mortality (odds ratio, 0.61; 95% confidence interval, 0.24-1.56), midterm mortality (incidence rate ratio, 0.97; 95% confidence interval, 0.57-1.66), acute kidney injury (odds ratio, 0.66; 95% confidence interval, 0.22-1.96), stroke (odds ratio, 0.67; 95% confidence interval, 0.23-1.93), wound infection (odds ratio, 1.37; 95% confidence interval, 0.41-4.53), concomitant aortic valve replacement (odds ratio, 0.92; 95% confidence interval, 0.42-2.00), coronary artery bypass grafting (odds ratio, 0.86; 95% confidence interval, 0.37-1.99), mitral valve procedures (odds ratio, 0.71; 95% confidence interval, 0.20-2.56), reoperation for bleeding (odds ratio, 0.48; 95% confidence interval, 0.15-1.58), proximal ascending aorta diameter (standardized mean difference, 0.19; 95% confidence interval, -0.21 to 0.59) or midascending aorta diameter at follow-up (standardized mean difference, -0.53; 95% confidence interval, -1.67 to 0.60). External wrapping of the ascending aorta was associated with shorter cardiopulmonary bypass time (unweighted mean absolute difference, 42.4 minutes; standardized mean difference, -2.46; 95% confidence interval, -3.49 to -1.43), crossclamp time (unweighted mean absolute difference, 30.6 minutes; standardized mean difference, -2.12; 95% confidence interval, -3.18 to -1.07), intensive care unit length of stay (unweighted mean absolute difference, 22.6 hours; standardized mean difference, -0.58; 95% confidence interval, -0.81 to -0.36), and hospital length of stay (unweighted mean absolute difference, 2.4 days; standardized mean difference, -0.36; 95% confidence interval, -0.63 to -0.10). CONCLUSION(S): Thirty-day and midterm mortality did not significantly differ between external wrapping of the ascending aorta and ascending aorta replacement. In addition, external wrapping of the ascending aorta was associated with shorter cardiopulmonary bypass and crossclamp times and reduced intensive care unit and hospital length of stay. However, this study did not establish the clinical equivalence of external wrapping of the ascending aorta. Ascending aorta replacement remains the gold standard surgical technique for a moderately dilated ascending aorta. The retrospective design, limited follow-up, heterogeneous patient selection, and inconsistent outcomes reporting of the included studies limit the applicability of these findings to clinical practice. Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved. <129> Accession Number 2038638896 Title EFFECT OF GENERAL AND SPINAL ANESTHESIA ON POSTOPERATIVE MYOCARDIAL INJURY IN ELDERLY PATIENTS UNDERGOING HIP FRACTURE SURGERY: A RANDOMIZED STUDY. Source Turk Geriatri Dergisi. 29(3) (pp 358-367), 2026. Date of Publication: 2026. Author Ayik M.B.; Turk H.S.; Duymaz I.; Altinay M.; Kilinc L.; Sayin P.; Cinar A.S.; Oba S. Institution (Ayik, Turk, Duymaz, Altinay, Kilinc, Sayin, Cinar, Oba) Sisli Hamidiye Etfal Training and Research Hospital, Anesthesiology and Reanimation, Istanbul, Turkey Publisher Turkish Geriatrics Society Abstract Introduction: Postoperative myocardial injury following non-cardiac surgery is a clinically relevant complication in elderly patients and is related to worse postoperative outcomes. This study investigated whether anesthesia technique affects the development of myocardial injury after hip surgery in elderly patients. Material(s) and Method(s): This prospective randomized single-blind study included 100 patients older than 65 years with hip fractures who were scheduled for hip fracture surgery classified as American Society of Anesthesiologists physical status II-III who were scheduled for hip surgery. Patients received either general or spinal anesthesia according to group allocation. Age, sex, baseline hemodynamic parameters, intraoperative heart rate, and mean arterial pressure values were monitored at 10-minute intervals. Troponin T levels were assessed before surgery and repeatedly during the first 72 postoperative hours. Intensive care unit stay, hospital stay, postoperative complications, and 30-day mortality were also evaluated. Result(s): The general and spinal anesthesia groups showed no significant difference in MINS incidence, troponin changes, mortality, hospital stay, or ICU stay. Conclusion(s): General and spinal anesthesia were related to similar postoperative myocardial injury rates in elderly patients undergoing hip surgery. Copyright © 2026, Turkish Geriatrics Society. All rights reserved. <130> Accession Number 2049583926 Title Efficacy and hemodynamic safety of perioperative dexmedetomidine for the prevention of postoperative delirium in elderly patients undergoing cardiac surgery: an updated systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Neurology. 17 (no pagination), 2026. Article Number: 1895312. Date of Publication: 2026. Author Li A.; Wu H.; Zhang K.; Ying J. Institution (Li) Department of thoracic surgery, The First People's Hospital of Taizhou, Taizhou, China (Wu, Ying) Department of Emergency Medicine, The First People's Hospital of Taizhou, Taizhou, China (Zhang) Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Publisher Frontiers Media SA Abstract Background - Postoperative delirium (POD) is a common and clinically important complication after cardiac surgery in older adults. We performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and hemodynamic safety of perioperative dexmedetomidine for POD prevention in older adults undergoing cardiac surgery. Methods - We searched PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from inception through July 12th, 2026 for RCTs comparing perioperative dexmedetomidine with placebo or alternative sedative /analgesic regimens in elderly patients aged 60 years or older, or in extractable elderly subgroups, undergoing cardiac surgery. Primary outcomes were POD incidence and delirium duration. Secondary outcomes included length of intensive care unit (ICU) stay, length of hospital stay, and the risk of bradycardia and hypotension. Results - Fifteen RCTs involving 3, 274 patients were included. Perioperative dexmedetomidine was associated with a lower incidence of POD (Risk Ratio [RR] 0.70, 95% Confidence Interval [CI] 0.56 to 0.86, p = 0.001, I2 = 19%; GRADE: moderate certainty) and shorter duration of delirium among patients with POD (Mean Difference [MD] -1.12 days, 95% CI -1.89 to -0.35, p = 0.01, I2 = 83%; GRADE: low certainty). The apparent benefit was more evident in active-comparator trials than in placebo/saline-controlled trials, but this comparator-dependent pattern should not be interpreted as proof of a uniform neuroprotective effect. However, dexmedetomidine was associated with increased bradycardia (RR 2.08, 95% CI 1.31 to3.31, p = 0.0019, I2 = 0%; GRADE: low certainty). No significant differences were observed for length of ICU stay, length of hospital stay, or hypotension. Conclusion - Perioperative dexmedetomidine may reduce POD incidence in selected older cardiac surgery patients, particularly when compared with selected active sedative or analgesic regimens. However, the certainty of evidence was moderate, and the effect was less clear in saline/placebo-controlled trials. Evidence for delirium duration was based on few affected patients, showed substantial heterogeneity, and should not drive the main clinical conclusion. Dexmedetomidine increased reported bradycardia, and clinical use should be individualized with careful hemodynamic monitoring. Systematic review registration - https://osf.io/f6nwu Copyright © 2026 Li, Wu, Zhang and Ying. <131> Accession Number 2049707721 Title Percutaneous left atrial appendage occlusion versus oral anticoagulation in nonvalvular atrial fibrillation. Source Trends in Cardiovascular Medicine. (no pagination), 2026. Date of Publication: 2026. Author Odeh A.; Shubietah A.; Salah M.R.; Itraish J.; Jiao T.; Foy A.J.; Mandrola J.; Ruzieh M. Institution (Odeh) Department of Internal Medicine, Northwestern Memorial Hospital, Chicago, IL, United States (Odeh, Ruzieh) Feinberg School of Medicine, Northwestern University, Chicago, IL, United States (Shubietah) Department of Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, United States (Salah) University of Chicago Medical Center, Chicago, IL, United States (Salah) Endeavor Health - NorthShore Hospitals, Evanston, IL, United States (Itraish) Department of Biology, University of Florida, Gainesville, FL, United States (Jiao) Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States (Foy) Beebe Hospital, Lewes, DE, United States (Mandrola) Baptist Health Louisville, Louisville, KY, United States (Ruzieh) Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, United States Publisher Elsevier Inc. Abstract Percutaneous left atrial appendage occlusion (pLAAO) has emerged as an alternative to oral anticoagulation (OAC) for stroke prevention in atrial fibrillation, yet no individual trial has been powered to detect meaningful differences in ischemic stroke or systemic embolism. We evaluated the comparative efficacy and safety of pLAAO vs OAC in nonvalvular atrial fibrillation using pooled analysis of randomized controlled trials. We searched PubMed, Embase, and Cochrane Central through April 3, 2026. Risk ratios were pooled using a random-effects model. Bayesian and trial sequential analyses were performed to assess non-inferiority using a prespecified margin of RR = 1.40, and power of available evidence. The primary efficacy endpoint was ischemic stroke or systemic embolism; primary safety endpoints were major bleeding and hemorrhagic stroke. Seven RCTs enrolling 7353 patients were included. Compared with OAC, pLAAO was associated with significantly more ischemic stroke or systemic embolism (3.3% vs 2.0%; RR 1.48, 95% CI 1.06-2.07). Hemorrhagic stroke was numerically lower with pLAAO but non-significant (0.6% vs 0.9%; RR 0.65, 95% CI 0.39 - 1.07). Major bleeding did not differ (8.3% vs 8.1%; RR 0.98, 95% CI 0.84-1.15). Bayesian analysis yielded a posterior probability of non-inferiority of 45.3%, failing the prespecified margin. Trial sequential analysis confirmed insufficient evidence to establish non-inferiority, and the major bleeding Z-curve entered the futility zone. Compared with OAC, pLAAO was not non-inferior for the outcome of ischemic stroke or systemic embolism, and did not significantly reduce major bleeding, though hemorrhagic stroke was numerically lower with pLAAO. Copyright © 2026 Elsevier Inc. <132> Accession Number 2049140266 Title Effects of remimazolam vs. propofol on plasma neurofilament light chain and postoperative delirium in frail elderly patients undergoing major non-cardiac surgery: a prospective, randomized, assessor-blinded controlled trial. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 571. Date of Publication: 01 Dec 2026. Author He X.-Y.; Zhang S.-H.; Xie L.; Bao J.-T.; An M.-Z.; Li Z.-P.; Zhou Q.-H.; Jia X.-Y. Institution (He, Xie, Bao) Anesthesia Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou city, China (He, Zhang, Xie, Bao, An, Li, Jia) Department of Anesthesiology and Pain Medicine, Jiaxing First Hospital, No. 1882, Zhonghuan South Road, Zhejiang Province, Jiaxing City, China (Zhou) Department of Anesthesiology and Pain Medicine, the Second Affiliated Hospital of Jiaxing University, 1518 North Ring City Road, Zhejiang Province, Jiaxing City, China Publisher BioMed Central Ltd Abstract Background: The relationship between remimazolam administration and early neurological complications, particularly postoperative delirium (POD), in elderly patients undergoing major non-cardiac surgery remains unclear. Plasma neurofilament light chain (NfL) is a potential biomarker for central nervous injury. This study aims to compare the effects of remimazolam and propofol on postoperative plasma NfL concentrations and the incidence of POD in frail elderly patients undergoing major non-cardiac surgery. Method(s): This was a single-center randomized controlled trial on frail patients who underwent non-cardiac surgery. Participants were randomized to receive either Remimazolam (Group R) or Propofol (Group P) for induction and maintenance of general anesthesia, with all other anesthetic management standardized. The primary outcome was plasma NfL concentration on postoperative day 1, and the incidence of POD was assessed as a key clinical secondary endpoint. The secondary endpoint encompassed the incidence of hypotension during the anesthesia induction, as well as the time-weighted average of the area under the curve below the baseline for mean arterial pressure (AUB-MAP). Result(s): A total of 123 patients were enrolled. No significant differences were observed in plasma NfL concentrations on postoperative day 1 between Group R and Group P (123.3[83.6-198.2] vs. 149.0[102.0-226.6], pg/ml, P = 0.186, respectively); and similarly, no differences in POD were found between Group R and Group P (6/62[9.7%] vs. 7/61[11.5%], unadjusted odds ratio 0.827, 95% CI 0.261-2.62, P = 0.746). In the secondary outcomes, the incidence of hypotension during the anesthesia induction in Group R was significantly decreased (3[4.8%] vs. 19[31.3%], P < 0.001). And the time-weighted average of AUB-MAP in Group R was higher than Group P (-21.3 +/- 10.7 vs. -25.4 +/- 9.6, mmHg, P = 0.03). Conclusion(s): In frail elderly patients undergoing major non-cardiac surgery, remimazolam group shows no significant difference from propofol in plasma NfL levels or POD incidence on the first day. Due to its advantage in maintaining hemodynamic stability, remimazolam may be a safer anesthetic option for frail patients sensitive to hemodynamic changes. Trial registration: Chinese Clinical Trials Registry, ChiCTR2400093862. Copyright © The Author(s) 2026. <133> Accession Number 2049769045 Title Effect of cerebral embolic protection devices on TAVI outcomes: a network meta-analysis of randomized controlled trials. Source Hellenic Journal of Cardiology. (no pagination), 2026. Date of Publication: 2026. Author Theodoropoulou T.; Vythoulkas-Biotis N.; Apostolos A.; Ktenopoulos N.; Drakopoulou M.; Synetos A.; Tsalamandris S.; Latsios G.; Tsioufis K.; Toutouzas K. Institution (Theodoropoulou, Apostolos, Ktenopoulos, Drakopoulou, Synetos, Tsalamandris, Latsios, Tsioufis, Toutouzas) Unit of Structural Heart Diseases and Valvulopathies, First Department of Cardiology, Hippokration General Hospital, School of Medicine, National and Kapodistrian University, Athens, Greece (Vythoulkas-Biotis) Third Department of Cardiology, Sotiria Chest Diseases Hospital, School of Medicine, National and Kapodistrian University, Athens, Greece (Apostolos) Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom Publisher Hellenic Cardiological Society <134> Accession Number 2049137074 Title 'Aspirin versus ticagrelor for the management after coronary revascularization - a systematic review and meta-analysis of randomised trials'. Source BMC Cardiovascular Disorders. 26(1) (no pagination), 2026. Article Number: 811. Date of Publication: 01 Dec 2026. Author Regmi D.R.; Regmi S.; Upreti S.; Gautam N. Institution (Regmi) Nepalese Army Institute of Health Sciences (NAIHS), Bhandarkhal, Syanobharyang, Kathmandu, Nepal (Regmi, Upreti) Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal (Gautam) Gulmi Durbar Basic Hospital, Gulmi, Nepal Publisher BioMed Central Ltd Abstract Objective: To compare the efficacy and safety of ticagrelor monotherapy versus aspirin monotherapy in patients with coronary artery disease undergoing coronary revascularization. Method(s): We conducted a systematic review and meta-analysis of RCTs comparing ticagrelor monotherapy with aspirin monotherapy after PCI or CABG. MEDLINE, Embase, Cochrane Central, Scopus, ClinicalTrials.gov and Google Scholar were searched up to 19th January 2026. The primary outcome was major adverse cardiovascular events (MACE), a composite of all-cause mortality, myocardial infarction and stroke. Secondary outcomes included all-cause mortality, myocardial infarction, stroke, major bleeding, repeat revascularization and stent thrombosis. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model with restricted maximum likelihood estimation and Knapp-Hartung adjustment. Result(s): Five randomised trials involving 25,994 participants were included, of whom 12,998 received ticagrelor monotherapy and 12,996 received aspirin monotherapy. Ticagrelor monotherapy was associated with a significantly lower risk of MACE than aspirin monotherapy (RR 0.86, 95% CI 0.78 to 0.95; p = 0.012; I2 = 0%). All-cause mortality was also reduced with ticagrelor (RR 0.86, 95% CI 0.77 to 0.97; p = 0.023; I2 = 0%). No significant differences were observed for myocardial infarction (RR 0.87, 95% CI 0.70 to 1.07; p = 0.138; I2 = 0%), stroke (RR 1.01, 95% CI 0.85 to 1.19; p = 0.913; I2=0%), major bleeding (RR 1.00, 95% CI 0.84 to 1.20; p = 0.976; I2 = 0%), repeat revascularization (RR 0.89, 95% CI 0.58 to 1.37; p = 0.452; I2 = 45.8%) or stent thrombosis (RR 0.88, 95% CI 0.20 to 3.90; p = 0.481; I2 = 0%). Conclusion(s): Ticagrelor monotherapy was associated with a potential reduction in MACE and all-cause mortality compared with aspirin monotherapy after coronary revascularisation, without increasing major bleeding. However, these findings were driven primarily by PCI trials, particularly the GLOBAL LEADERS and GLASSY trial program, and should be interpreted cautiously because PCI and CABG populations were analyzed together. Trial registratrion: CRD420261286239 Copyright © The Author(s) 2026. <135> Accession Number 2049743633 Title Candida bloodstream infection in left ventricular assist device recipients: Case series and review of the literature. Source Medical Mycology. 64(9) (no pagination), 2026. Article Number: myag095. Date of Publication: 01 Sep 2026. Author Sama J.; Butt S.; A A.E.A.; Rao R.; Shariff M.; Misra R.K.; Saleem K.; Modi S.; Guglin M.; Ilonze O.J. Institution (Sama, A, Rao, Shariff, Modi, Ilonze) Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, IN, United States (Butt, Misra) Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, United States (Saleem) Division of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, IN, United States (Guglin) Rutgers Health Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States Publisher Oxford University Press Abstract Candida (C-BSI) is a rare infection in patients with left ventricular assist devices (LVADs). We aim to describe the characteristics and outcomes of C-BSI. We performed a retrospective search for C-BSI in patients with LVADs at our institution from January 2012 to May 2024. We performed a literature review using the keywords 'fungemia ventricular assist device', 'candidemia ventricular assist device', 'Candida ventricular assist device,' or 'Candida endocarditis ventricular assist device' from 1990 to 2024. Clinical characteristics and outcomes were extracted. We identified three institutional cases along with 21 additional cases from the literature. The incidence of candidemia was 3.1% (3/97) and 1.8% (16/867), respectively, in the case series and literature review. The mean age was 45.6 years (range 19-73 years), and the average body mass index (BMI) was 31.8 kg/m2. There was a 100% mortality rate in our cohort and 62.5% mortality rate in the literature review cohort. Among the surviving patients in the literature review, 66.7% underwent heart transplantation, and 33.3% were discharged on antifungal therapy. About 41.2% of patients experienced right heart failure, with four requiring temporary mechanical circulatory support post-operatively. Obesity was present in 75.0% of patients, and 42.1% had an LVAD-related infection. C-BSI developed after an average of 426 days of LVAD support, with 33.3% occurring within 30 days postoperatively. The average duration of C-BSI was 29 days.Candida auris was the most common species. C-BSI is a rare fatal complication in LVAD patients. Obesity, delayed sternal wound closure, and right heart failure may contribute to these poor outcomes. Copyright © The Author(s) 2026. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights) <136> Accession Number 2049259883 Title Association Between Intraoperative Anesthesia Handover and Patient Morbidity and Mortality: a Systematic Review and Meta-Analysis. Source Anesthesia and Analgesia. (no pagination), 2026. Date of Publication: 2026. Author Yao Y.-T.; Samost-Williams A.; Allafy L.; More A.; Lin W.W.; Li Y.-F.; Chao M.; Baranov A.; Anderson V.L.; Chamoun R.; Tore M.; Tharavath V.; Nacif L.O.; Dhakal B.R.; Khudirat M.; Akinwunmi S.; Luo Y.-T.; Tolan J.; Uzair S.; Turan A. Institution (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, Samost-Williams, Allafy, More, Lin, Li, Chao, Baranov, Anderson, Chamoun, Tore, Tharavath, Nacif, Dhakal, Khudirat, Akinwunmi, Luo, Tolan, Uzair, Turan) Department of Anesthesiology, Critical Care and Pain Medicine, Center of Outcomes Research, University of Texas, Houston, TX, United States (Yao, Samost-Williams, Allafy, More, Lin, Li, Chao, Baranov, Anderson, Chamoun, Tore, Tharavath, Nacif, Dhakal, Khudirat, Akinwunmi, Luo, Tolan, Uzair, Turan) Outcomes Research Consortium, Houston, TX, United States Publisher Lippincott Williams and Wilkins Abstract BACKGROUND: - Intraoperative anesthesia handovers (IAHs) are common during prolonged procedures and shift-based staffing, but their association with postoperative outcomes remains uncertain. We performed an updated systematic review and meta-analysis to evaluate whether IAH, compared with no IAH, is associated with postoperative morbidity and mortality in surgical patients. METHOD(S): - We searched PubMed, Embase, and Cochrane databases from inception to July 10, 2025, without language restriction. Eligible studies were observational studies or randomized controlled trials (RCTs) comparing patients with versus without IAH and reporting postoperative mortality or morbidity. Because of substantial clinical and methodological heterogeneity, narrative synthesis was the primary approach. As an exploratory analysis, adjusted odds ratios (aORs) were pooled using the generic inverse variance method with a random-effects model only for studies reporting adjusted effect estimates for clinically comparable composite short-term postoperative morbidity and mortality outcomes. Studies reporting mortality alone, morbidity alone, unadjusted estimates only, or noncomparable outcome definitions were summarized narratively. Sensitivity analyses excluded studies with distinct populations or designs, including the RCT, pediatric cohort, and thoracic surgery cohort. RESULT(S): - Thirteen studies were included, comprising 12 retrospective cohort studies and 1 multicenter RCT, representing 5 additional studies compared with the largest previous meta-analysis and including 1 RCT not available in previous quantitative syntheses. Overall, 1030, 883 patients were included, 170, 746 patients (16.6%) of whom experienced IAH and 860, 137 did not. Seven studies, comprising 6 retrospective cohort studies and 1 RCT and involving 485, 623 patients, contributed to the exploratory meta-analysis of composite short-term postoperative morbidity and mortality. The included studies varied substantially in surgical populations, definitions of IAH, outcome definitions, data sources, and adjustment strategies. The multicenter RCT found no significant effect of IAH on 30-day mortality, readmission, or postoperative complications. In the exploratory pooled analysis, IAH was not significantly associated with composite postoperative morbidity and mortality (aOR = 1.04; 95% confidence interval [CI], 0.98-1.11; P = 0.18; I2 = 72%). Sensitivity analyses excluding the RCT, pediatric cohort, or thoracic surgery cohort yielded similar nonsignificant findings. CONCLUSION(S): - Current evidence does not support a consistent independent association between IAH and increased postoperative morbidity and mortality. However, substantial heterogeneity and residual confounding limit causal interpretation. Future prospective studies should clarify context-specific risks and evaluate standardized IAH interventions. Copyright © 2026 International Anesthesia Research Society <137> Accession Number 2049759559 Title Safety and Efficacy of Ticagrelor with Aspirin DAPT vs. Aspirin Alone in Patients undergoing CABG following ACS: A Systematic Review and Meta-analysis. Source Cardiovascular and Hematological Disorders - Drug Targets. (no pagination), 2026. Date of Publication: 2026. Author Mahajan K.; Dutta D.; Kamrul-Hasan A.B.M.; Mahajan N.; Sharma J.; Himral S.; Vohra S.; Pradhan A. Institution (Mahajan, Sharma, Himral) Department of Cardiology, Himachal Heart Institute, Himachal Pradesh, Mandi, India (Dutta) Department of Endocrinology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India (Kamrul-Hasan) Department of Endocrinology, Mymensingh Medical College, Mymensingh, Bangladesh (Mahajan) Department of Research Methodology, St. Louis, United States (Vohra) Department of Cardiology, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, United States (Pradhan) Department of Cardiology, King George Medical College, Lucknow, India Publisher Bentham Science Publishers Abstract Background: It remains uncertain whether Dual Antiplatelet Therapy (DAPT) or aspirin alone is better for patients following Coronary Artery Bypass Grafting (CABG) post-Acute Coronary Syndrome (ACS). Currently available Systematic Reviews and Meta-Analyses (SRMA) are limited to the analysis of different combinations of DAPT across various clinical conditions of cardiovascular disease and are not restricted to CABG post-ACS. This SRMA aimed to evaluate the safety and efficacy of Ticagrelor with Aspirin (TA) versus aspirin alone in patients who underwent CABG following ACS. Method(s): Electronic databases were searched for studies involving patients who underwent CABG after ACS and received TA in the intervention arm versus aspirin in the control arm. The primary outcomes were death and major bleeding. The secondary outcomes were Composite Cardiovascular Outcomes (CCO), Myocardial Infarction (MI), stroke, saphenous vein graft patency, revascularization, and side effects. Result(s): Data from five studies (4 RCTs and one cohort study; 9,659 patients) were analysed. The risk of death {OR 1.18 (95% CI 0.60-2.28); P =0.63; I2=46%} and major bleeding {OR 1.65 (95% CI 0.95-2.86); P =0.07; I2=44%} was numerically higher with TA than with aspirin alone, although these differences were not statistically significant. Composite cardiovascular outcomes {OR 0.96 (95% CI 0.74-1.24); P =0.74; I2=0%}, myocardial infarction {OR 0.99 (95% CI 0.67-1.46); P =0.94; I2=0%}, stroke {OR 0.60 (95% CI 0.33-1.08); P =0.09; I2=0%}, saphenous vein graft patency {OR 1.75 (95% CI 0.93-3.27); P =0.08; I2=75%}, and revascularisation {OR 1.21 (95% CI 0.46-3.15); P =0.70; I2=49%} were similar between the two groups. Discussion(s): These findings suggest that the theoretical advantage of intensified platelet inhibition with ticagrelor-based DAPT does not translate into improved clinical outcomes in patients undergoing CABG after ACS. The pathophysiology of graft failure, which is often driven by technical factors and progressive atherosclerosis rather than platelet-mediated thrombosis alone, may partly explain the absence of additional benefit from potent dual antiplatelet therapy. At the same time, the observed numerical increase in bleeding events highlights the potential trade-off associated with more aggressive platelet inhibition in the postoperative setting. Conclusion(s): In patients undergoing CABG following ACS, ticagrelor-aspirin DAPT does not confer significant improvement in ischemic outcomes compared with aspirin monotherapy and may increase bleeding risk. Aspirin alone appears to provide comparable protection, supporting its continued role as the cornerstone of antiplatelet therapy after surgical revascularization. Nevertheless, antiplatelet therapy after CABG should be individualised according to each patient's ischaemic/thrombotic and bleeding risk rather than applied uniformly. Copyright 2026, Bentham Science Publishers <138> Accession Number 2038632729 Title ANATOMICAL PROXIMITY OF THE LEFT CIRCUMFLEX CORONARY ARTERY TO THE MITRAL VALVE ANNULUS AND ITS IMPLICATIONS FOR MITRAL VALVE SURGERY: A SYSTEMATIC REVIEW. Source International Journal of Medicine and Public Health. 16(3) (pp 3214-3219), 2026. Date of Publication: 01 Jul 2026. Author Sreekanth C.; Sameer P.A.; Krishna Kishore G.; Periyasamy V.; Showri R. Institution (Sreekanth, Showri) Department of Anatomy, PES University Institute of Medical Sciences and Research, Karnataka, Bangalore, India (Sameer) Department of Anatomy, Sri Devraj Urs Medical College, Karnataka, Kolar, India (Krishna Kishore, Periyasamy) Shridevi institute of Medical Sciences and Research Hospital, Karnataka, Tumakuru, India Publisher Pink Petals Publications Pvt Ltd Abstract Background: Anatomical proximity between the left circumflex coronary artery (LCx) and the mitral valve annulus (MVA) presents a risk of iatrogenic coronary compromise during mitral valve (MV) operations and transcatheter interventions. This systematic review evaluated spatial LCx-MVA distances across annular sectors, coronary dominance patterns, and their surgical implications. Material(s) and Method(s): Following PRISMA 2020 guidelines (PROSPERO: CRD42026849201), MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library were searched (2015-2026) for multidetector CT (MDCT), 3D-TEE, and cadaveric studies evaluating LCx-to-annulus proximity. Result(s): Fourteen studies (n=1,842) were included. Overall mean LCx-to-annulus distance was 4.8+/-2.1" mm". The anterolateral commissure (P1/A1 sector) exhibited the closest proximity (3.2+/-1.4" mm" ), whereas the posteromedial sector (P3/A3) was furthest (8.4+/-2.3" mm" ). Critical proximity (<2" mm" ) occurred in 13.8% of patients (95%" CI: " 10.2%-17.4%), primarily localized to the P1/A1 zone (78%). Left-dominant coronary systems demonstrated significantly shorter distances (2.3+/-0.9" mm" ) and a >3-fold higher rate of critical proximity (28.4%) compared to right-dominant systems (9.1%). Surgical LCx injury (0.4%-1.8% incidence) was predominantly driven by direct suture transfixion (62%) and dynamic traction (28%). Conclusion(s): The LCx courses in close proximity to the MVA, with the anterolateral commissure representing the highest-risk zone. Left-dominant circulation markedly increases susceptibility to iatrogenic compromise. Routine pre-procedural MDCT/3D-TEE mapping and intraoperative TEE Doppler interrogation of LCx flow are essential for injury prevention. Copyright © 2026, Pink Petals Publications Pvt Ltd. All rights reserved. <139> Accession Number 2049584555 Title Regulatory T cells in cardiac allograft vasculopathy: from mechanistic insights to clinical tolerance. Source Frontiers in Immunology. 17 (pp 1-23), 2026. Article Number: 1893663. Date of Publication: 05 Aug 2026. Author Li B.; Su Y.; Hao Y.; Ye W.; Wang S.; Li X.; Li R.; Zheng K.; Zou Z.; Li Y.; Tao Z.; Wu J.; Zhang X.; Xia J. Institution (Li, Su, Hao, Ye, Wang, Li, Li, Zheng, Zou, Li, Tao, Wu, Zhang, Xia) Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Li, Su) Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Wu, Zhang, Xia) Center for Translational Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Wu, Zhang, Xia) Institute of Translational Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Wu, Zhang, Xia) Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Wuhan, China (Wu, Zhang, Xia) NHC Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China (Wu, Zhang, Xia) Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China Publisher Frontiers Media SA Abstract Cardiac allograft vasculopathy (CAV) is the primary impairment that influences the long-term prognosis of transplanted hearts. CAV is characterized by diffuse intimal hyperplasia of the coronary arteries, which is mediated by chronic inflammation, the alloimmune response, and vascular remodeling. Current immunosuppressive regimens effectively control acute rejection but have limited efficacy in preventing CAV and are associated with significant adverse effects upon long-term use. Regulatory T cells (Tregs) are essential for preserving immunological homeostasis and facilitating transplantation tolerance. They are pivotal in suppressing the activation of effector T cells (Teffs), modulating local inflammation, and postponing the progression of CAV. This review comprehensively elucidates the pathophysiology of and diagnostic advancements in CAV, emphasizes the phenotypic heterogeneity, immunosuppressive mechanisms, and protective role of Tregs in heart transplantation, and thoroughly discuss the interplay of PD-1/PD-L1, IL-33, IL-6, CTLA-4, fatty acid oxidation (FAO), and other signaling pathways in modulating Treg function and CAV pathogenesis. In terms of the translational medicine, the adoptive infusion of in vitro-expanded autologous Tregs has demonstrated the ability to postpone CAV in preclinical models; nonetheless, its clinical use is limited by cell stability, challenging preparation processes, and the lack of efficacy biomarkers. Therefore, this review seeks to establish a theoretical foundation and research viewpoint to comprehensively understand the immunological mechanisms of CAV and the advancement of novel Treg-targeted therapies. Copyright © 2026 Li, Su, Hao, Ye, Wang, Li, Li, Zheng, Zou, Li, Tao, Wu, Zhang and Xia. <140> Accession Number 2049588140 Title Individualized versus conventional intraoperative blood pressure management among major non-cardiac surgery patients: a systematic review and meta-analysis of randomized controlled trials. Source Frontiers in Medicine. 13 (no pagination), 2026. Article Number: 1889492. Date of Publication: 2026. Author Alshammari A.M.; Ali R.; Alkathiry A.M.; Qattea A.; Algmaizi S.; Alminhali S.; Alshehri R.A.; Halwani E.W.; Al Mrdef E.A.S.; Siddiqui J.J.; Almshrafi N.A.; Alkhars A.A.; Elaraby A.; Alkhamis A. Institution (Alshammari, Qattea) College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Ali) Medical Intern, Ibn Sina National College, Jeddah, Saudi Arabia (Alkathiry) GP, General Directorate of Prisons' Health, Al-Ahsa, Saudi Arabia (Algmaizi) Department of Emergency Medicine, Al-Quwayiyah Hospital, Al-Quwayiyah, Saudi Arabia (Alminhali) College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Alshehri) College of Medicine, Taif University, Taif, Saudi Arabia (Halwani) College of Medicine, Al-Rayan National Colleges, Madinah, Saudi Arabia (Al Mrdef) College of Medicine, Najran University, Najran, Saudi Arabia (Siddiqui) International Medical Center, Jeddah, Saudi Arabia (Almshrafi) College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (Alkhars, Alkhamis) Anesthesia Department, King Faisal General Hospital, Al-Ahsa, Saudi Arabia (Elaraby) Faculty of Medicine, Al-Azhar University, Cairo, Egypt Publisher Frontiers Media SA Abstract Introduction - Intraoperative hypotension is common during non-cardiac surgery and is associated with high rates of morbidity and mortality. Individualized blood pressure management aims to minimize postoperative complications by tailoring patients' blood pressure targets based on their baseline values rather than relying on conventional management. This meta-analysis aims to evaluate the efficacy of individualized and conventional blood pressure management strategies in patients undergoing non-cardiac surgery. Methods - We conducted a search of PubMed, Scopus, Web of Science, and Cochrane CENTRAL from their inception to January 2026 to identify randomized controlled trials (RCTs) that compared individualized blood pressure management with conventional care in adults undergoing major non-cardiac surgery. The primary outcomes were acute kidney injury/renal replacement therapy and all-cause mortality. The secondary outcomes included myocardial infarction, delirium, postoperative cognitive dysfunction, composite complications, mean intraoperative mean arterial pressure (MAP), and length of hospital stay. Results - Nine RCTs comprising 4, 017 patients (with 2, 014 receiving individualized blood pressure management and 2, 003 in the control group) were included. Individualized blood pressure management did not significantly reduce the risk of acute kidney injury/the need for renal replacement therapy (RR 0.88, 95% CI: 0.68-1.15, p = 0.36) or all-cause mortality (RR 0.96, 95% CI: 0.63-1.46, p = 0.83) compared to conventional management. Similarly, no significant differences were observed for myocardial infarction, postoperative cognitive dysfunction, composite complications, or length of hospital stay. However, individualized management significantly reduced delirium rates (RR 0.55, 95% CI: 0.35-0.88, p = 0.01) and achieved higher mean intraoperative MAP (MD 5.53 mmHg, 95% CI: 1.66-9.40, p = 0.01). Conclusion - Individualized intraoperative blood pressure management did not reduce major postoperative complications, such as acute kidney injury, or mortality rates compared to conventional care. However, it was associated with reduced postoperative delirium and improved intraoperative hemodynamic stability. These findings suggest that while individualized strategies may not significantly affect clinical outcomes, they offer benefits in preventing delirium. Systematic review registration - https://www.crd.york.ac.uk/PROSPERO/view/CRD420261319820. Copyright © 2026 Alshammari, Ali, Alkathiry, Qattea, Algmaizi, Alminhali, Alshehri, Halwani, Al Mrdef, Siddiqui, Almshrafi, Alkhars, Elaraby and Alkhamis. <141> Accession Number 2049129046 Title Frailty in patients undergoing video-assisted thoracoscopic surgery for lung cancer: a narrative review of assessment, outcomes and prehabilitation. Source World Journal of Surgical Oncology. 24(1) (no pagination), 2026. Article Number: 374. Date of Publication: 01 Dec 2026. Author Xu Y.; Cao M.; Liu Y.; Li X.; Zhang Q. Institution (Xu, Cao, Liu, Zhang) The Second Affiliated Hospital of Shandong First Medical University, Shandong Academy of Medical Sciences, No. 706 Taishan Street, Shandong, Taian, China (Li) The Thoracic Surgery Department of The First Affiliated Hospital of Soochow University, No. 899 Pinghai Street, Gusu District, Jiangsu, Suzhou, China Publisher BioMed Central Ltd Abstract Background: Older adults with lung cancer are increasingly being considered for video-assisted thoracoscopic surgery (VATS), including segmentectomy or lobectomy with lymph node assessment. Although VATS reduces surgical trauma compared with thoracotomy, it does not eliminate heterogeneity in physiological reserve, treatment tolerance, or postoperative recovery. Frailty may therefore complement conventional preoperative assessment, which is typically based on chronological age, comorbidity burden, pulmonary function, and cardiac risk. Methods and main findings: This narrative review summarises the evidence on frailty assessment, perioperative outcomes, and prehabilitation strategies in patients undergoing lung cancer surgery, with a particular emphasis on VATS. Practical tools, such as the Clinical Frailty Scale and 4-metre gait speed, may support routine screening because they are brief, feasible, and clinically interpretable. More comprehensive approaches, including multidimensional frailty indices, nutritional assessment, sarcopenia evaluation, and comprehensive geriatric assessment, may be useful for selected patients. Available evidence suggests that frailty is associated with postoperative pulmonary complications, prolonged hospitalisation, non-home discharge, increased healthcare utilisation, and mortality after lung resection. However, direct evidence from frail patients with lung cancer undergoing VATS remains limited, and many recommendations are extrapolated from mixed thoracic surgery cohorts, studies of open lung resection, geriatric oncology, and non-thoracic surgical literature. Conclusion(s): Frailty should be considered an actionable component of perioperative risk stratification, rather than a stand-alone criterion for determining surgical eligibility or the extent of VATS resection. Future studies in thoracic oncology should define optimal frailty assessment pathways and determine whether frailty-guided interventions can improve short-term recovery, long-term functional outcomes, tolerance of adjuvant therapy, and oncological outcomes after minimally invasive lung cancer surgery. Copyright © The Author(s) 2026. <142> Accession Number 2049129067 Title Incidence and risk factors of persistent postoperative pain after cardiac surgery: a systematic review and meta-analysis. Source BMC Anesthesiology. 26(1) (no pagination), 2026. Article Number: 570. Date of Publication: 01 Dec 2026. Author Yang Y.; Liu F.; Yao H. Institution (Yang) School of Nursing, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China (Yang) The Third People's Hospital of Chengdu, Sichuan, Chengdu, China (Liu) Department of Emergency division, Municipal Hospital, Shandong, Qingdao, China (Yao) Department of Intensive Care Unit, Zhejiang Provincial People's Hospital, Zhejiang, Hangzhou, China Publisher BioMed Central Ltd Abstract Background: Persistent postoperative pain after cardiac surgery (PPPCS) is a prevalent complication. This paper aims to appraise the incidence of PPPCS and analyze its related risk factors through systematic evaluation and Meta-analysis. Method(s): According to PRISMA guidelines, two researchers independently searched seven databases (PubMed, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang Database and China Biomedical Database) until October 5, 2024. Finally, 40 eligible studies were included. The quality of the included articles was evaluated by Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality Agency Scale. The random-effect model was selected for Meta-analysis. Meta-regression analysis was conducted to test whether the publication time affected the incidence of PPPCS. Result(s): The incidence of PPPCS changed at different times after operation: 31.7% (27.2%, 36.2%) at 3 to 6 months, 25.1% (19.5%, 30.7%) at 6 to 12 months, 24.4% (18.1%, 30.7%) at 12 to 24 months, and 13.1% (7.6%, 18.6%) at more than 24 months. Meta-regression revealed that longer postoperative follow-up (12-24 months and beyond 24 months) was associated with a lower overall incidence of PPPCS.Significant risk factors included females, age < 69 years old, BMI>=28 kg/m2, poor wound healing, intraoperative remifentanil infusion, chronic pain history, and moderate-severe pain (day 0-5). Conclusion(s): The incidence of PPPCS ranged from 13.1% to 31.7%. Female sex, younger age, elevated BMI, poor wound healing, intraoperative remifentanil use, history of chronic pain, and severe acute postoperative pain were associated with higher odds of PPPCS. However, given the observational nature of the included studies, variable confounder adjustment, small numbers of studies for certain risk factors, and high heterogeneity, these associations should be interpreted cautiously and require confirmation in prospective studies with standardized definitions and more comprehensive adjustment. The identified factors may guide risk stratification but should not yet be regarded as definitively established causal determinants of PPPCS. Copyright © The Author(s) 2026. <143> Accession Number 2049424273 Title A review bridging pharmacokinetics, preclinical data, and human evidence on curcuminoids in cardiovascular disease. Source Frontiers in Pharmacology. 17 (no pagination), 2026. Article Number: 1906759. Date of Publication: 2026. Author Zolnik K.; Mogielnicki A.; Kalaska B. Institution (Zolnik, Mogielnicki, Kalaska) Department of Pharmacodynamics, Medical University of Bialystok, Bialystok, Poland Publisher Frontiers Media SA Abstract Curcumin, the major curcuminoid of turmeric (Curcuma longa L.), has attracted sustained interest as a nutraceutical with pleiotropic anti-inflammatory, antioxidant, and vascular actions. However, extrapolating experimental in vitro findings to cardiovascular outcomes in humans is challenged by low aqueous solubility, chemical instability at intestinal pH, extensive first-pass metabolism, and substantial inter-product variability in formulation. Preclinical research supports antihypertensive and vasculoprotective effects, but many in vitro studies rely on micromolar exposures that are difficult to achieve following oral dosing. In humans, randomized trials and meta-analyses suggest modest improvements in surrogate cardiometabolic risk markers (e.g., minor alterations in lipid profiles and inflammatory biomarkers), with substantial heterogeneity across populations, doses, durations, and formulations. However, these results cannot establish turmeric-derived preparations as standard cardiovascular therapy. Evidence for clinically meaningful cardiovascular outcomes remains limited to a small number of short-term perioperative or acute coronary syndrome studies. For example, a single-center coronary artery bypass grafting trial reported fewer perioperative myocardial infarctions with high-dose curcuminoids, whereas in a larger perioperative trial nanocurcumin did not reduce postoperative atrial fibrillation. Overall, published GRADE assessments for cardiometabolic markers report low certainty. Exposure-guided, formulation-specific trials with standardized endpoints are required. In this mini review, we synthesize preclinical and human evidence on curcuminoids across key cardiovascular areas, including blood pressure and vascular function, lipid metabolism and inflammation, periprocedural myocardial injury and arrhythmias, and hemostasis. We also emphasize the importance of achieving systemic exposure, understanding metabolite biology, characterizing formulations, and using clinically relevant cardiovascular endpoints to improve the interpretability and reproducibility of future studies. Copyright © 2026 Zolnik, Mogielnicki and Kalaska. <144> Accession Number 2038636269 Title Recurrent ischemic stroke in atrial fibrillation patients despite DOAC therapy: Recent advances and their therapeutic implications. Source Kardiologia Polska. 84(7-8) (pp 869-874), 2026. Date of Publication: 02 Sep 2026. Author Paciaroni M.; Maruccia A.; Pugliatti M. Institution (Paciaroni, Maruccia, Pugliatti) Department of Neurosciences and Rehabilitation, University of Ferrara, Ferrara, Italy Publisher Via Medica Abstract Direct oral anticoagulants (DOACs) are currently the preferred anticoagulant therapy in patients with non-valvular atrial fibrillation. Nevertheless, for patients receiving oral anticoagulants, clinical trials reported a residual annual risk of recurrent ischemic events ranging from 0.7% to 2.3%, in both primary and secondary prevention settings. Furthermore, in the non-randomized RENO-EXTEND study, patients who had an ischemic stroke while on DOAC therapy, also had a recorded combined rate of thromboembolic and bleeding events of 16.7%, corresponding to the annual prevalence of 13.4%. Reliable evidence on how to proceed with management of those patients who experience ischemic stroke while receiving DOAC therapy, is limited. This patient setting needs to take into consideration the following strategies: 1) Exclude poor adherence to treatment; 2) Assess potential drug-drug interactions; 3) Ensure the prescription of the most appropriate DOAC dose; 4) Confirm the underlying mechanism of the recurrent ischemic event; 5) Continue with the same DOAC after a cardioembolic event occurring during DOAC therapy, when appropriate; 6) Consider switching to a different DOAC so to improve adherence; 7) Evaluate, on a case-by-case basis and for the shortest feasible duration, the possible addition of an antiplatelet agent to DOAC therapy; 8) Consider left atrial appendage occlusion combined with indefinite DOAC therapy in selected patients with recurrent events despite anticoagulation; 9) Implement stricter risk factor control. Moreover, results from randomized controlled trials investigating more effective management strategies are needed to improve treatment of patients in this setting. Copyright © by the Author(s), 2026. <145> Accession Number 652214530 Title Cardiac involvement in Behcet's disease: a comprehensive state-of-the-art review. Source Clinical and experimental rheumatology. (no pagination), 2026. Date of Publication: 04 Sep 2026. Author Belfeki N.; Ghriss N.; Jebri F.; Hamrouni H.; Hatemi G.; Mekinian A. Institution (Belfeki, Ghriss) Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Sud Ile de France, Melun, France (Jebri) Department of Cardiology, Polyclinique de l'Europe, France (Hamrouni) Department of Imaging, Groupe Hospitalier Sud Ile de France, Melun, France (Hatemi) Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (Mekinian) Department of Internal Medicine and Inflammation-Immunopathology-Biotherapy (DHUi2B), Hopital Saint Antoine, Assistance Publique des Hopitaux de Paris, UPMC University, Sorbonne Universites, Paris, France Abstract Behcet's disease (BD) is a chronic multisystemic inflammatory vasculitis which can cause cardiac involvement in less than 6%. It can affect all cardiac wall giving rise to pericarditis, myocarditis, endocardial lesions with valvular involvement (especially aortic insufficiency), intracardiac thrombosis, coronary arteritis, myocardial infarcts, arrythmia, and aortitis. Clinical presentation can be confusing, silent, or overshadowed, so diagnosis is frequently delayed. Early diagnosis is mandatory and different imaging techniques play a pivotal role to screen the heart. Biological agents, including tumour necrosis factor inhibitors, show promising results. Cardiac surgery must be accompanied by immunosuppressive therapy to prevent iatrogenic or trauma-triggered pseudo aneurysm secondary to arterial hypersensitivity. A multidisciplinary approach and tailored monitoring are essential to improve patient outcome. Strong data are still lacking to define evidence-based diagnostic algorithms, risk-stratification tools, and standardised management strategies for this severe cardiac manifestation. Besides, further studies are needed to determine specific biomarkers to refine early diagnosis, assess therapeutic efficiency, and prognosis. Through a comprehensive literature review, we aim to synthesise current data on the epidemiology, clinical presentation, contemporary imaging modalities, prognosis, and evidence-based management strategies of cardiac involvement in BD, and to highlight emerging perspectives. <146> Accession Number 2049144563 Title The utility of focused transthoracic echocardiography in preoperative assessment: a systematic review and narrative synthesis of current evidence. Source Journal of Clinical Monitoring and Computing. (no pagination), 2026. Date of Publication: 2026. Author McIver W.J.; Dillon S.; Schofield K.; Merritt J.; Morgan E.; Bangash M.N.; Parekh D. Institution (McIver, Merritt, Morgan, Bangash, Parekh) Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospitals Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, United Kingdom (Dillon) College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom (Schofield) Department of Intensive Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, United Kingdom (McIver, Parekh) Department of Inflammation and Ageing, College of Medicine and Health, University of Birmingham, Mindelsohn Way, Birmingham, United Kingdom Publisher Springer Science and Business Media B.V. Abstract We aimed to evaluate the feasibility, diagnostic yield, accuracy, impact on management and clinical outcomes of focused transthoracic echocardiography (fTTE) in preoperative assessment. Medline, Embase and Cochrane Trials were searched to 19 January 2026. Studies evaluating preoperative fTTE were included. Cardiac surgery, examinations performed by cardiologists or cardiac physiologists, and intraoperative or postoperative examinations were excluded. Screening and data extraction were performed independently by two reviewers. Risk of bias was assessed for comparative effectiveness studies. Thirty-five studies involving 3728 patients were included. Study populations, scanning protocols and operator experience were highly heterogeneous. Median feasibility was 92.5%, with examination times of 3-16 min. Cardiac abnormalities were identified in 22-64% of patients. No formal diagnostic-accuracy studies were identified; agreement with formal TTE was variable and clinically important missed diagnoses were reported. Step-up and step-down changes in management occurred in 48 (21-54) % and 20 (1-49) % of patients, respectively. Three studies comparing plans before and after fTTE found no overall change in anaesthetic management. Individual changes in management included increased arterial-line use and reduced postoperative intensive-care admission. Four randomised trials found that echocardiography-guided pre-induction fluid therapy reduced post-induction hypotension. Three randomised trials in emergency surgical populations showed no improvement in mortality or morbidity compared with standard care. Preoperative fTTE is feasible and can identify clinically relevant cardiac and haemodynamic abnormalities and influence perioperative management. However, performance is operator- and setting-dependent, diagnostic-accuracy evidence is sparse, and benefit for patient-centred outcomes remains unproven. Copyright © The Author(s) 2026. <147> Accession Number 2038636233 Title Prognostic impact of heart failure guideline-directed medical therapy in patients with low blood pressure. Source Kardiologia Polska. 84(7-8) (pp 906-914), 2026. Date of Publication: 02 Sep 2026. Author Fonseca A.M.; Grijo C.; Costa A.; Reis C.; Ribeiro R.; Correia F.; Toste A.; Guimaraes C.; Gouveia R.; Elias C.; Matos I.; Carreira M.; Pereira J.; Almeida J.; Lourenco P. Institution (Fonseca, Grijo, Costa, Reis, Ribeiro, Correia, Toste, Guimaraes, Gouveia, Elias, Matos, Carreira, Pereira, Almeida, Lourenco) Internal Medicine Department, Centro Hospitalar e Universitario de Sao Joao, Porto, Portugal (Pereira, Almeida, Lourenco) Department of Medicine, Faculty of Medicine, Porto University, Porto, Portugal (Almeida, Lourenco) Clinical Investigation Unit, Internal Medicine Department, Centro Hospitalar e Universitario Sao Joao, Porto, Portugal Publisher Via Medica Abstract Background: Patients with hypotension have consistently been excluded from heart failure (HF) randomized controlled trials. Aim(s): We aimed to study HF patients with hypotension. Method(s): A retrospective study of HF outpatients with left ventricular systolic dysfunction, followed from January 2012 to December 2020. We defined hypotension as systolic blood pressure (SBP) <100 mm Hg. The endpoint was all-cause mortality or heart transplantation. Patients were followed until January 2023. A Cox-regression analysis was used to study the prognostic impact of guideline-directed medical therapy separately in HF patients with SBP <100 mm Hg and those with SBP >=100 mm Hg. Adjustments were made for confounders. Result(s): We studied 1206 HF patients, mean age 71 years, of whom 91.4% were on beta-blockers (BBs), 82.8% were on renin-angiotensin-system inhibitors (RASi), and 29.6% on mineralocorticoid receptor antagonists. SBP was <100 mm Hg in 157 (13.0%) patients. Hypotensive patients more often presented with atrial fibrillation and severe left ventricular systolic dysfunction. They had lower hemoglobin and higher B-type natriuretic peptide levels, and were less medicated with RASi, but more with mineralocorticoid receptor antagonists and diuretics. BBs were similarly prescribed in both groups. During a median follow-up of 47 (27-85) months, 645 (53.5%) patients died, 61.1% vs. 52.3% in hypotensive and non-hypotensive groups, respectively (P = 0.04). RASi prescription is associated with survival-benefit in both hypotensive (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.29-0.83) and non-hypotensive (HR, 0.64; 95% CI, 0.50-0.80) patients. BBs predicted better survival in non-hypotensive (HR, 0.61; 95% CI, 0.46-0.81), but not in hypotensive patients. Conclusion(s): Hypotension was associated with poor prognosis in HF patients. In patients with SBP <100 mm Hg, the BB use had no prognostic impact, however, the RASi use implied a survival benefit. Despite their exclusion from most HF therapy trials, hypotensive patients appear to benefit from RASi drugs. Copyright © by the Author(s), 2026. <148> Accession Number 652211856 Title Outcome-Guided Immunosuppressive Therapy and Clinical Events in Patients With Cardiac Sarcoidosis: An Observational Registry. Source Journal of the American Heart Association. (pp e049395), 2026. Date of Publication: 18 Sep 2026. Author Ebbinghaus-Holst T.F.; Ebbinghaus H.; Ueberham L.; Latuscynski K.; Paetsch I.; Jahnke C.; Jozwiak-Nozdrzykowska J.; Bode K.; Nedios S.; Hindricks G.; Dinov B. Institution (Ebbinghaus-Holst, Ebbinghaus, Latuscynski, Paetsch, Jahnke, Jozwiak-Nozdrzykowska, Bode, Nedios) Department of Electrophysiology Helios Heart Center of Leipzig Leipzig Germany, Germany (Ebbinghaus) Department of Cardiology Hospital St. Georg Leipzig Germany, Germany (Ueberham) Department of Cardiology University Hospital of Leipzig Leipzig Germany, Germany (Hindricks) DHZ Charite Berlin Germany, Germany (Dinov) Department of Cardiology and Angiology University Hospital of Giessen, UKGM Giessen Germany, Germany Abstract BACKGROUND: Immunosuppressive therapy (IST) is commonly used in cardiac sarcoidosis, but the strategy to guide it is unclear and its effectiveness uncertain. We assessed the association between IST, guided by clinical course and positron emission tomography, and clinical outcomes in cardiac sarcoidosis. METHOD(S): We compared 83 patients with cardiac sarcoidosis who received IST with 20 who declined therapy. IST was escalated for persistent symptoms and inflammation. Ventricular arrhythmia recurrence, ventricular pacing, New York Heart Association class, and left ventricular (LV) ejection fraction were assessed after 12 months. Death, LV assist device, and heart transplantation were assessed during a median follow-up of 24.9 months. RESULT(S): Sustained ventricular tachycardia recurred in 12% of patients with IST versus 20% of those without IST (P=0.264). Within the IST group, New York Heart Association class and LV ejection fraction improved during 12 months (P=0.011 and P=0.002), but the between-group difference in New York Heart Association change was not significant (P=0.490). Major adverse cardiovascular events occurred less frequently with IST (10.8% versus 40.0%, P=0.004). After adjustment for baseline LV ejection fraction, IST had a lower hazard of major adverse cardiovascular events (hazard ratio, 0.30 [95% CI, 0.11-0.80]; P=0.017), consistent among sensitivity analyses. Given only 17 events and baseline imbalance, residual confounding cannot be excluded and this is hypothesis-generating. CONCLUSION(S): In this observational registry, glucocorticoid-based IST was associated with lower rates of death, heart transplantation, and LV assist device implantation. No significant between-group difference was detected in sustained ventricular tachycardia recurrence, although the study was underpowered to exclude smaller differences. Because treatment was not randomized, these associations cannot establish causality.

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