Background Native aortic valve endocarditis continues to present significant operative challenges, often complicated by heart failure, peri-annular extension and conduction disturbances. This study aimed to evaluate temporal trends, outcomes and predictors of mortality following surgery within a nationwide cohort.Methods A retrospective analysis was performed using data from the UK National Institute for Cardiovascular Outcomes Research registry. All patients undergoing aortic valve replacement (AVR) for infective endocarditis between 1996 and 2019 were included. The primary endpoint was in-hospital mortality. Univariate and multivariable logistic regression analyses were conducted to identify independent predictors of adverse outcomes, with bootstrap validation across 500 datasets.Results A total of 3694 patients underwent AVR for native valve endocarditis between 1996 and 2019. Mean age was 58.0 years (IQR 45.9–68.2) and 21.9% (n=809) were female. Biological prostheses were most frequently implanted (55.7%). In-hospital mortality was 7.8% (n=290).Non-survivors were significantly older and more likely to have chronic kidney disease, diabetes, pulmonary disease, cardiogenic shock and poor preoperative ventricular function. On multivariable analysis, operative urgency (OR 2.49, 95% CI 1.98 to 3.14) and preoperative inotropic support (OR 2.24, 95% CI 1.42 to 3.52) were the most powerful predictors of mortality. Other risk factors included New York Heart Association class III–IV (OR 1.73–1.94), advanced age (OR 1.02/year), chronic kidney disease (OR 1.53) and preoperative atrial fibrillation (OR 1.58). Later years of surgery conferred improved survival (OR 0.96, 95% CI 0.94 to 0.99).Conclusions Surgery for native aortic valve endocarditis remains high risk, though outcomes have improved over time. Operative urgency and preoperative inotropic requirement are the most powerful predictors of mortality.

Saphenous vein graft (SVG) failure following coronary artery bypass grafting may require re-intervention, with current guidelines favoring percutaneous coronary intervention (PCI) of the bypassed native coronary artery over SVG-PCI. The Percutaneous Coronary Intervention of Native Coronary Artery versus Saphenous Vein Graft in Patients with Prior Coronary Artery Bypass Graft Surgery (PROCTOR) trial is the first randomized controlled trial comparing native coronary artery PCI with SVG-PCI. The study shows that at 1 year, SVG-PCI was associated with significantly lower major adverse cardiac events than native vessel PCI. These findings question existing guideline recommendations, although longer-term follow-up is required.

Background To determine the proportion of dialysis‐dependent patients undergoing coronary artery bypass graft (CABG) who subsequently received a renal transplant (RT) and to compare early and mid‐term outcomes with those who remained on dialysis. The levels of bacterial and viral (COVID‐19) infections were also investigated. Methods Twelve datasets were accessed in NHS England’s Secure Data Environment service for England, via the BHF Data Science Centre’s CVD‐COVID‐UK/COVID‐IMPACT consortium. A retrospective cohort study that included all adults with chronic dialysis who underwent first‐time CABG in England between 1 January 2018 and 31 March 2022 was analysed. A sensitivity analysis with stratification by infection status was performed. Results Of 313 dialysis‐dependent CABG patients, 55 (17.6%) received RT. Transplant recipients were younger (median 58 vs. 64 years, p < 0.001), less likely to require urgent CABG (30.9% vs. 54.7%, p = 0.004) and more often had no prior MI (76.4% vs. 53.5%, p = 0.036). In‐hospital mortality for the whole cohort was 9.9% (30/313) with all deaths in the group not receiving subsequent RT (12% vs. 0%, p < 0.014). Viral infection did not significantly affect postoperative outcomes. All dialysis patients were infected with bacterial endocarditis. Kaplan–Meier analysis showed significantly better survival in RT recipients (3.64% alive at 50 months) compared with nonrecipients (0.78%) ( p < 0.001). Most patients waited for 2 years or longer before receiving RT. Conclusions CABG in dialysis‐dependent patients carries high mid‐term mortality. Survival among those who subsequently underwent RT showed improvement but requires future substantiation through competing risk analysis (mortality vs. transplant) to prevent overestimation of the risk in the non‐RT group. Further research on the effect of microbes on cardiac intervention in this context is required to identify ways to improve outcomes.

Data on outcome for robotic coronary artery bypass grafting (CABG) is sparse. The aim of this study was to compare clinical outcomes between conventional and robotic-assisted CABG. This was a single-center retrospective study comparing conventional and robotic-assisted CABG between January 2024 and October 2024. Baseline patient characteristics, intra-operative details, and post-op outcomes were compared between 2488 conventional and 136 robotic procedures. Propensity matching was done for age, gender, comorbid illness, and operative characteristics. Learning curve was analyzed using a cumulative sum (CUSUM) chart. One hundred and thirty-two propensity-matched pairs were compared. Before matching, the conventional CABG group had a higher frequency of females and diabetes mellitus, and a slightly higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 risk score, while ejection fraction was marginally higher in the robotic surgery group. After matching, the groups were comparable in terms of demographic details, clinical presentation, comorbid illness, and laboratory parameters. The duration of surgery, ventilation duration, and the number of distal anastomoses were higher in the conventional group before matching. After matching, the difference persisted for ventilation duration alone. Patients in the robotic-assisted CABG group had a lower incidence of arrhythmia (5.3

Epicardial adipose tissue (EAT) independently predicts adverse cardiovascular events. Prediabetes with metabolic syndrome carries high cardiovascular risk, yet EAT in this critical subpopulation versus incident type-2 diabetes (T2D) remains unexplored. Coronary CT-angiography records were retrospectively reviewed to compare adults with prediabetes (impaired fasting glucose 110–125 mg/dL and HbA1c < 6.5

OBJECTIVES:Data on hospital readmission and secondary care utilization after coronary artery bypass grafting (CABG) beyond 30 days remain limited. We aim to address this gap by reporting cardiovascular and procedure-related readmission rates in the 60 months after primary isolated surgical revascularization in the United Kingdom. METHODS:All patients who underwent isolated CABG from January 2013 to April 2025 from the UK National Adult Cardiac Surgery Audit dataset were included. All cause readmissions to any NHS hospital during the first 60 months of follow-up were analysed from the Hospital Episode Statistics dataset. The relation to the time before, during, and after the COVID-19 pandemic was also investigated. Finally, the primary and secondary diagnoses, as well as any procedure(s) undertaken during readmission, were evaluated. RESULTS:A total of 101,759 patients were identified (84% male, median age 66.9 years [first and third quartile: 59.7, 73.6]). Of these 69,426 patients, required readmission for any cause. The cumulative incidence of readmission at 12 and 60 months was 42.0% and 68.2%, respectively. The overall readmission rate during the first lockdown to the third lockdown relaxation of the COVID-19 pandemic was 42.0% (ranged: 40.7%-45.0%). No significant differences in readmission rates were observed during the COVID-19 pandemic. At 12 months, cardiovascular-related readmissions accounted for 15% (n = 13 529) of all readmissions, with arrhythmia 25%, heart failure 19% and acute coronary syndrome 15.2%. The primary diagnoses between 13 and 60 months 24.7% (n = 17 162) were arrhythmia, 22.2%, angina pectoris, 19.4%, heart failure 17.1%. The overall incidence of urgent repeat revascularization during readmission at 12 and 60 months was 1.71% and 4.20%, respectively. The primary readmission diagnoses related to the surgical procedure (excluding cardiovascular-related) in the first 12 months was 25.5% (n = 23 047), with non-cardiac chest pain 30.1%, surgical wound disruption/infection 16.8% and anaemia 15.0%. Between 13 and 60 months, procedure-related primary diagnoses accounted for 26.1% (n = 18 143), of which non-cardiac chest pain 35.6%, anaemia 26.2%, and respiratory tract infection 20.8%. CONCLUSIONS:Analysis of this unselected UK cohort reveals that cardiovascular-related readmission represented one-quarter of all readmissions at 5 years after the index CABG. This high readmission rate underscores the need for further research to understand the underlying causes and implement strategies to optimize resource use.

Artificial intelligence (AI)–enabled electrocardiograms (ECGs) extracted from hospital electronic medical record (EMR) systems can accurately predict reduced left ventricular ejection fraction (LVEF). However, this limits the applicability to hospital settings. The widespread availability of smartphones presents an opportunity to extend AI-ECG–based cardiac screening to non-hospital settings. The aim of this study was to compare the diagnostic performance of mobile phone ECG images with the standard EMR-based ECG image method. In this prospective validation study, ECG images from 86 patients were analysed using EMR-derived ECG images and photographs of printed ECGs captured using mobile phones. Both inputs were analysed using the same previously validated deep learning model. Echocardiography-derived EF (Ejection Fraction) served as the reference standard. Model performance was assessed using sensitivity, specificity, predictive values, accuracy, receiver operating characteristic area under the curve (ROC-AUC), and precision–recall AUC (PR-AUC), with thresholds selected using Youden’s index. Both methods demonstrated identical sensitivity (0.89) and high negative predictive value (NPV) (0.96). Both the EMR-derived and mobile phone–acquired ECG models identified the same number of true positive cases (n = 17) and the same number of false negatives (n = 2). Compared with the EMR images, the mobile photographs showed a slight reduction in specificity (0.75 vs 0.82) and accuracy (0.78 vs 0.84). The ROC-AUC (0.86 vs 0.89) was also similar. AI-based LVEF prediction from mobile phone–captured ECG photographs demonstrates performance comparable to EMR-based ECG images, with preserved sensitivity and excellent NPV. This approach enables predicting EF from AI-ECG using mobile phone images and has the potential for screening heart failure in resource-limited and community-based settings.

Objective: In the last decade, there has been an increased use of biological prosthesis in patients aged 50 to 70 years old undergoing surgical aortic valve replacement (SAVR). The COVID-19 pandemic disrupted health care services, which may have affected this trend. This study aims to evaluate the trends in prosthesis use and long-term clinical outcomes in patients aged 50 to 70 years old who underwent SAVR before, during, and after the COVID-19 pandemic in the United Kingdom. Methods: This was a retrospective analysis of prospectively collected data in all patients aged 50 to 70 years who underwent first-time, elective/urgent isolated SAVR from January 2013 to April 2025. Results: A total of 11,010 patients underwent SAVR during the study period, with a median age of 63.4 years (first and third quartile: 58.6, 67.0 years), of whom 67% (n = 7359) were male. The use of biological prosthesis increased from 57.5% in 2013 to 71.3% in 2024. Patients who received a mechanical prosthesis when compared with a biological prosthesis had a lower all-cause mortality (hazard ratio, 1.22; 95% CI, 1.03-1.43; P = .021). The 1-, 5-, and 10-year survival rates were 98.02% versus 97.60%, 91.69% versus 91.66% and 81.08% versus 76.41%, respectively. Patients with a mechanical prosthesis had a greater cumulative incidence of cerebrovascular accident (adjusted subdistribution hazard ratio [sHR], 1.58; 95% CI, 1.13-2.22; P = .008) and major bleeding (sHR, 1.57; 95% CI, 1.15-2.14; P = .005) but a lower incidence of infective endocarditis (sHR, 0.43; 95% CI, 0.30-61; P < .001) and of repeat valvular intervention (sHR, 0.23; 95% CI, 0.09-0.55; P < .001). Conclusions: The use of biological prosthesis has increased incrementally since 2013 and persisted post-COVID-19 pandemic. Mechanical valves had a lower all-cause mortality, cumulative incidence of infective endocarditis, and need for repeat intervention. However, they were associated with a greater incidence of stroke and bleeding. The lifetime management of this group of patients remains complex, and long-term high-quality randomised controlled trials are required.

BACKGROUND:End-stage renal disease (ESRD) patients have increased gallstone disease prevalence and unique perioperative challenges. In ESRD patients awaiting renal transplantation, asymptomatic gallstones identified during pre-transplant evaluation carry additional clinical significance given the disproportionate risk of post-transplant biliary emergencies. Limited literature exists regarding laparoscopic cholecystectomy (LC) outcomes in this population. METHODS:True prospective observational study, CTRI-registered (CTRI/2016/12/007489) was conducted from December 2016 to March 2020 at a tertiary hospital in Eastern India. ESRD patients (n = 109) on maintenance hemodialysis were matched 1:2 with controls (n = 224) based on age, sex, BMI, and gallstone characteristics. Primary outcomes included ICU admission rate, major complications (Clavien-Dindo ≥ 3), and conversion to open surgery. RESULTS:ESRD patients demonstrated significantly higher complication rates (61.5% vs. 15.2%, p < 0.001), ICU admission requirements (81.7% vs. 8.0%, p < 0.001), and conversion rates (7.3% vs. 1.8%, p = 0.009). Major complications occurred in 18.3% versus 0.9% (p < 0.001). Cardiovascular complications affected 22.0% of ESRD patients versus 1.3% of controls (p < 0.001). Mean operative time was longer (89.3 ± 28.4 vs. 76.2 ± 24.1 min, p < 0.001). Hospital stay was extended (4.2 ± 2.8 vs. 2.3 ± 1.1 days, p < 0.001). Independent risk factors for major complications included hemoglobin < 8 g/dL (OR 3.24), LVEF < 50% (OR 2.89), and ASA Grade IV (OR 4.17). Subgroup analysis showed no significant difference in comorbidity burden between asymptomatic (n = 57) and symptomatic (n = 52) ESRD patients (all p > 0.05). Thirty-day mortality was 0.9% versus 0%. CONCLUSIONS:For ESRD patients awaiting transplantation, elective pre-transplant LC is remains feasible with appropriate patient selection, preoperative optimization, and intensive postoperative monitoring, and is justified given the severe consequences of post-transplant biliary emergencies, with LC-related post-transplant complications occurring in only 12.2% of transplanted patients, all Clavien-Dindo Grade I. TRIAL REGISTRATION:Clinical Trials Registry of India (CTRI/2016/12/007489).

Aims:Echocardiography is a key diagnostic modality for cardiac dysfunction but is often over utilized due to variability in pre-test clinical assessment. There is a need for a scalable, cost-effective screening tool that can reduce unnecessary referrals without compromising diagnostic accuracy. To develop and validate an AI tool that uses standard 12-lead ECG images to predict the presence of major echocardiographic abnormalities, including reduced ejection fraction (EF ≤35%), valvular heart disease, and elevated pulmonary artery pressure, as a triage tool prior to echocardiography. Methods and results:51,055 patients aged ≥15 years from a tertiary cardiac care centre, which underwent ECG and echocardiography on the same day between January 2021, and February 2024 were identified. ECGs were stored as images and pre-processed for model input. Echocardiographic findings were extracted using structured reports and regular expression-based keyword searches. The final dataset (n = 52,817) was split into training (40,796), epoch-monitoring (2,148), and testing (9,873) sets. An ensemble of 3 deep learning models was trained. Model performance was assessed using AUROC, PRAUC, sensitivity, specificity, positive predictive value, and negative predictive value. The internal test set demonstrated an AUROC of 0.87 (95% CI: 0.86-0.88) and PRAUC of 0.66 (95% CI: 0.65-0.69). At the Youden threshold (0.27), sensitivity, specificity, PPV, and NPV were 0.80, 0.80, 0.46, and 0.95, respectively. External validation was performed on 20,053 patients. It yielded an AUROC of 0.84 and PRAUC of 0.50. Conclusion:The proposed AI model accurately identifies major echocardiographic abnormalities from ECG images, achieving high NPV and demonstrating strong generalizability.

There has been controversy over the ideal management strategy for asymptomatic carotid artery stenosis. Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trials (CREST-2) evaluated whether adding carotid revascularisation to intensive medical therapy improves outcomes in patients with high-grade asymptomatic carotid artery stenosis. The study showed that carotid endarterectomy did not reduce the 4-year composite outcome compared with medical therapy alone, owing to higher early procedural risk that offset the lower late ipsilateral stroke rates. Carotid artery stenting on the other hand produced a statistically significant benefit, despite small periprocedural risks. Overall, intensive medical therapy achieved low disabling stroke rates, supporting selective rather than routine use of revascularisation.

Coronary artery disease is the leading cause of mortality worldwide and presents with disproportionately severe patterns in the South Asian population. Coronary artery bypass grafting remains the most durable revascularization modality. Yet, its evolution in India has been inconsistent, perhaps in part due to the absence of a dedicated scientific body focused exclusively on coronary surgery. Following the successful completion of the PROMOTE Patency Trial, the first multicenter randomized clinical trial in Indian cardiac surgery, a motivated group of surgeons recognized the need for sustained collaboration, research, and subspecialty-driven progress. This realization led to the formation of the Society of Coronary Surgeons in December 2020 under the leadership of its Founder President, L. R. Sajja, during the unprecedented disruptions of the COVID-19 pandemic. The society’s creation marks a pivotal advance in India’s effort to cultivate indigenous coronary research, data collection, standardized training, and region-specific guidelines. This perspective outlines the origins of the Society of Coronary Surgeons, the evolution of coronary surgery, the need for a coronary subspecialty society in India, and the importance of establishing a national coronary surgery database tailored to Indian patient characteristics. The Society of Coronary Surgeons represents both a scientific necessity and a transformative opportunity for the future of coronary surgery in India.