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Introduction Preoperative fasting is essential in surgical care to reduce the risk of pulmonary aspiration during anesthesia. International guidelines, such as those from the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA), recommend fasting durations of six hours for solids and two hours for clear liquids. However, adherence to these guidelines often varies in clinical practice, leading to prolonged fasting times that can negatively impact patient outcomes, including dehydration, hypoglycemia, discomfort, and delayed recovery. This quality improvement study aimed to evaluate adherence to international preoperative fasting guidelines within cardiovascular and thoracic surgery wards, identify barriers to compliance and implement targeted interventions to enhance adherence and improve patient outcomes. Methods The study was conducted using the Plan-Do-Study-Act cycle methodology. The study included 769 patients scheduled for elective procedures. A baseline audit of 90 (out of the 769) patients in September 2023 revealed that 86 (95.6%) and 82 (91.1%) fasted, respectively, from clear fluids for more than two hours and solid food for more than six to 12 hours, indicating significant non-adherence to the guidelines. This was followed by the implementation of an intervention plan that included staff training, patient education, and the introduction of a preoperative fasting checklist. Quarterly audits were conducted to assess the effectiveness of these interventions. Data on fasting durations, patient demographics, and associated complications were collected and analyzed using descriptive statistics and regression analysis. Results Following the intervention, there was a marked improvement in adherence, with significant reductions in prolonged fasting times across each quarter (p < 0.001). The last audit showed 529 (68.8%) fasted for more than two hours and 530 (68.9%) patients fasted for more than six to 12 hours, respectively, from clear fluids and solid food. Median fasting times were 4.1 hours for clear fluids and 12.0 hours for solid food. These improvements were accompanied by a reduction in postoperative complications such as dehydration, hypoglycemia, and postoperative nausea and vomiting. The study identified key barriers to adherence, including inadequate staff understanding of guidelines, inconsistent patient instructions, and changes in operating room schedules. The interventions effectively addressed these issues, though patients scheduled for afternoon surgeries continued to experience longer fasting durations than those scheduled for morning surgeries, suggesting the need for further adjustments to preoperative protocols. Conclusion This quality improvement study demonstrated that adherence to international preoperative fasting guidelines can be significantly enhanced through targeted interventions. The successful reduction in fasting durations and associated complications underscores the importance of continuous monitoring and protocol adjustments to align fasting practices with the best evidence, ultimately optimizing patient safety, comfort, and surgical outcomes., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. IRB of A.A. Vishnevskiy 3rd CCM Hospital issued approval NA. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sidik et al.)

Introduction: The template method (TM), pioneered by Ozaki for aortic valve neocuspidization (AVNeo), has been widely adopted for aortic valve replacement, though it requires specialized instruments. This study introduces a novel formula method (FM), which uses the diameter of the aortic valve fibrous ring (AV-D) to determine the dimensions of the neocusps to be trimmed from autologous without the need for templates, potentially reducing costs and complexity. We aimed to compare the clinical outcomes of the FM with the established TM in patients undergoing AVNeo., Methods: A retrospective and prospective study was conducted on 31 patients who underwent isolated AVNeo between January 21, 2019 and December 15, 2022. Patients were divided into two groups: FM (n = 17) and TM (n = 14). The formula for the cusp free margin horizontal length is L1 = AV-D + 10 mm, cusp height is H = AV-D, cusp suture margin is L2 is a parabola that joins L1 and H, and cusp wings to be secured to aortic sinus = 3mm. The primary endpoints were major adverse valve-related events, including cardiac death, reoperation, and infective endocarditis. Secondary endpoints included significant aortic regurgitation, peak pressure gradients, aortic valve area, and New York Heart Association (NYHA) functional class. Intraoperative times, early postoperative outcomes, and mid-term hemodynamic performance were evaluated for both techniques., Results: Both the FM and TM demonstrated comparable intraoperative and postoperative outcomes. The cardiopulmonary bypass time, myocardial ischemia time, and blood loss were similar between the groups. Mid-term outcomes also showed no significant differences in valve function or hemodynamic parameters, with both groups exhibiting substantial reverse left ventricular remodeling. The FM group had a peak pressure gradient of 14.1 ± 4.3 mmHg compared to 18.4 ± 12.0 mmHg in the TM group (p = 0.219). The aortic valve area was 2.43 ± 0.3 cm² in the FM and 2.4 ± 0.2 cm² in the TM (p = 0.890). No significant differences were observed in freedom from reoperation or adverse events., Conclusion:  Both techniques showed excellent mid-term hemodynamic performance and comparable intraoperative and postoperative outcomes. The FM for AVNeo provides a cost-effective and practical alternative to the TM, offering similar clinical outcomes without the need for expensive templates; it has the potential to improve the accessibility of AVNeo, particularly in resource-limited settings. However, further research with larger cohorts and long-term follow-up is needed to fully assess the durability and long-term benefits of the FM., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. I.M. Sechenov First Moscow State Medical University IRB issued approval N/A. The study was conducted in compliance with the ethical requirements of the Ministry of Health of the Russian Federation Order No. 922n, dated November 15, 2012, "On the approval of the Procedure for providing medical care to the adult population in the field of 'surgery'." The study was also approved by the Institutional Review Board of I.M. Sechenov First Moscow State Medical University. Patients were informed of the procedure and were required to sign informed consent for surgery. Individual written consent to publish their study data was also obtained. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Komarov et al.)

Introduction Type A aortic dissection (TAAD) is a life-threatening condition that often leads to cerebral malperfusion (CM), a severe complication that can result in permanent neurological damage. Traditionally, a cardiopulmonary bypass (CPB) with selective antegrade cerebral perfusion (ACP) is employed during aortic arch reconstruction to protect cerebral circulation. However, the use of CPB carries inherent higher risks, including embolic events, hypothermia, and interrupted cerebral perfusion, especially in patients with CM. This study evaluates an innovative off-pump extra-corporeal ACP technique using an axillo-axillary shunt to provide uninterrupted bihemispheric cerebral perfusion during branch-first stage total aortic arch replacement (BF-TAR) for TAAD with CM; the shunt depends on cardiac contradiction to transfuse blood from the donor axillary artery to the recipient axillary artery, which then flows to through the carotid and vertebral arteries to the brain. Methods Between 2021 and 2023, 18 patients with TAAD complicated by CM underwent BF-TAR; the novel axillo-axillary shunt technique was employed for ACP because of the risks of ischemic neurologic injury. Outcomes measured included operative mortality, neurological complications, cardiopulmonary bypass times (measured after completion of the branch-first stage), and overall morbidity. Results The axillo-axillary shunt provided stable, continuous ACP in all patients. No new permanent neurological deficits were observed. Five (27.8%) patients experienced transient neurological symptoms such as blurred vision, dizziness, and confusion, which resolved within 48 hours. Operative mortality was 5.6% (1 patient), and minor complications included transitory lower limbs ischemia in 3 patients (16.7%) and deep sternal wound infection in 1 patient (5.6%). All transitory complications were managed by "watchful waiting". The mean CPB time was 145.3 ± 48.6 minutes, while the mean cross-clamp time was 100.6 ± 17.4 minutes, which was better than the average of 227 ± 32 minutes and 147 ± 23 minutes reported in other studies. Postoperative imaging confirmed well-reconstructed aortic arches with no residual malperfusion or graft-related complications. Conclusion The off-pump axillo-axillary shunt technique provides a safe and effective method for maintaining continuous bihemispheric cerebral perfusion during total aortic arch replacement in patients with TAAD complicated by CM. This approach minimizes the risks associated with CPB, including embolic events and interrupted cerebral perfusion while achieving favorable neurological and surgical outcomes. Further studies with larger cohorts and longer follow-ups are warranted to validate the long-term benefits of this innovative technique., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. IRB of Bakulev Scientific Center of Cardiovascular Surgery · Moscow, RUS issued approval Protocol №: 4 (15.12.2021). The Institutional Review Board approved this short study after initial tests showed it was a viable and effective approach to cerebral perfusion with improved hemodynamic parameters as compared to conventional measures. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Elias et al.)

Introduction: Preoperative fasting is recommended by international guidelines as a means to minimize the risk of aspiration of gastric content during induction of anesthesia or surgery. Prolonged preoperative fasting is, however, discouraged due to the associated side effects such as dehydration and electrolyte imbalance, which can negatively impact recovery after surgery. An initial quality improvement study revealed poor implementation of the best practice guidelines on preoperative fasting in three departments of a hospital and an institutional action plan was devised to enforce adherence to these guidelines. This present study aimed to assess compliance with the action plan and for that matter, adherence to international consensus on preoperative fasting in three surgical departments., Methods: Adult patients undergoing elective cardiac, thoracic, and vascular surgery at a university teaching hospital were surveyed over four months (September October, November, and December of 2023). Data on the length of preoperative fasting was collected using a standardized questionnaire. A total of 306 patients who were scheduled for elective surgery were included in the study., Results: Of the 306 patients, 139 (45.4%) had vascular surgeries, 108 (35.4%) received cardiac surgeries, and 59 (19.3%) had thoracic surgeries. For clear fluids, the overall median fasting time (Q1, Q3) was 4.5 (2.7, 7.4) hours, and for solid food, 14.5 (12.1, 19.0) hours. Extended abstinence from clear fluids and solid food for more than 12 hours was observed in 43 (14.1%) and 231 (75.5%) instances, respectively, while abstinence from solid food for more than 24 hours was noticed in 40 (13.1%) cases. When compared to patients having operations in the morning, those scheduled for afternoon surgery had longer median fasting periods from clear fluids and solid food, p<0.001: 6.2 (4.0, 12.0) hours vs. 3.4 (2.0, 5.2) hours for clear fluids and 16.7 (12.6, 22.6) hours vs. 13.2 (9.6, 15.2) hours for solid food, respectively., Conclusion: Patients continue to abstain from clear fluids and solid food for extended periods of time, despite the fact that there is worldwide agreement regarding shorter periods of preoperative fasting. Compared to patients undergoing morning surgery, individuals hospitalized for afternoon procedures were more likely to fast for extended periods of time., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sidik et al.)

Recent advancements in artificial intelligence (AI) applications in medicine have been significant over the past 30 years. To monitor current research developments, it is crucial to examine the latest trends in AI adoption across various medical fields. This bibliometric analysis focuses on AI applications in cardiology. Unlike existing literature reviews, this study specifically examines journal articles published in the last decade, sourced from both Scopus and Web of Science databases, to illustrate the recent trends in AI within cardiology. The bibliometric analysis involves a statistical and quantitative evaluation of the literature on AI application in cardiovascular medicine over a defined period. A comprehensive global literature review is conducted to identify key research areas, authors, and their interrelationships through published works. The leading institutions and most influential authors in research on the role of AI in cardiology were located in the United States, the United Kingdom, and China. This study also provides researchers with an overview of the evolution of research in AI and cardiology. The main contribution of this study is to highlight the prominent authors, countries, journals, institutions, keywords, and trends in the development of AI in cardiology., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Sidik et al.)