In March 2026, the American College of Cardiology (ACC), the American Heart Association (AHA) and other professional societies released the "Guideline on the Management of Dyslipidemia". Building on the 2018 "Guideline on the Management of Blood Cholesterol", the new guideline incorporates recent evidence from large-scale randomized cardiovascular outcome trials and contemporary risk-prediction studies. It broadens the focus of lipid management from cholesterol-centered treatment to a comprehensive, life-course management of atherogenic lipoprotein risk. For patients undergoing cardiovascular surgery, the guideline is pertinent not only for perioperative risk stratification and postoperative secondary prevention, but also offers a more sophisticated framework for long-term comprehensive management. In this article, combined with clinical guidelines and key evidence-based evidence, we interpret the major updates of the 2026 edition of the guideline and implications for cardiovascular surgical practice, with the aim of providing a reference for perioperative and long-term blood lipid management for cardiovascular surgery patients.
Objective To evaluate the efficacy and safety of the Perclose ProGlide vascular closure system for femoral artery access site closure in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). Methods We retrospectively analyzed the perioperative data of patients who underwent transfemoral TAVR at the Second Hospital of Hebei Medical University from January 2023 to September 2025. Based on the closure method for the main arterial access site, patients were divided into a surgical group (surgical cut-down and repair) and a ProGlide group (pre-closure with the ProGlide system). The effectiveness of access site closure and clinical outcomes were compared between the two groups. Results A total of 413 patients were included, with 183 in the surgical group and 230 in the ProGlide group. The surgical group consisted of 112 males and 71 females, with a mean age of (68.2±6.3) years. The ProGlide group included 141 males and 89 females, with a mean age of (69.2±5.2) years. No mortality was observed in either group. In the ProGlide group, immediate hemostasis was successfully achieved with two ProGlide devices in 220 (95.7%) patients. An additional 10 patients required a third device to achieve hemostasis. At 6 hours post-procedure, no active bleeding was observed. Subcutaneous hematoma occurred in 5 patients, all of whom resolved after 10 minutes of manual compression. The final hemostasis success rate was 97.8% for the ProGlide group. In the surgical group, no active bleeding or subcutaneous hematoma was observed at 6 hours post-procedure, yielding a hemostasis success rate of 100.0%. Poor wound healing occurred in 28 patients and access site-related nerve injury in 41 patients in the surgical group. In contrast, no patients of poor wound healing or nerve injury were reported in the ProGlide group. No major vascular complications occurred in either group. At 6 hours post-procedure, the Kolcaba Comfort Scale score was significantly higher in the ProGlide group than that in the surgical group (P<0.001). Compared to the surgical group, the ProGlide group had significantly shorter procedure times and postoperative hospital stays (both P<0.001). ConclusionThe Perclose ProGlide vascular closure system provides effective closure for the main femoral access site in transfemoral TAVR. Compared with the conventional surgical cut-down method, it offers the advantages of being less invasive, enabling faster recovery, and providing greater procedural convenience, making it a valuable technique worthy of broader clinical adoption.
ObjectiveTo systematically compare the perioperative efficacy and safety of transcatheter aortic valve replacement (TAVR) via peripheral arterial versus transapical approaches for patients with pure native aortic regurgitation (PNAR). MethodsPatients with PNAR who underwent TAVR in the Department of Cardiac Surgery, The Second Hospital of Hebei Medical University from 2015 to 2023 were retrospectively enrolled and divided into a peripheral group and a transapical group according to surgical approach. The baseline data, intraoperative procedural parameters, complication profiles and postoperative recovery indicators were collected for intergroup comparative analysis. ResultsA total of 82 patients were enrolled, including 40 patients in the peripheral group [28 males, 12 females, aged (68.25±7.62) years] and 42 patients in the transapical group [30 males, 12 females, aged (67.81±8.15) years]. No perioperative death occurred in either group. The procedural success rate and device success rate were significantly lower in the peripheral group than those in the transapical group (all P<0.05), while the overall success rate showed no statistically significant intergroup difference (P=0.506). There were no significant differences between the two groups in the incidences of moderate or greater paravalvular regurgitation, coronary artery obstruction, new-onset stroke, peripheral vascular complications or conversion to open thoracotomy (all P>0.05). The rates of valve-in-valve implantation, new-onset transient atrioventricular block and permanent pacemaker implantation were remarkably higher in the peripheral group (all P<0.05). The duration of ICU stay and postoperative hospital stay were markedly shorter in the peripheral group (all P<0.05). Repeated-measures analysis of variance with Greenhouse-Geisser correction for sphericity assumption revealed statistically significant main effects of time, main intergroup effects and group-time interaction effects for two normally distributed cardiac function indicators including left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) (all P<0.05). Patients in the peripheral group suffered more severe baseline cardiac impairment and higher preoperative surgical risk stratification, and achieved prominent catch-up improvement in LVEF and LVEDD after surgery; the levels of the two indicators were nearly equivalent between the two groups on postoperative day 7. N-terminal pro-B-type natriuretic peptide decreased significantly in both groups after surgery with a larger decline magnitude in the peripheral group, and the levels of the two groups became comparable on postoperative day 7. ConclusionBoth peripheral arterial access and transapical TAVR are safe and effective for PNAR treatment with equivalent overall perioperative success rates. Surgical approach should be selected individually based on aortic root anatomy, baseline cardiac function and surgical risk stratification in clinical practice. Clinicians should stay alert to potential long-term risks of peripheral approach, including compromised valve durability and limited accessibility to subsequent coronary intervention.