Search Results (1,612)

Artificial intelligence (AI) is rapidly transforming cardiovascular medicine, driven by the increasing availability of large-scale clinical data and advances in machine learning. Early computational applications in cardiology were primarily limited to rule-based electrocardiogram interpretation systems. Over time, these approaches have evolved into sophisticated deep learning models capable of analysing complex cardiovascular signals and imaging data. In parallel with the broader development of digital health technologies, including wearable devices, electronic health records, and remote monitoring systems, AI applications have expanded across multiple domains of cardiovascular care. These now include electrocardiographic (ECG) and electrophysiological analysis, cardiovascular imaging, surgical planning, and multimodal risk prediction. More recently, multimodal AI models have emerged that integrate heterogeneous data sources such as imaging, physiological signals, clinical records, and genomic information, enabling more comprehensive characterisation of cardiovascular disease. Beyond diagnostic applications, AI is increasingly influencing system-level aspects of cardiovascular medicine, including clinical decision support, workflow optimisation, medical education, and clinical trial design. This narrative review traces the historical and clinical evolution of artificial intelligence in cardiovascular medicine from early automated ECG interpretation systems to contemporary multimodal and system-level applications. It highlights key technological developments, current clinical applications, translational challenges, and the emerging role of AI within digital cardiovascular health ecosystems, with particular emphasis on early disease detection, risk stratification, prognostic modelling, and personalised cardiovascular care. Full article

Background/Objectives: Body mass index (BMI) is widely used to classify weight status, but it does not reflect fat distribution, muscle mass, or bone mass. Bioelectrical impedance analysis (BIA)-derived visceral fat rating (VFR) is a device-generated estimate of visceral adiposity. This study assessed age- and gender-related differences in anthropometric and BIA-derived body composition parameters, with particular attention to the relationship between BMI classification and VFR. Methods: This cross-sectional study included consecutive adults admitted to a single plastic surgery clinic over three months. Waist and hip circumferences were measured, waist-to-hip ratio was calculated, and body composition was assessed using a Tanita BC-420 MA analyzer. Associations between age, BMI, and BIA-derived parameters were assessed using Spearman’s rank correlation. BMI categories were cross-tabulated with VFR categories, and multivariable linear regression was used to assess VFR in relation to age, BMI, and gender. Results: The study included 326 patients. Mean BMI was higher in men than in women (27.6 ± 4.33 vs. 26.4 ± 5.07; p = 0.006), and men also had higher VFR (12.8 ± 6.15 vs. 7.75 ± 3.74; p < 0.001). Older age groups had higher VFR values, ranging from 2.16 ± 1.82 in participants aged 18–29 years to 14.3 ± 5.0 in patients aged ≥ 80 years. BMI and VFR were strongly correlated, but BMI categories did not fully correspond to VFR categories. Manufacturer-defined elevated VFR was observed in 5 patients with normal BMI and 24 patients with overweight, whereas 26 patients classified as obese had a manufacturer-defined normal VFR category. Conclusions: In this surgical cohort, older age groups had markedly higher VFR values than younger groups despite relatively modest differences in BMI. Because VFR is a device-generated estimate rather than a direct measure of visceral adiposity, these cross-sectional findings should be interpreted cautiously. Validation against established reference methods is needed before drawing broader clinical conclusions. Full article

Background/Objectives: Thyroidectomy is widely considered a safe procedure; however, several post-operative complications can occur, including post-surgery hemorrhage, which is considered a rare but life-threatening condition. Different strategies are employed before, during, and after surgery to minimize the risks. The aim of the present study is to describe a standardized patient management and surgical technique in thyroid surgery to prevent post-operative hemorrhage. Methods: Patients undergoing a thyroidectomy between January 2024 and June 2025 in a single center were included. Pre-operative strategies included blood pressure checks and thyroid function blood exams. Surgery was performed using a standardized technique and with a surgical energy device. Following the procedure, high blood pressure was corrected pharmacologically. Results: One hundred and twenty-three patients undergoing total thyroidectomy were included. Only one patient suffered from a post-operative hemorrhage, exhibiting an asymptomatic cervical hematoma that had been spontaneously drained one day after surgery. None of the patients required further surgeries for post-operative bleeding. Conclusions: With the application of standardized patient management and surgical techniques, zero cases of re-operation for post-operative bleeding were reported. This result strongly encourages the utilization of a standardized surgical technique to improve pre- and post-operative patient management and minimize the risk of life-threatening complications such as post-operative bleeding. Full article

Remote center-of-motion mechanisms are essential in minimally invasive surgery because they allow surgical instruments or an endoscopic camera to pivot around a trocar entry point while eliminating lateral motion at the incision. This paper presents the design, kinematic modeling, prototype implementation and preliminary evaluation under laboratory conditions of a compact, spherical, remote center-of-motion robot for minimally invasive surgical orientation tasks. The proposed mechanism uses a spherical kinematic architecture actuated by a contra-rotating differential gearbox. This gearbox generates two coaxial output rotations of equal magnitude and opposite direction from a single input, mechanically synchronizing the opposed motion of the two base links and eliminating the need for cable-pulley transmission or dual electronically synchronized motors. A second actuator chain rotates the gearbox assembly around the base axis, thereby decoupling the extension–retraction motion from base-axis rotation. Forward and inverse kinematic formulations were derived for teleoperation of the robot using a 7 degrees of freedom haptic device and for remote center-of-motion orientation control using a 3-axis joystick. A proof-of-concept prototype was developed and integrated with a custom embedded controller, closed-loop motor control, a master-console interface and video feedback loop. The system was evaluated in a phantom-torso setup using a custom endoscopic camera, internal visual markers and an OptiTrack-based measurement of the remote center-of-motion accuracy. The qualitative experiment confirmed functional integration of the mechanical, electronic and software subsystems, while the optical-tracking measurement showed that the pivot constraint was maintained with a mean deviation of 1.69 mm and a root-mean-square deviation of 2.13 mm over the analyzed orientation sweep. The main limitations remain the 1:1 gearbox ratio, limited actuator torque, additively manufactured gearing and the absence of repeated-trial repeatability and full workspace characterization. Full article

Objectives: Incomplete partition type III is a rare malformation of the inner ear characterized by the absence of the modiolus, fixation of the stapes, and significant communication between the cochlea and the internal auditory canal (IAC). During cochlear implant (CI) surgery, there is a risk that the electrode array may enter the IAC, resulting in non-specific stimulation of auditory neurons or other nerve fibers inside the IAC. In this study, we present our experience with CI surgery in patients with incomplete partition type III and report the types of devices utilized. Methods: A retrospective analysis was conducted on all our patients with cochlear incomplete partition type III who underwent surgical cochlear implantation in a tertiary referral unit over the past 16 years. Results: Of the perimodiolar electrodes used initially, four were correctly positioned within the cochlea from initial insertion, and no reinsertion was necessary. A lateral wall electrode array CI was selected to replace the last failed perimodiolar insertion, but it also required two insertion attempts due to its initial misplacement into the internal auditory canal. Conclusions: In this study, electrode array selection was influenced by surgeon preference and by intraoperative factors such as the severity of the gusher. Our observations suggest that perimodiolar CIs can be used in selected cases of incomplete partition type III and did not appear to increase the risk of IAC misplacement compared with the lateral wall array used in one patient. However, these findings should be interpreted cautiously as observations from the authors’ experience rather than as generalized conclusions regarding the relative safety of perimodiolar versus lateral wall electrode arrays. Lateral wall arrays may also be misplaced into the IAC, and their use may be considered in cases with severe and difficult-to-control gusher. Full article

This work presents an interdisciplinary engineering framework and a collaborative digital platform supporting the design, optimization, and proof-of-concept validation of patient-specific surgical devices for maxillofacial applications. The proposed methodology starts from computed tomography images and integrates three-dimensional anatomical reconstruction, hybrid CAD modelling, material characterization, finite element analysis, topology optimization, and additive manufacturing within a unified collaborative environment involving surgeons and engineering specialists. The proposed workflow was validated through a proof-of-concept study performed on patient-specific additively manufactured anatomical replicas. A comparative evaluation between the conventional wafer-based workflow and the proposed device-based approach demonstrated the technical feasibility of the methodology, achieving sub-millimetric positioning accuracy together with an estimated reduction in operative time under identical simulated surgical conditions. Although these results do not represent clinically validated outcomes, they provide representative preclinical estimates supporting the effectiveness of the proposed engineering approach and establish a solid basis for future in vivo investigations. The principal contribution of this work lies in the methodological integration of clinical planning, engineering design, numerical validation, additive manufacturing, and multidisciplinary collaboration within a single digital framework. In addition, a novel patient-specific device for orthognathic surgery is presented as a representative case study demonstrating the applicability of the proposed methodology to the development of customized surgical solutions. Full article

Background: In low-flow, low-gradient aortic stenosis (LFLG AS), restricted aortic valve opening may represent either fixed valvular obstruction or flow-dependent incomplete leaflet opening due to reduced forward flow. Aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CM) may coexist, making it difficult to distinguish myocardial disease–driven low-flow physiology from clinically relevant valvular obstruction. Case Presentation: An 88-year-old man presented with decompensated heart failure and paradoxical LFLG AS. Dobutamine stress echocardiography (DSE) failed to restore normal flow, and the calculated aortic valve area remained within the severe range despite stress. Computed tomography showed a low aortic valve calcium score (AVCS) of 313 Agatston units, leaving true-severe versus pseudo-severe AS indeterminate. Further evaluation confirmed wild-type ATTR-CM. Because the contribution of AS to heart failure was uncertain, the patient was initially managed with optimized heart failure therapy. Approximately two years later, he was readmitted with recurrent acute decompensated heart failure, severe left ventricular systolic dysfunction, dobutamine dependency, end-organ congestion, and a classical LFLG AS phenotype. Although AS severity remained indeterminate, a clinically relevant valvular afterload component could not be excluded. At that time, tafamidis was not immediately available because of local access limitations. Because left ventricular assist device implantation and heart transplantation were not feasible and surgical aortic valve replacement carried prohibitive risk, transcatheter aortic valve implantation (TAVI) was performed after discussion by the Heart Team. Left ventricular ejection fraction improved early after TAVI, from 19.9% before the procedure to 29.4% at 3 days and 44.1% at 35 days. At 1-year follow-up, left ventricular ejection fraction remained improved at 51%, and more than two years after TAVI, the patient continues regular outpatient follow-up without recurrent heart failure hospitalization. Conclusions: In ATTR-CM with LFLG AS, DSE and AVCS may not definitively determine AS severity. Carefully selected TAVI, combined with ATTR-directed and optimized heart failure therapy, may be associated with early left ventricular functional recovery and sustained clinical improvement. Full article

Medical device-related pressure injuries (MDRPIs) represent a significant subset of hospital-acquired pressure injuries, yet nurses’ knowledge regarding their prevention remains inadequately characterized. MDRPIs are a critical yet often overlooked patient safety issue in acute-care settings. This study aimed to evaluate the knowledge levels of nurses regarding MDRPI risk factors in a hospital located in Eastern Türkiye. A descriptive cross-sectional study was conducted with 284 nurses working in intensive care, palliative care, surgical, and internal medicine units between October and December 2024. Data were gathered through a structured questionnaire assessing knowledge of risk factors, evidence-based prevention strategies, and device-specific clinical competencies. Statistical analysis included descriptive statistics, ANOVA, and multiple regression modeling. Results revealed moderate overall MDRPI knowledge levels with significant variation by clinical unit, years of experience, prior training exposure, and frequency of medical device use. Regression analysis identified prior education on pressure injury prevention as the strongest predictor of knowledge scores. Nurses in intensive care units demonstrated higher knowledge and prevention competency compared to those in palliative care and general medical-surgical units (p < 0.001). These findings underscore the need for targeted, device-specific educational interventions and standardized training protocols to enhance nurses’ competency in MDRPI prevention across diverse clinical settings. Strengthening in-service training protocols is essential to reduce preventable patient harm and improve clinical outcomes in regional healthcare facilities. Full article

Background: Despite modern technology of energy instruments, secure arterial vessel sealing remains a surgical challenge. Particularly in cases of fragile vessel walls or limited visibility, additional reinforcement techniques are potentially desirable. TachoSil^®, a collagen-based, fibrin-coated fleece, is routinely employed in clinical practice for hemostasis and suture support. Whether its external use in terms of collagen augmentation improves the burst strength of bipolarly sealed arteries is to be examined. Objective: To investigate the influence of a TachoSil^® cuff on sealing quality and burst pressures after bipolar vessel sealing in a standardized ex vivo model. Materials and Methods: Porcine carotid arteries (outer diameter 5–7 mm) were examined in two groups: native vessels (group A, n = 12) and vessels with TachoSil^® cuffs (group B, n = 12). Sealing was performed with marSeal^® 5 plus and maXium^® sealer. Burst pressures were measured by continuously increasing intraluminal pressure. Histological analyses were performed. Results: Mean burst pressures were significantly reduced in group B (805 ± 78 mbar) as compared to group A (1452 ± 275 mbar; p < 0.001). Histologically, no structural fusion between vessel walls and collagen fleece was observed. Conclusions: External collagen augmentation using TachoSil^® leads to a significant reduction in the burst strength of bipolarly sealed arteries, despite unaltered sealing duration. The combination of collagen fleece and energy sealing does not have a synergistic effect and should not be used in planned vessel sealing. Further studies are needed to evaluate the underlying mechanisms and possible alternative augmentation strategies. Full article

Background: Same-day or post-admission cancellation of elective surgery is associated with inefficient operating room utilization, patient distress, and disruption of coordinated perioperative care. Functional neurosurgery is particularly vulnerable to late-stage cancellation because procedural readiness depends on parallel clinical, anatomical, medication-related, device-related, and systemic considerations. Objective: This paper aims to describe the implementation of a structured preoperative review framework for functional neurosurgery and to evaluate its association with late-stage surgical cancellation after patient admission. Methods: We performed a retrospective single-center before-and-after study of consecutive functional neurosurgical procedures scheduled at Sheba Medical Center between January 2020 and December 2025. The ABCDE framework was introduced in 2023 as a structured workflow model organized around five domains: Anatomy, Bacteria, Clotting, Devices, and Elsewhere. Included procedures were deep brain stimulation, vagus nerve stimulation, focused ultrasound, intrathecal pump implantation or replacement, implantable pulse generator replacement, spinal cord stimulation, peripheral nerve stimulation, and other palliative neuromodulation procedures. The primary endpoint was late-stage cancellation, defined as cancellation after hospital admission and initiation of operative preparation. The primary comparison was between 2020–2022 and 2023–2025. A sensitivity analysis excluded 2020 because of pandemic-era disruption. Results: A total of 867 procedures were scheduled. Late-stage cancellation occurred in 16 of 407 pre-implementation procedures and 5 of 460 post-implementation procedures, corresponding to rates of 3.9% and 1.1%, respectively. The absolute risk difference was −2.8 percentage points (95% CI, −5.2 to −0.8), and the relative risk for cancellation after implementation was 0.28 (95% CI, 0.10 to 0.75). A two-sided Fisher’s exact test comparing cancellation versus non-cancellation across the pre-implementation and post-implementation periods was statistically significant (16/407 vs. 5/460; p = 0.0074). After excluding 2020, the direction of effect remained similar, but the difference was not statistically significant: 8 of 302 procedures in 2021–2022 were canceled compared with 5 of 460 in 2023–2025 (2.6% vs. 1.1%; p = 0.15). Detailed source-level attribution was incomplete for 10 of 21 cancellation events, and domain-level analyses should therefore be interpreted descriptively. Conclusions: Implementation of the ABCDE framework was associated with fewer late-stage surgical cancellations in this single-center before-and-after study. Because the design is observational, the number of events is small, and the study period overlaps with pandemic-era disruption and post-pandemic service stabilization, the findings should be interpreted as hypothesis-generating rather than causal. The framework may provide a practical structure for standardizing preoperative review in functional neurosurgery, but prospective studies with formal adherence tracking and procedure-specific analyses are needed. Full article

Tricuspid regurgitation (TR) is being increasingly recognized in the patient population. It is a common cardiac cause of chronic disability. This pathology is characterized by a heterogeneous and broad spectrum of clinical manifestations with signs and symptoms. The results from various and different analyses and studies suggest that TR-related deaths may have increased over the last 20 years. This trend may justify a greater focus on timely diagnosis and management of TR. For a long time, this problem has been underestimated or treated with only pharmacological therapy (diuretics). The use of the isolated surgical option remains infrequent, especially in patients at high surgical risk, for whom a significant number of patients with TR are still not treated, and a disability remains that is difficult to manage and rehabilitate. To date, there are emerging as an alternative to surgery in high-risk patients with severe TR multiple transcatheter devices that aim to reduce TR through different functional mechanisms. There are numerous minimally invasive treatments for TR, and many devices used for the treatment of this disabling pathology. In fact, there are various treatments with a transcatheter approach using ever-new devices. The use of heterotopic implantation of bioprosthetic valves in the superior and inferior vena cava represents an additional therapeutic armamentarium that, through caval reflux, can constitute an additional resource, too. Starting from a single clinical experience and describing a clinical case report, a narrative review has been undertaken by reviewing the various studies that have investigated this type of approach and their impact on the general, cardiac, and functional sides, to then discuss the cost–benefit ratio in light of knowledge on this specific topic. Full article

Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR) has come a long way since the first-in-human implant by Prof Cribier & colleagues in 2002. Initially a consideration for inoperable/high-surgical-risk patients, TAVI is now indicated in patients with severe tricuspid aortic stenosis and suitable anatomy aged 70 or higher. This has been made possible due to improvements in preprocedural planning, performance upgrades to and evolution of transcatheter heart valve (THV) systems and increasing operator experience. Younger age at index implantation, complexities of redo TAVI planning and methods to improve THV durability are the next frontiers. This review summarizes these advancements while emphasizing preprocedural planning, current guidelines, and individualized device selection, with a brief note on polymeric heart valves—developed to overcome the disadvantageous bioprosthetic dysfunction seen with current THVs. Full article

Background: Hypoglossal nerve stimulation (HNS) is an established surgical therapy for adults with moderate-to-severe obstructive sleep apnea (OSA) who are intolerant to positive airway pressure. Although aggregate response rates of ~70–80% have been reported, substantial variability across clinical settings remains poorly understood. Prior meta-analyses have largely emphasized pooled continuous outcomes, limiting interpretation of responder-based endpoints and drivers of between-study heterogeneity. Methods: A PRISMA-compliant systematic review and meta-analysis was performed. MEDLINE, Embase, and Cochrane CENTRAL were searched from inception through 31 December 2025. Eligible studies enrolled adults with OSA treated with implantable HNS, reported Sher-defined response (≥50% AHI reduction and residual AHI < 20 events/hour), and/or continuous outcomes, and included ≥20 patients. Random-effects models (REML) were applied. Heterogeneity was quantified using I² and τ², with prediction intervals. Meta-regression assessed baseline AHI, BMI, and follow-up duration. Subgroup analyses examined device laterality, stimulation modality, sleep assessment method, and follow-up. Results: Thirty-eight studies (39 cohorts; n = 3220) were included. The pooled Sher response rate was 74.0% (95% CI 67.6–79.5%). Heterogeneity was substantial. HNS significantly improved all continuous outcomes (AHI −23.3 events/hour; ESS −4.5 points; ODI −14.5 events/hour). Comparative analyses favored HNS over surgical comparators, inactive stimulation, and delayed treatment. Revision and explantation rates were 5% and 4%, respectively. Meta-regression showed no significant effects of baseline AHI, BMI, or follow-up, explaining negligible variance. Subgroups suggested numerically higher response with breathing-synchronized stimulation, but heterogeneity remained high. Conclusions: HNS achieves Sher response in approximately three-quarters of appropriately selected CPAP-intolerant OSA patients, with durable clinical benefits and a favorable safety profile. Persistent unexplained heterogeneity highlights limitations of conventional predictors and underscores the need for more granular response determinants. Full article

Objectives: Transaxillar Impella 5.0/5.5 implantation is a hybrid surgical and fluoroscopy-guided procedure. We evaluated the learning curve using radiation exposure as a marker of procedural efficiency and assessed whether structured mentorship accelerates procedural proficiency. Methods: This retrospective single-center study included consecutive transaxillar Impella 5.0/5.5 implantation attempts by two surgeons. Surgeon A adopted the technique independently, whereas Surgeon B was trained under direct proctorship. The primary endpoint was radiation exposure (dose–area product), and the secondary endpoint was fluoroscopy time. Temporal trends were analyzed by regression, and CUSUM plots were generated. Results: Of 104 procedures, 14 were excluded (12 transaortic, 2 unsuccessful). Ninety procedures were analyzed (74 Surgeon A, 16 Surgeon B). In Surgeon A, radiation exposure decreased significantly with increasing case number. In Surgeon B, no significant association between case number and radiation exposure was observed. Fluoroscopy time was not associated with case number in either group. CUSUM analysis suggested an early increase followed by stabilization in Surgeon A, whereas no clear pattern was observed in Surgeon B. The between-surgeon interaction was not statistically significant. ECMELLA configuration was the only independent predictor of increased radiation exposure, whereas device type, surgery type, and patient age were not significant predictors. Conclusions: Transaxillar Impella implantation appears to have a measurable early learning phase. Structured mentorship may attenuate the early learning phase, although this finding remains exploratory. Full article

Background/Objectives: Addressing cochlear malformations in the context of cochlear implantation is particularly important because the dimensions of the cochlea can affect intraoperative surgical decisions and options as well as the postoperative outcomes of each patient. High-resolution computed tomography (CT) is routinely used to assess the dimensions of the cochlea and the presence of any structural malformations. The purpose of this paper is to evaluate the dimensions of the cochlea and its malformations by using imaging measurements and correlating the data obtained with certain types of medical devices used. Methods: A retrospective observational study was conducted, through the systematic analysis of computed tomography images, on 130 cochlear implants between 2014 and 2024 at the ENT Clinic in Târgu Mureș, Romania, analyzing 103 patients. Data related to the anatomical features of the cochlea and their dimensions were evaluated, with an emphasis on the volume of the malformed and non-malformed cochleas. The collected data were statistically analyzed, evaluating the volume of the cochlea in relation to the gender and age of the patients, as well as the presence of cochlear malformations related to the analyzed side—the right and left ear. Results: The age groups analyzed were 58% between 0 and 7 years, 14% between 8 and 17 years, and 28% between 17 and 68 years, with the minimum age for implantation being 10 months and the maximum age being 68 years. Analyzing the presence of malformations by gender, it was found that enlarged cochlear aperture occurs at a rate of 14.89% in females and 17.02% in males, while an enlarged vestibular aqueduct occurs at a rate of 4.26% in females and 8.51% in males. Incomplete partition types I and II have a frequency of 10.64% in women and 14.89% in men. Incomplete partition type I is equally present in 10.64% of women and men. Cochlear hypoplasia occurs at a low frequency of 2.13% in women and is not observed in men in our analysis. Conclusions: In this study, we analyzed cochlear volume variables between malformed and normal cochleae. Cochlear dimensions (width and height) did not show statistically significant variations between the right and left ears, both in malformed and non-malformed cochleae. The cochlear volume is consistent across the groups studied and is not influenced by malformations or the demographic variables analyzed. Cochlear malformations, according to our assessments, do not present contraindications for a cochlear implant, which nevertheless demonstrates that a preliminary imaging assessment is extremely useful for determining the type of implant that can be used. Full article