Category: General

Cochrane Database Syst Rev. 2026 Aug 24;8(8):CD000071. doi: 10.1002/14651858.CD000071.pub5.

ABSTRACT

RATIONALE: Extracranial carotid artery stenosis is a major cause of stroke. Carotid endarterectomy with patch angioplasty is a widely used surgical technique to reduce the risk of stroke in people with carotid stenosis. Patch materials include biological materials, like autologous vein or bovine pericardium, and synthetic materials, such as polytetrafluoroethylene (PTFE), Dacron, polyurethane, and polyester. This review is an update of one first published 30 years ago and last updated in 2021, and it has been conducted in line with current Cochrane guidance. In this update, we incorporated an expanded search strategy using additional databases and restructured our analytical framework to group patch materials into biological and synthetic categories. We also reassessed our level of certainty about the evidence.

OBJECTIVES: To assess the benefits and harms of synthetic patch materials and biological patch materials (autologous vein and bovine pericardium) used in carotid endarterectomy, particularly for pseudoaneurysm outcomes, stroke, and death.

SEARCH METHODS: To identify studies for inclusion in this updated Cochrane review, we searched Embase Ovid, CINAHL (EBSCO), PubMed, Scopus, the Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) to 30 April 2025. We also searched reference lists of relevant articles and conference proceedings.

ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) that compared one type of carotid patch with another for carotid endarterectomy.

OUTCOMES: We prespecified seven main outcomes: perioperative ipsilateral stroke, perioperative arterial rupture, long-term ipsilateral stroke, long-term stroke (any type), long-term stroke or death, long-term arterial occlusion/re-stenosis greater than 50%, and long-term pseudoaneurysm formation. We defined perioperative outcomes as those measured up to 30 days after surgery and long-term outcomes as those measured up to at least one year after the operation (including events in the first 30 days). We considered other complications as secondary outcomes, but we did not prioritise these for presentation in our summary of findings table.

RISK OF BIAS: Two review authors independently assessed the risk of bias in the studies using the original Cochrane risk of bias tool RoB 1. We judged each domain as having low, high, or unclear risk of bias, and we resolved any disagreements about these judgements by discussion.

SYNTHESIS METHODS: We used random-effects meta-analysis for primary analyses, with the restricted maximum likelihood (REML) method to estimate between-study variance. For meta-analyses including three or more studies and with heterogeneity greater than zero, we used the Hartung-Knapp-Sidik-Jonkman method to calculate confidence intervals; otherwise, we used Wald-type confidence intervals. Where only one study contributed data for an outcome, or event counts were too sparse for pooling, we reported study-level estimates narratively. We used GRADE to assess the certainty of the evidence for the main outcomes.

INCLUDED STUDIES: We identified one new study for inclusion from our updated searches, as well as several reports of extended follow-up data from previously included studies. Therefore, we included 15 RCTs involving 4971 participants in this review update. These studies contributed data on 2473 relevant carotid endarterectomy procedures. Twelve of the studies had long-term follow-up (mean follow-up ranged from 6 to 80 months).

SYNTHESIS OF RESULTS: Twelve of the included studies (with 2021 carotid endarterectomy procedures) contributed data to our main comparison of synthetic and biological patches. The evidence is very uncertain about the effect of synthetic patches compared with biological patches on perioperative ipsilateral stroke (OR 2.12, 95% CI 0.77 to 5.88; 5 studies, 797 participants), perioperative arterial rupture (OR 0.67, 95% CI 0.10 to 4.28; 6 studies, 1068 participants), and long-term pseudoaneurysm formation (OR 0.11, 95% CI 0.00 to 10.02; 5 studies, 980 participants) (all very low certainty evidence). Synthetic patches may result in little or no difference in long-term ipsilateral stroke (OR 1.60, 95% CI 0.79 to 3.26; 5 studies, 971 participants), long-term stroke (any type) (OR 1.21, 95% CI 0.67 to 2.18; 7 studies, 1167 participants), and long-term arterial occlusion or re-stenosis greater than 50% (OR 0.78, 95% CI 0.40 to 1.50; 9 studies, 1431 participants) compared to biological patches (all low-certainty evidence). Synthetic patches probably result in little or no difference in long-term stroke or death compared with biological patches (OR 1.01, 95% CI 0.91 to 1.12; 6 studies, 1115 participants) (moderate-certainty evidence). For most outcomes, we judged the certainty of the evidence as low or very low because studies were small, events were few, and confidence intervals were wide. Our concerns about study limitations also reduced our certainty about some outcomes.

AUTHORS’ CONCLUSIONS: This 2026 updated review incorporates an expanded search strategy and a restructured analytical framework that groups patch materials into biological and synthetic categories. It also includes data from one newly identified trial (195 participants), together with extended follow-up data for some previously included trials. We believe that these changes have improved the completeness and methodological quality of our evidence synthesis. The available evidence suggests that the use of synthetic patches after carotid endarterectomy may result in little or no difference in long-term ipsilateral stroke and stroke of any type compared to the use of biological patches. Synthetic patches may result in little or no difference in long-term arterial occlusion or re-stenosis greater than 50% compared to biological patches, and probably result in little or no difference in long-term stroke or death. The evidence is very uncertain about the effect of synthetic compared with biological patches on perioperative ipsilateral stroke, perioperative arterial rupture, and long-term pseudoaneurysm formation. Most findings were affected by study design limitations and imprecision. Large, high-quality trials are needed to confirm or clarify these findings.

FUNDING: None REGISTRATION: DOIs of previous review versions: https://doi.org/10.1002/14651858.CD000071; https://doi.org/10.1002/14651858.CD000071.pub2; https://doi.org/10.1002/14651858.CD000071.pub3; https://doi.org/10.1002/14651858.CD000071.pub4.

PMID:42635089 | PMC:PMC13501495 | DOI:10.1002/14651858.CD000071.pub5

Clin Transplant. 2026 Aug;40(8):e70658. doi: 10.1111/ctr.70658.

NO ABSTRACT

PMID:42611543 | PMC:PMC13484882 | DOI:10.1111/ctr.70658

Eur J Vasc Endovasc Surg. 2026 Aug 27:S1078-5884(26)00816-6. doi: 10.1016/j.ejvs.2026.08.025. Online ahead of print.

NO ABSTRACT

PMID:42660342 | DOI:10.1016/j.ejvs.2026.08.025

J Surg Case Rep. 2026 Aug 11;2026(8):rjag698. doi: 10.1093/jscr/rjag698. eCollection 2026 Aug.

ABSTRACT

A 57-year-old woman with known metastatic thymoma who had recently undergone a thoracotomy with resection of a diaphragmatic nodule presented with a symptomatic para-esophageal diaphragmatic hernia. She was managed with an emergency laparoscopic diaphragm repair using a bovine pericardial patch. On visualizing the thoracic cavity through the hernia defect, sub-pneumonic pleural nodules were noted. Although not the primary goal of the surgery, these nodules were resected as re-accessing the thoracic cavity would have been challenging. This case presents a novel minimally invasive approach to the management of a diaphragmatic hernia and incidentally noted metastatic thymoma.

PMID:42583297 | PMC:PMC13460346 | DOI:10.1093/jscr/rjag698

Cell Stem Cell. 2026 Sep 3;33(9):1528-1539.e10. doi: 10.1016/j.stem.2026.07.010. Epub 2026 Aug 11.

ABSTRACT

Therapeutic management of heart valve disease is currently hampered by a lack of mechanistic understanding of human valve development and pathobiology. Here, we develop a protocol to generate three-dimensional human heart valve-like tissues from pluripotent stem cells with enhanced maturational properties that partially recapitulate key molecular features of native valves. This includes an abundance of valve interstitial cells, resident macrophage cells, and the transcriptional profile of native heart valves. Importantly, we define a heart valve maturation signature from proteomic analysis and show that maturation of stem cell-derived valve cells is enhanced under 3D culture. We demonstrate that bioengineered valve-like microtissues can be used for modeling valve disease. Namely, treatment with inflammatory cytokines augmented tissue passive tension and induced molecular hallmarks of valve calcification, consistent with the pathological signature of clinical samples from diseased valves. Thus, bioengineered human heart valve-like tissues provide a platform to understand human heart valve development, maturation, and disease pathogenesis.

PMID:42580349 | DOI:10.1016/j.stem.2026.07.010

J Funct Biomater. 2026 Jul 28;17(8):362. doi: 10.3390/jfb17080362.

ABSTRACT

Background: Energy dissipation reflects the viscoelastic behavior of biological tissues and plays a key role in arterial elastic recoil and diastolic flow support. In the native aorta, efficient storage and release of mechanical energy are essential for maintaining ventriculo-aortic coupling. The energy dissipation ratio (EDR) quantifies the proportion of mechanical energy lost during a loading-unloading cycle and may provide insight into the biomechanical performance of aortic substitutes. Bovine pericardial patches (BPPs) are widely used in cardiovascular surgery for arterial reconstruction, patch angioplasty, and tubular replacement. Today, EDR has not been systematically investigated in BPPs. Methods: Forty glutaraldehyde-treated BPPs from four commercial manufacturers (n = 10 per supplier) were subjected to low-cycle fatigue testing using a uniaxial tensile system under controlled physiological conditions (37 °C). Standardized bone-shaped specimens were tested at progressive strain percentage levels. Thickness, EDR, and the percentage of specimens failing to reach progressively higher strain levels were evaluated from stress-strain hysteresis loops. Results: BPPs thickness ranged from 0.253 to 0.608 mm, with no significant differences among most groups. For the 10% strain, all BPPs reached the target deformation and demonstrated comparable EDR values. In detail, the mean EDR was 21.40 ± 7.02% for Edwards Lifesciences, 24.95 ± 6.80% for Supple Peri-Guard (Baxter), 24.99 ± 6.04% for Xenosure (LeMaitre), and 23.37 ± 6.12% for Invengenx-Tisgenx, with no statistically significant intergroup differences (p > 0.05). For the 20% strain, only 18.75% of specimens remained structurally intact, and variability increased. At 30% strain, structural failure occurred in nearly all samples. No significant orientation-dependent differences were observed. Conclusions: Commercially available BPPs exhibit similar biomechanical behavior under moderate deformation. However, tolerance to higher strain is limited. EDR analysis provides a clinically relevant parameter to assess elastic performance and may contribute to optimizing aortic substitute selection.

PMID:42646165 | PMC:PMC13514306 | DOI:10.3390/jfb17080362

Future Cardiol. 2026 Aug;22(8):799-802. doi: 10.1080/14796678.2026.2713321. Epub 2026 Aug 6.

ABSTRACT

A 70-year-old male with bicuspid aortic valve developed oxacillin-sensitive Staphylococcus aureus bacteremia complicated by infective endocarditis, aortic root abscess, and embolic stroke. Initial management included aortic valve replacement with a bioprosthetic valve, aortic root reconstruction with bovine pericardial patch, and anterior mitral leaflet repair. Despite appropriate antimicrobial therapy, the patient developed recurrent symptoms three years later. Transesophageal echocardiography revealed severe aortic regurgitation and a large pseudoaneurysm resulting from dehiscence of the previous pericardial patch repair. The patient underwent successful repeat sternotomy with aortic root replacement using a valved conduit and reimplantation of coronary arteries. This case highlights the challenging nature of endocarditis involving the aortic root, particularly when complicated by abscess formation requiring patch reconstruction, and emphasizes the importance of long-term surveillance for pseudoaneurysm formation following such complex repairs.

PMID:42561458 | PMC:PMC13540169 | DOI:10.1080/14796678.2026.2713321

Future Cardiol. 2026 Aug;22(8):799-802. doi: 10.1080/14796678.2026.2713321. Epub 2026 Aug 6.

ABSTRACT

A 70-year-old male with bicuspid aortic valve developed oxacillin-sensitive Staphylococcus aureus bacteremia complicated by infective endocarditis, aortic root abscess, and embolic stroke. Initial management included aortic valve replacement with a bioprosthetic valve, aortic root reconstruction with bovine pericardial patch, and anterior mitral leaflet repair. Despite appropriate antimicrobial therapy, the patient developed recurrent symptoms three years later. Transesophageal echocardiography revealed severe aortic regurgitation and a large pseudoaneurysm resulting from dehiscence of the previous pericardial patch repair. The patient underwent successful repeat sternotomy with aortic root replacement using a valved conduit and reimplantation of coronary arteries. This case highlights the challenging nature of endocarditis involving the aortic root, particularly when complicated by abscess formation requiring patch reconstruction, and emphasizes the importance of long-term surveillance for pseudoaneurysm formation following such complex repairs.

PMID:42561458 | PMC:PMC13540169 | DOI:10.1080/14796678.2026.2713321

Multimed Man Cardiothorac Surg. 2026 Aug 6;2026. doi: 10.1510/mmcts.2026.046.

ABSTRACT

Extensive mitral annular calcification represents a major technical challenge in mitral valve surgery and is associated with increased operative mortality and morbidity, including atrioventricular disruption, circumflex artery injury and prosthetic valve dehiscence. Management strategies remain controversial, including in patients suitable for transcatheter interventions. We present a case of severe symptomatic mitral regurgitation in an elderly female patient with extensive circumferential mitral annular calcification. Preoperative imaging confirmed severe mitral regurgitation with restricted calcified mitral leaflets and preserved left ventricular systolic function. Transcatheter mitral valve implantation was considered, but deemed unsuitable because of annular size. The patient therefore underwent endoscopic mitral valve replacement through a right minithoracotomy using femoro-femoral cardiopulmonary bypass. An endoaortic balloon was used to arrest the heart with cardioplegia. After excision of the native valve and limited debridement of calcification, a bioprosthetic mitral valve was implanted and tied with pledgeted braided sutures and an automatic suture knotting device (CorKnot). A bovine pericardial patch was sutured to the posterior portion of the prosthetic sewing ring using a posterior skirt technique to reinforce the posterior annulus and reduce paravalvular leakage risk. Postoperative echocardiography demonstrated a well-functioning prosthetic valve with preserved ventricular function and a trivial paravalvular leak.

PMID:42559759 | DOI:10.1510/mmcts.2026.046

JACC Case Rep. 2026 Aug 25:110004. doi: 10.1016/j.jaccas.2026.110004. Online ahead of print.

ABSTRACT

OBJECTIVE: To demonstrate the technique of totally endoscopic robotic repair of partial atrioventricular septal defect with complex mitral valve reconstruction in an adult patient.

KEY STEPS: Totally endoscopic robotic approach with peripheral cannulation and bicaval control. Bovine pericardial patch closure of the primum atrial septal defect. Left atriotomy for optimal mitral valve exposure. Leaflet shaving, cleft closure, autologous pericardial augmentation, and flexible annuloplasty.

POTENTIAL PITFALLS: Inadequate exposure may compromise assessment of the cleft and leaflet pathology. Careful leaflet remodeling, preservation of leaflet mobility, and avoidance of excessive tension during cleft closure are essential to prevent residual regurgitation or mitral stenosis.

TAKE-HOME MESSAGES: Totally endoscopic robotic repair enables safe and reproducible treatment of partial atrioventricular septal defect with complex mitral valve reconstruction in selected adults. Enhanced visualization and instrument dexterity facilitate precise intracardiac repair while avoiding median sternotomy.

PMID:42640240 | DOI:10.1016/j.jaccas.2026.110004