Search Results (14,555)

Background: High-frequency ultrasound (HFUS) has emerged as a valuable non-invasive imaging modality for the preoperative assessment of basal cell carcinoma (BCC). However, its ability to reliably differentiate between histopathological subtypes based on morphological and vascular characteristics requires further validation. Methods: Between January 2010 and December 2011, 320 patients with a total of 330 histologically confirmed BCC lesions were examined using HFUS (15–18 MHz linear transducer). Lesions were classified according to ultrasound contour (sharp vs. irregular) and vascularity (hypervascular vs. hypovascular) and correlated with histopathological subtype (solid vs. infiltrative). Postoperative ultrasound follow-up was performed in a subset of patients for recurrence detection. Results: Solid BCCs were predominantly characterised by sharp, well-defined margins, whereas infiltrative tumours more frequently exhibited irregular contours. This association was highly significant (χ² = 24.7, df = 1, p < 0.001; OR = 71.9, 95% CI: 37.0–139.8). Vascularity patterns also differed significantly between subtypes: solid tumours were more likely to present with hypervascular features, while infiltrative tumours more frequently exhibited hypovascular patterns (χ² = 23.8, df = 1, p < 0.001; OR = 3.24). No statistically significant associations were observed between ultrasound morphology and patient sex or age. Among patients who participated in postoperative HFUS follow-up, seven histologically confirmed recurrences were detected. Conclusions: HFUS provides reliable preoperative information on BCC morphology and vascularity, enabling accurate differentiation between solid and infiltrative subtypes. These findings support the role of HFUS as a valuable adjunct to dermatoscopy in treatment planning and postoperative surveillance of BCC. Full article

Background and Objectives: Tear film instability and corneal surface irregularity are important sources of variability in keratometric and corneal topographic measurements, particularly affecting astigmatic magnitude and axis. Accurate preoperative biometry is crucial for optimal refractive outcomes in cataract surgery. Dry eye disease (DED) may compromise the reproducibility of keratometric parameters, leading to errors in intraocular lens (IOL) power calculation. This study aimed to evaluate the impact of DED on the reproducibility of keratometric measurements and to assess the effect of a four-week treatment with lipid-containing artificial tears on these parameters in cataract patients. Materials and Methods: This cross-sectional study included 116 patients scheduled for cataract surgery, of whom 65 (56.0%) had DED and 51 (44.0%) served as controls. All patients underwent two preoperative keratometric measurements 10–20 min apart (IOL1 and IOL2). The control group proceeded to surgery the next day, while surgery in the DED group was postponed. Patients with DED received preoperative therapy with lipid-containing artificial tears. Follow-up assessments occurred one month after therapy (keratometric measurement named IOL3) and eight weeks postoperatively. Clinical evaluation included slit-lamp examination, dry eye testing according to Dry eye Workshop II (DEWS II) criteria: Ocular surface Disease Index (OSDI), Tear Break-Up Time (TBUT), Schirmer I, Oxford staining, and meibomian gland assessment), ocular biometry, and postoperative spherical equivalent measurement using an auto ref-keratometer. Nonparametric statistical analyses were applied to evaluate associations between parameters. Results: In the DED group, corneal astigmatism showed a significant difference between IOL1 and IOL2 (Wilcoxon signed-rank test {Z = 2.43; p = 0.015}). Significant changes in predicted IOL power were observed between pretreatment and posttreatment values (t = 2.57; p = 0.013) and between IOL2 and IOL3 (t = 2.23; p = 0.029), indicating improved keratometric stability following tear film therapy. No additional significant correlations were identified. Conclusions: DED adversely affects the reproducibility of keratometric measurements and may compromise IOL power selection. Preoperative identification and treatment of DED, followed by repeated biometry after tear film stabilization, are strongly recommended to enhance refractive accuracy and optimize surgical outcomes in cataract patients. Full article

Background: Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes—ODS, Wexner incontinence score (WIS), and LARS—in patients undergoing LRR-TSE. Methods: This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons. Results: ODS improved significantly over time (p < 0.001), decreasing from 12.8 ± 3.2 preoperatively to 2.4 ± 2.1, 4.2 ± 2.2, and 5.2 ± 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 ± 12.7 at 3 months to 8.8 ± 6.8 at 6 months and 3.5 ± 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 ± 5.2), followed by improvement at 6 and 12 months (3.2 ± 3.7 and 2.4 ± 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged ≥50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme’s procedure. Conclusions: LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months. Full article

Background: Intentional tooth replantation (ITR) is a promising treatment option for preserving teeth in cases where conventional endodontic therapy is challenging, or when previous endodontic treatment and apicoectomy have been unsuccessful. The procedure involves extracting the compromised tooth, preserving the alveolar socket and root surface, performing extraoral endodontic therapy, and replanting the tooth in the alveolar socket. Objective: An increase in evidence-based support for ITR has improved the viability of ITR as a treatment option for patients. This review aims to further establish and provide new areas of potential research for ITR with respect to root morphology, extraction, and surgical techniques, maintenance of the tooth socket, and methods for post-op stabilization. Materials and Methods: A literature review was performed across PubMed from 1 January 1980 to 1 July 2025, with a focus on oral surgery techniques, atraumatic extraction techniques, topographical discrepancies in root system anatomy, and ITR procedural outcomes. Conclusions: Although ITR is not a common procedure performed in contemporary clinical practice, gathering sufficient data on the variables influencing the procedure may help patient outcome and improve communication between the endodontist and oral surgeons. Full article

Background: Three-dimensional virtual surgical planning (Three-dimensional VSP) has become standard practice in the treatment of mandibular oral squamous cell carcinoma (OSCC) in the last decade. Dutch guidelines recommend a care pathway interval (CPI) of a maximum of 30 days, and a free bone margin of at least 5 mm. Fused MRI and CT data are used for accurate tumor delineation. Based on this data, a virtual surgical plan is created and transferred to the operating room using resection guides and patient-specific implants (PSIs). Long-term evaluation is needed to further optimize its clinical use. Objectives: This study evaluates adherence to bone margin and CPI guidelines in mandibular OSCC. Additionally, it assesses the accuracy of tumor resection and reconstruction using 3D-VSP and compares the complications of 3D-planned mandibular reconstruction using different kinds of osteosynthesis plates. Methods: All patients who underwent a segmental mandibulectomy between 2014 and 2024 at the University Medical Center Groningen were included. CPI, clinical outcomes, and complications were analyzed. The preoperative virtual plan was compared with the postoperative outcome to assess accuracy. Results: The median CPI was 34 days, and 93.7% of bone margins were tumor-free. Mean absolute resection deviation was 1.63 mm (±1.42). PSI reconstructions were significantly more accurate in intergonial distance and coronal angle compared to conventional plates. Plate-related complications were more common in non-bony reconstructions; PSI reconstructions showed significantly more plate exposure. Conclusions: 3D-VSP leads to high accuracy in resection and reconstruction and favorable bone margins. Shortening the CPI and reducing biological complications are essential to further improve oncological outcomes. Full article

Background/Objectives: Although the endoscopic extended latissimus dorsi (eeLD) flap avoids dorsal scarring, a lateral thoracic incision is still required. We developed an axillary-approach endoscopic extended latissimus dorsi (Ax-eeLD) flap enabling harvest through a single 40-mm axillary incision and two 5-mm ports. This study evaluated its safety and feasibility and compared outcomes with conventional eeLD. Methods: Patients who underwent Ax-eeLD flap (study group) were retrospectively analyzed and compared with the patients who underwent conventional eeLD flap (control group, n = 15). The flap was elevated endoscopically via a single 40-mm axillary incision and two 5-mm ports, harvesting the entire latissimus dorsi muscle with its surrounding adipose tissue. Outcomes included incision length, operative time, complications, secondary fat grafting, and BREAST-Q scores. Results: Fifteen patients (post-mastectomy, n = 13; congenital hypoplasia, n = 2) underwent Ax-eeLD flap. All procedures used only the planned incisions without intraoperative complications. The study group had significantly shorter incisions than the control group (39 ± 1 mm vs. 89 ± 9 mm, p < 0.01). Operative times were similar between the groups. Eight patients developed seromas, all of which were resolved by outpatient aspiration. The frequency of postoperative cases requiring fat grafting did not differ significantly between the study and control groups (4 vs. 8; p = 0.26). BREAST-Q scores improved postoperatively and were similar between groups. Conclusions: Ax-eeLD flap enables minimally invasive harvest of the latissimus dorsi without lateral thoracic scarring. This retrospective case series supports technical feasibility and safety; further prospective studies with objective volume assessment are required. Full article

Background and Objectives: Inadvertent perioperative hypothermia is a common and clinically significant complication during laparoscopic surgery, leading to pain, agitation, shivering, and delayed recovery. This randomized controlled trial evaluated the effect of peri-induction active warming with an electric resistive blanket on postoperative pain and agitation—the primary outcomes—compared with passive insulation. Materials and Methods: This study was registered at ClinicalTrials.gov (Identifier: NCT06022926; date of registration: 15 August 2023) prior to the enrollment of the first patient. One hundred and thirty-two American Society of Anesthesiologists I–II adults undergoing laparoscopic cholecystectomy were randomly allocated (1:1) to two groups: one received active warming with a resistive carbon fiber underbody blanket (Group 1), and the other received passive insulation (Group 2). The tympanic core temperature was measured at four perioperative time points (TT1–TT4). Postoperative agitation (Riker Sedation–Agitation Scale, RSAS) and pain (Numerical Rating Scale, NRS) were assessed 20 min after extubation in the post-anesthesia care unit (PACU). Secondary outcomes included intraoperative and postoperative temperature, postoperative shivering, adverse events (bradycardia, tachycardia, hypotension, hypertension, postoperative nausea and vomiting, and respiratory depression), and the PACU length of stay. Results: Baseline core temperatures (TT1) were similar between the groups (36.5 ± 0.55 °C vs. 36.6 ± 0.54 °C; p = 1.00). However, mean core temperatures at TT2, TT3, and TT4 were significantly higher in the active warming group compared with the control group (TT2: 36.7 ± 0.53 °C vs. 36.5 ± 0.54 °C; TT3: 36.6 ± 0.49 °C vs. 36.4 ± 0.54 °C; TT4: 36.6 ± 0.51 °C vs. 36.2 ± 0.52 °C; all p < 0.001). Active warming markedly reduced postoperative agitation (RSAS ≥ 5: 3.1% vs. 19.4%, p = 0.004) and pain (NRS ≥ 4: 15.4% vs. 49.3%, p < 0.001). The incidence of shivering was lower (20.0% vs. 46.3%, p = 0.006), and the PACU stay was shorter (24 [23–28] min vs. 35 [30–40] min, p < 0.001) with active warming. No significant differences in adverse events were observed between groups. Logistic regression identified the intraoperative fentanyl dose as a predictor of agitation and identified shivering and the PACU duration as predictors of pain. Conclusions: Peri-induction active warming effectively maintained normothermia and improved recovery quality by reducing postoperative agitation, pain, shivering, and PACU stays without increasing adverse events. It should be considered a standard component of thermal management in short- and medium-duration laparoscopic surgeries. Full article

Background and Clinical Significance: Annular pancreas is a rare congenital anomaly in which pancreatic tissue partially or completely encircles the duodenum, potentially causing duodenal obstruction. Clinical presentation varies from asymptomatic cases to persistent vomiting, feeding intolerance, and failure to thrive, often leading to delayed diagnosis. Case Presentation: We report a 2-year and 10-month-old girl with a long-standing history of intermittent, recurrent vomiting since the neonatal period, without growth impairment or other alarming symptoms. Initial imaging suggested proximal duodenal dilation, with suspicion for superior mesenteric artery (SMA) syndrome. Endoscopy revealed mechanical obstruction at the second portion of the duodenum. Contrast-enhanced CT confirmed annular pancreas partially encircling the duodenum. The patient underwent duodeno-duodenostomy with an uneventful postoperative course and complete resolution of symptoms. This case illustrates the diagnostic challenges of annular pancreas in older children with atypical presentations. Multimodal imaging is crucial for accurate diagnosis. Surgical bypass remains the definitive treatment, offering excellent long-term outcomes. Conclusions: Persistent or recurrent vomiting in children, even without classic signs such as bilious vomiting or failure to thrive, should prompt consideration of annular pancreas. Early recognition and timely surgical intervention can prevent prolonged morbidity and ensure normal growth and development. Full article

Background/Objectives: Postoperative pulmonary complications (PPCs) remain frequent and increase morbidity, mortality, and resource use. Preoperative risk scores (ARISCAT, NSQIP-derived calculators) use mostly static variables and may miss the dynamic perioperative host response preceding respiratory deterioration or infection. We address the gap in clinically interpretable syntheses of perioperative blood biomarker trajectories that distinguish infectious from non-infectious PPCs and clarify bedside-ready versus exploratory markers. Methods: We conducted a narrative review with a structured Medline search (inception to 1 November 2025) plus reference screening. We included English-language adult surgical studies (observational or interventional) evaluating perioperative blood biomarkers in relation to PPCs or postoperative pulmonary infection; case reports, editorials, and reviews were excluded. No formal risk-of-bias assessment or quantitative meta-analysis was performed. Results: Across 298 cited publications, serial patterns of routinely available biomarkers (C-reactive protein, procalcitonin, lactate, albumin, and leukocyte-derived indices) were most consistently associated with PPC risk and helped separate expected postoperative inflammation from evolving infection when interpreted longitudinally rather than as single values. Mechanistic biomarkers (cytokines/immune-function assays, endothelial injury and coagulation/fibrinolysis markers, oxidative stress indicators) add biological insight but are limited by assay availability, heterogeneous sampling windows, and absent standardized cut-offs. Omics signatures and machine learning models combining biomarker kinetics with clinical variables are promising but require prospective, transportable validation. Conclusions: Key barriers to implementation include biological variability, non-specificity across postoperative syndromes, heterogeneous sampling windows, and lack of standardized cut-offs. Integrating multimarker panels into validated, dynamic predictive frameworks represents a promising direction for perioperative precision medicine. Full article

Major hepatectomy (MH) has traditionally been associated with higher R0 rates in colorectal liver metastases (CRLM), but at the cost of increased morbidity. Parenchymal-sparing hepatectomy (PSH) has emerged as an alternative approach aimed at reducing perioperative complications while preserving functional liver parenchyma without compromising oncological outcomes. We retrospectively analyzed 248 consecutive patients undergoing liver resection for CRLM between 2016 and 2025, classified as PSH (n = 215, 86.7%) or MH (n = 33, 13.3%). MH was performed more frequently in patients with greater tumor burden, including larger lesions, more numerous metastases, and bilobar disease (all p < 0.001). PSH was associated with shorter hospital stay, fewer postoperative complications, and lower 30-day readmission rate. In multivariable Cox analyses, surgical strategy was not associated with recurrence-free survival or overall survival, which were primarily driven by tumor burden. Among patients who developed liver recurrence, repeat hepatectomy was more often feasible after PSH than MH (p = 0.026), emphasizing the long-term value of preserving functional parenchyma. Overall, PSH was associated with lower postoperative morbidity, enabling earlier recovery, while facilitating future liver resections when needed in this chronically evolving disease. Full article

Background: Treatment of chronic painful insertional Achilles tendinopathy is known to be challenging. If non-surgical treatment does not give sufficient relief of symptoms, surgery may be indicated. Treatment with ultrasound (US)- and colour Doppler (CD)-guided wide-awake-local-anaesthetic-no-tourniquet (WALANT) surgery for insertional Achilles tendinopathy is a new approach with promising clinical results. This study aimed to evaluate clinical results of this new approach on patients suffering from insertional Achilles tendinopathy. Methods: Forty-eight consecutive patients with 53 symptomatic tendons (33 men with 34 tendons, mean age 49.3 ± 12.0 years; 14 women with 18 tendons, mean age 55.0 ± 7.4 years) and a duration of more than 12 months with painful insertional Achilles tendinopathy (including tendon, bursae, bone, and plantaris pathology) were included. US- and CD-guided WALANT surgery with removal of pathological bursae, bone, and tendons was used. Immediate weight-bearing loading was allowed, followed by a structured rehabilitation protocol for the first 12 weeks after surgery. VISA-A scores before and after surgery and a questionnaire that evaluated subjective satisfaction with the treatment and current activity level were used. Results: In total, 42/48 patients with 46/53 tendons participated in a 3-year follow-up (mean 34 ± 9 months) by an independent examiner; 39/42 patients with 43/46 tendons were satisfied (n = 37) with the treatment. The mean VISA-A score increased significantly from 41.9 ± 18.2 pre-operatively to 87.7 ± 18.2 post-operatively (p < 0.001). There were three surgical complications, two superficial wound infections, and one minor wound rupture. Conclusions: Patients who suffered from chronic painful insertional Achilles tendinopathy treated with US- and CD-guided WALANT surgery followed by immediate weight-bearing showed high patient subjective satisfaction rates and better functional scores at the 3-year follow-up with a low complication rate. This novel treatment approach warrants more study, including randomised trials comparing it against traditional surgical procedures according to Nunley and Keck and Kelly. Full article

Background: The prognostic relevance of surgical timing at glioblastoma recurrence remains uncertain, and definitions of early versus delayed reoperation vary widely. Whether earlier surgery provides meaningful survival or functional benefit has not been clearly established. Methods: Databases including PubMed, Embase, Scopus, and Web of Science were searched from inception to May 2025. Eighteen observational studies met the inclusion criteria, fourteen of which provided extractable hazard ratios for survival. The primary outcome was overall survival after reoperation; secondary outcomes included functional status (ΔKPS or discharge home) and major postoperative complications. Random-effects models with Hartung–Knapp adjustment were used, with subgroup analyses stratified by KPS, extent of resection, and eloquence. Results: Across 2267 reoperated patients from 14 survival studies, earlier reoperation was associated with significantly longer survival (pooled HR 0.86; 95% CI 0.78–0.95). Subgroup analyses showed stronger effects in patients with KPS ≥ 70 (HR 0.81; 95% CI 0.72–0.92), non-eloquent tumors (HR 0.84; 95% CI 0.75–0.94), and near-total/gross-total resection (HR 0.79; 95% CI 0.68–0.93). Functional outcomes were pooled from 9 studies (n = 1182), demonstrating higher odds of postoperative stability or improvement with early surgery (OR 1.28; 95% CI 1.12–1.46). Major complications were reported in 9 studies (n = 1344) and did not differ between groups (OR 0.98; 95% CI 0.81–1.19). Sensitivity analyses and influence diagnostics showed consistent effect estimates and no undue single-study influence. Conclusions: Earlier reoperation for recurrent glioblastoma is associated with improved survival and better functional outcomes without increased morbidity in appropriately selected patients. Surgical timing should be incorporated into multidisciplinary planning. Prospective studies with standardized timing definitions and time-dependent modeling are needed to validate these findings. Full article

Background and Objectives: The treatment of duodenal injuries remains one of the most challenging issues in clinical surgery due to their high morbidity and mortality rates. The primary objective of this study was to evaluate the histopathology and other diagnostic outcomes of wound repair following surgical reconstruction of large experimental duodenal defects using synthetic (ePTFE, expanded polytetrafluoroethylene) or organic (JSP, jejunal serosal patch) materials. Materials and Methods: A total of 20 European rabbits were randomly divided into two equal groups (n = 10 each). A grade III defect covering over 50% of the duodenum’s circumference was created in the second part of the duodenum of the rabbits. The anesthesia, duodenal injury, postoperative care, and animal sacrifice protocols were identical for all experimental rabbits. The effectiveness of JSP and ePTFE patch repair techniques was investigated based on clinical, macroscopic, and microscopic assessments at two and four weeks postoperatively. Results: Survival rates were comparable between groups (p > 0.05). Remarkable mucosal regeneration was evident in all experimental animals by two weeks, showing complete coverage of the jejunal serosal and ePTFE patches by re-epithelialized mucosa with functional villus formation. While partial development of the underlying muscular and serosal layers was observed in both groups at four weeks, the JSP group achieved a significantly higher median histological score (19 vs. 14; p = 0.003). Conversely, the ePTFE group exhibited a major safety concern: a highly significant increase (p ≤ 0.001) in Grade 4 dense, inseparable adhesions throughout the abdominal cavity, which were entirely absent in the JSP group. Conclusions: Both JSP and ePTFE are viable for duodenal reconstruction, but the autologous JSP is superior in tissue healing and safety. Severe adhesions associated with ePTFE constitute a significant clinical concern, limiting its use to a second-line alternative. Consequently, JSP is the preferred option, while ePTFE requires further long-term safety validation. Full article

In recent years, there has been rapid growth in aesthetic medicine and an increase in the number of minimally invasive procedures aimed at improving appearance. With the increasing number of procedures performed, the incidence of post-operative complications is also rising, and high-frequency ultrasound (HFUS) is increasingly being used to assess these complications. The article presents the case of a 52-year-old woman who reported for an HFUS examination several months after non-surgical nose correction with hyaluronic acid (HA) and implantation of polydioxanone (PDO) lifting threads. The patient experienced post-treatment complications in the form of erythema, oedema and pain, followed by blanching and bruising of the skin. Hyaluronidase and prednisone were used for treatment. Four months after the procedure, the patient returned for another HFUS examination because, despite the disappearance of most symptoms, uneven purple-blue discoloration of the skin on the nose and a subjective feeling of cold persisted. At the time of the HFUS examination, the discoloration was barely visible. The grey-scale HFUS examination revealed foci corresponding to HA deposits and PDO threads located in close proximity to the dorsal artery of the nose. A Doppler examination revealed blood flow disturbances in this artery, which may indicate compression by the threads and be the likely cause of the patient’s complaints. High-frequency ultrasound has proven to be a useful diagnostic method for assessing such complications. Due to its safety, non-invasiveness and high reliability, HFUS has the potential to become a common diagnostic tool in aesthetic medicine practice. Full article

Background: Renal and cardiac dysfunction are major determinants of adverse outcomes following transcatheter aortic valve replacement (TAVR). The ratio of blood urea nitrogen to left ventricular ejection fraction (BUN/EF) integrates renal and cardiac status into a single physiological index. This study aimed to evaluate the prognostic value of both baseline and temporal (48–72 h) BUN/EF ratios for predicting mortality after TAVR. Methods: A total of 429 patients (mean age 76 ± 8 years; 51% female) who underwent TAVR for severe aortic stenosis between 2017 and 2025 were retrospectively analyzed. The primary endpoint was long-term all-cause mortality; in-hospital mortality was secondary. Receiver operating characteristic (ROC) curves, Cox regression, and reclassification metrics (NRI, IDI) assessed prognostic performance. Restricted cubic spline (RCS) analysis explored non-linear associations. Results: During a median follow-up of 733 days, overall and in-hospital mortality rates were 37.8% and 7.9%, respectively. Both baseline and 48–72 h BUN/EF ratios were independently associated with mortality (HR = 3.46 and 3.79 per 1 SD increase; both p < 0.001). The temporal ratio showed superior discrimination for in-hospital mortality (AUC = 0.826 vs. 0.743, p = 0.007). Adding baseline BUN/EF to EuroSCORE II significantly improved model performance (AUC 0.712 vs. 0.668, p = 0.031; NRI = 0.33; IDI = 0.067). RCS analysis revealed a linear relationship for baseline and a steep, non-linear association for temporal ratios with mortality risk. Conclusions: The 48–72 h BUN/EF ratio is a robust dynamic biomarker that predicts early mortality after TAVR, while baseline BUN/EF identifies patients at long-term risk. Integrating this simple bedside index into risk algorithms may refine postoperative monitoring and improve outcome prediction in TAVR populations. Full article