Thorac Cardiovasc Surg [JOURNAL]
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200 papers
Minimally Invasive Total Arterial Bypass Grafting via Left Mini-thoracotomy in Obese Patients.
Gadelkarim I, Shaqu R, Kang J … +6 more , Zakhary W, Dashkevich A, Ender J, Waha S, Borger M, Verevkin A
Thorac Cardiovasc Surg · 2025 Aug · PMID 40738131 · Publisher ↗
Minimally invasive cardiac surgery total arterial coronary artery bypass grafting (MICS-CABG) has emerged as an alternative to conventional coronary artery bypass grafting (CABG). Its safety and efficacy in obese patient...
Minimally invasive cardiac surgery total arterial coronary artery bypass grafting (MICS-CABG) has emerged as an alternative to conventional coronary artery bypass grafting (CABG). Its safety and efficacy in obese patients remain a concern due to technical challenges. The current study compares early and long-term outcomes of MICS-CABG in obese and non-obese patients.Between January 2015 and December 2023, 279 patients underwent off-pump MICS-CABG at our center. Obesity was defined as body mass index ≥30 (kg/m). The primary endpoint was 30-day survival. Secondary endpoints were survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) at 5 years.Of all 279 patients, 56 (20.1%) were classified as obese and 223 (79.9%) as non-obese. Obese patients had a higher EuroSCORE II (2.06 ± 1.53 vs. 1.63 ± 0.94, = 0.008) and a higher prevalence of comorbidities including diabetes mellitus ( < 0.001) and pulmonary hypertension ( = 0.03). The incidence of postoperative complications including repeat thoracotomy for bleeding ( = 0.18), low cardiac output syndrome ( = 0.70), or wound infection ( = 0.38) did not differ between obese and non-obese patients. There were no deaths or myocardial infarctions within 30 days in obese patients (0% vs. 0.5%, = 0.95; 0% vs. 2.7%, = 0.47). Long-term outcome at 5 years, including survival (91.9% vs. 92.4%, = 0.99) and freedom from MACCE (83.3% vs. 84.6%, = 0.63), showed no difference between the two groups.MICS-CABG can be performed safely and efficaciously in select obese patients by specialized coronary surgeons at high-volume cardiac centers.
Transcatheter Mitral Valve Implantation Compared to Surgery: One-Year Clinical Outcome.
Ruge H, Burri M, Erlebach M … +7 more , Voss SS, Puluca N, Campanella C, Wirth F, Xhepa E, Stein A, Krane M
Thorac Cardiovasc Surg · 2026 Jun · PMID 40680795 · Publisher ↗
BACKGROUND: Transcatheter mitral valve implantation (TMVI) is an evolving technology, expanding therapeutic options for patients at higher operative risk. Data comparing TMVI to surgical mitral valve replacement (SMVR) a...
BACKGROUND: Transcatheter mitral valve implantation (TMVI) is an evolving technology, expanding therapeutic options for patients at higher operative risk. Data comparing TMVI to surgical mitral valve replacement (SMVR) are lacking. METHODS: Clinical outcomes after TMVI with the Tendyne mitral valve and SMVR were compared utilizing propensity score matching, including seven variables. The current study reports 1-year clinical outcomes after TMVI and 1-year mortality in both cohorts. RESULTS: Forty TMVI patients were compared to 80 SMVR patients. Baseline characteristics included in the matching protocol were well balanced: Age (78 years [interquartile range, IQR 75; 80] vs. 78 years [IQR 73; 80], = 0.797), female sex (60% vs. 60% [ = 1.0]), atrial fibrillation (68% vs. 64% [ = 0.839]), previous coronary artery bypass grafting (CABG) or surgical aortic valve replacement (25% vs. 25% [ = 1.0]), body mass index (kg/m; 26 ± 4 vs. 25 ± 4 [ = 0.723]), mitral valve pathology (regurgitation 70% vs. 74%, stenosis 7.5% vs. 4%, and mixed disease 22.5% vs. 23% [ = 0.649]), and concomitant tricuspid regurgitation (35% vs. 30% [ = 0.678]). Thirty-day mortality was similar in both groups (TMVI, = 1, 2.5%; SMVR, = 3, 3.75%, = 0.47). Kaplan-Meier estimated survival at 1 year was comparable after TMVI (80 ± 6% [95% CI 69-93%]) and SMVR (86 ± 4% [95% CI 79-94%], = 0.18) with seven additional deaths beyond 30 days in the TMVI group and eight in the SMVR group. In the TMVI group, two were non-cardiovascular deaths for encephalitis and sepsis after hip replacement, and five were cardiovascular deaths. In the SMVR group, one patient died due to intestinal ischemia, and in seven patients, the cause of death is unknown. At 1 year, in all TMVI patients, echocardiography showed ≤mild paravalvular regurgitation. Within 1 year after TMVI, 21 patients (52.5%) required rehospitalization for heart failure symptoms. CONCLUSION: TMVI and SMVR in a propensity score-matched cohort displaying an intermediate surgical risk resulted in similar 1-year survival. TMVI achieved a sustained MR elimination at 1 year, and 80% of patients presented in the New York Heart Association (NYHA) class I or II.
Validation of a Risk Calculator for Surgical Repair of Primary Mitral Regurgitation.
Akansel S, Dini M, Sündermann SH … +4 more , Jacobs S, Falk V, Kempfert J, Kofler M
Thorac Cardiovasc Surg · 2026 Jun · PMID 40680794 · Publisher ↗
OBJECTIVE: Risk estimation for cardiac procedures is essential for clinical decision-making. The aim of the study is to validate the recently introduced Society of Thoracic Surgeons (STS) risk score model for mitral valv...
OBJECTIVE: Risk estimation for cardiac procedures is essential for clinical decision-making. The aim of the study is to validate the recently introduced Society of Thoracic Surgeons (STS) risk score model for mitral valve repair (MVr) in degenerative mitral regurgitation (DMR) by investigating a large cohort undergoing minimally invasive MVr (MI-MVr). METHODS: A total of 1,081 consecutive patients with DMR undergoing non-emergent MI-MVr were retrospectively analyzed. The primary study endpoint was 30-day all-cause mortality (OM), while secondary endpoints were major morbidity and mortality (MM) and conversion-to-replacement (CONV). Predictive discrimination and calibration of the models were measured using receiver operating characteristic (ROC) analysis. RESULTS: A 30-day mortality of 0.55% was observed in the study cohort. All risk scores were significantly higher in non-survivors. Like existing risk models, the intention-to-treat-OM (ITT-OM) model was predictive for OM (OR: 2.078, 95% CI: 1.324-3.621; = 0.001), but its discriminatory ability was limited based on ROC analysis. EuroSCORE II showed the best discriminatory performance for mortality among the investigated models. Furthermore, second cross-clamping and CONV were independent predictors of OM (OR: 26.2, 95% CI: 4.3-160.0; < 0.001 and OR: 12.8, 95% CI: 1.8-89.2; = 0.010). The ITT-MM and ITT-CONV models demonstrated an acceptable discriminatory ability for predicting operative MM and CONV. CONCLUSION: The ITT-based risk model was validated in our study cohort undergoing MI-MVr for DMR, showing only limited discriminatory performance for mortality, while the EuroSCORE II demonstrated better discrimination for mortality despite systematic overestimation. This is the first report validating the recently introduced model. However, further studies with larger cohorts are needed to overcome the limitations of the present study.
Lung Chemoperfusion Improves Relapse-Free Survival after Metastasectomy for Colorectal Cancer.
Levchenko E, Klochkov M, Mikhnin A … +4 more , Levchenko N, Ergnyan S, Mamontov O, Shabinskaya V
Thorac Cardiovasc Surg · 2025 Dec · PMID 40645796 · Publisher ↗
Metastasectomy is a recommended and widely used operation for pulmonary metastases from colorectal cancer (CRC). The main disadvantage of pulmonary metastasectomy is the high rate of metastasis recurrence, which occurs i...
Metastasectomy is a recommended and widely used operation for pulmonary metastases from colorectal cancer (CRC). The main disadvantage of pulmonary metastasectomy is the high rate of metastasis recurrence, which occurs in almost half of patients. To suppress residual pulmonary microfoci, isolated lung chemoperfusion (ILuP) is used, but its effectiveness has not been studied.The results of pulmonary metastasectomy were studied in 160 patients. In 65 patients of the main group, open metastasectomy with isolated chemoperfusion of the lungs was performed; in 95 patients of the control group, standard open or thoracoscopic metastasectomy was performed. The study design included 1:1 pseudorandomization using the nearest neighbor method. For 17 patients who underwent standard metastasectomy and then metastasectomy with ILuP for recurrent pulmonary metastases, these patients themselves were used as the nearest neighbor. For the remaining patients, the matching pairs were selected by the Propensity Score Matching method. After balancing the sample, the main and control groups comprised 41 pairs of observations, which were subjected to further analysis with assessment of relapse-free pulmonary survival according to Kaplan-Meier. Factors influencing survival were studied in the Cox's model.The median recurrence-free survival in patients of the main group who underwent metastasectomy with ILuP was 22.3 months versus 9.1 months in the control group. One-year recurrence-free survival in the main group was 77.5 ± 6.6% versus 38.1 ± 9.1% in the control group.Isolated lung chemoperfusion increases median recurrence-free survival after pulmonary metastasectomy by more than one year for colorectal cancer.
Single-Incision Thoracoscopic Surgery using Spinal Needle Anchoring.
Son J, Kim DH, Cho SH
Thorac Cardiovasc Surg · 2025 Dec · PMID 40645795 · Full text
Single-incision thoracoscopic surgery (SITS) for primary spontaneous pneumothorax offers advantages over multiport video-assisted thoracoscopic surgery, but lesion retraction remains challenging. We describe a modified S...
Single-incision thoracoscopic surgery (SITS) for primary spontaneous pneumothorax offers advantages over multiport video-assisted thoracoscopic surgery, but lesion retraction remains challenging. We describe a modified SITS technique using spinal needle anchoring for precise lung stabilization. A bent spinal needle inserted through an intercostal space mimics a second-port grasper, enabling multiple re-hooking maneuvers for optimal lesion alignment. This technique allows for a smaller incision, minimizes instrument crowding, and reduces postoperative pain. The needle insertion site leaves no visible scar. Additionally, it is beneficial in cases with multiple bullae or challenging lung anatomy. SPINAL NEEDLE ANCHORING MAY REPRESENT A SIMPLE AND EFFECTIVE MODIFICATION OF THE SITS TECHNIQUE: .
Cardiopulmonary Bypass-Supported Coronary Artery Bypass Surgery: A Flexible and Effective Alternative to Off-Pump Surgery.
Guven H, Cetintas D
Thorac Cardiovasc Surg · 2025 Oct · PMID 40628467 · Publisher ↗
This study aimed to compare the early postoperative outcomes of cardiopulmonary bypass-supported beating-heart coronary artery bypass grafting (CPB-BH CABG) and off-pump coronary artery bypass (OPCAB) surgery.A total of...
This study aimed to compare the early postoperative outcomes of cardiopulmonary bypass-supported beating-heart coronary artery bypass grafting (CPB-BH CABG) and off-pump coronary artery bypass (OPCAB) surgery.A total of 589 patients who underwent beating-heart CABG between October 2021 and January 2025 were retrospectively analyzed. Patients were categorized into two groups based on CPB usage: CPB-BH CABG ( = 177) and OPCAB ( = 412). Primary outcomes included mortality and major complications, while secondary outcomes encompassed complete revascularization rates, number of distal anastomoses, hospital stay, and transfusion requirements.No significant differences were observed between the groups regarding preoperative characteristics. The CPB-BH group had longer operative times (268.7 vs. 223.6 minutes, < 0.001) and prolonged hospital stays (7 vs. 5 days, < 0.001). The rates of complete revascularization and the number of bypass grafts were slightly higher in the CPB-BH group, but did not reach statistical significance. The CPB-BH group required more blood transfusions ( < 0.001) and had a higher incidence of new-onset atrial fibrillation (33.9% vs. 24.0%, = 0.016). No significant differences were found for other major complications.CPB-BH CABG is a viable alternative to OPCAB, offering comparable revascularization outcomes while allowing the flexibility of cardiopulmonary bypass support when needed. Surgeons should not hesitate to utilize CPB when necessary to optimize surgical outcomes. Future prospective, randomized controlled trials are warranted to assess the long-term outcomes of both surgical techniques and their effectiveness in specific patient subgroups.
The Geometry of Survival: Left Ventricular Mass Index's Prognostic Value in Coronary Surgery.
Timur B, Aksoy R, Duman ZM … +4 more , Çalışkan R, Baş K, Aydoğdu C, Kocogullari CU
Thorac Cardiovasc Surg · 2025 Jul · PMID 40592484 · Publisher ↗
This study explores the impact of left ventricular mass and geometry on the prognosis of patients undergoing coronary artery bypass grafting. Left ventricular hypertrophy is a known risk factor for cardiovascular complic...
This study explores the impact of left ventricular mass and geometry on the prognosis of patients undergoing coronary artery bypass grafting. Left ventricular hypertrophy is a known risk factor for cardiovascular complications, yet its role in surgical outcomes remains underexplored.A retrospective cohort of 494 elective coronary artery bypass grafting patients treated between 2013 and 2018 was analyzed. Left ventricular mass was calculated using the Devereux formula, and patients were divided into normal and increased left ventricular mass index groups. Mortality rates, postoperative complications, and echocardiographic parameters were evaluated.Patients with increased left ventricular mass exhibited significantly higher 5-year mortality rates (27.2 vs. 11.5%, < 0.001), postoperative atrial fibrillation (24.8 vs. 16.0%, = 0.018), and carotid stenosis (21.8 vs. 12.5%, = 0.006). Elevated preoperative biomarkers, including creatinine and C-reactive protein, were observed in this group, with sustained impairment in postoperative kidney function. However, no significant differences in 30-day, 1-year, or 3-year mortality rates were detected.Left ventricular mass and geometry independently predict long-term outcomes in coronary artery bypass grafting patients. Targeted strategies to mitigate left ventricular remodeling may enhance postoperative outcomes. Future research should focus on therapeutic interventions to reverse adverse left ventricular changes and optimize patient survival and quality of life.
Bronchoscopic Management of Central Airway Obstruction in Children after Heart Surgery.
Ayten O, Özdemir C, Dalar L … +1 more , Karaci AR
Thorac Cardiovasc Surg · 2025 Jan · PMID 40578812 · Publisher ↗
Central airway stenosis following congenital heart malformation surgery is a rare but significant cause of postoperative weaning failure. In selected cases, bronchoscopic interventions are effective treatment options for...
Central airway stenosis following congenital heart malformation surgery is a rare but significant cause of postoperative weaning failure. In selected cases, bronchoscopic interventions are effective treatment options for managing these kind of airway obstructions and achieving successful weaning.The data of six pediatric patients who were unable to be weaned from mechanical ventilation due to central airway obstruction following congenital heart malformation surgery were retrospectively analyzed. Rigid and flexible bronchoscopies were performed under general anesthesia for six patients.Six patients (4 males and 2 females; age range: 4 months to 6 years) with an airway obstruction after surgery due to congenital heart malformations included the study. Three patients had an obstruction of the left main bronchus, two of the right main bronchus, and one of bilateral main bronchus. Balloon dilatation was applied to one patient, mechanical dilatation was applied to three patients, and airway stent was applied to two patients. Two of six patients died from nonprocedural causes (acute respiratory distress syndrome due to pneumonia and cardiac arrest due to severe heart failure) and four patients were weaned successfully from mechanical ventilation and they were still alive during the follow-up period. No procedural-related mortality was seen in the study population. In one patient, stent placement could not be performed due to desaturation and hemodynamic instability during the procedure, and in another patient, granulation tissue developed due to a covered metallic stent, and the metallic stent was removed and replaced with a biodegradable stent.In selected cases, bronchoscopic interventions offer efficient approach to managing airway obstructions due to congenital heart malformation surgery.
Surgical Repair of Pectus Arcuatum.
Lacin T, Ermerak NO, Onen HU … +1 more , Aridas AG
Thorac Cardiovasc Surg · 2025 Jul · PMID 40570892 · Publisher ↗
Pectus arcuatum, a very rare variant (chondromanubrial) of the carinatum chest wall deformity, occurs due to premature fusion of the sternal ossification centers causing obliteration of the manubrio-sternal joint. Typica...
Pectus arcuatum, a very rare variant (chondromanubrial) of the carinatum chest wall deformity, occurs due to premature fusion of the sternal ossification centers causing obliteration of the manubrio-sternal joint. Typically, patients undergo surgical repair for cosmetic purposes. This study reviews the clinical experience using titanium plate systems for surgical repair of pectus arcuatum.The records of our prospective Chest Wall Deformities Clinical Database since September 2018 include 27 pectus arcuatum patients. The patients aged 17 and older were evaluated for corrective surgery ( = 24, 16 male, 8 female, mean age: 24.9 years). The hybrid surgical technique included wedge osteotomy of the most protruded part of the sternum, excision of the associated costochondral junctions followed by placement of two parallel titanium plates to secure the sternum, and insertion of an excavatum bar ( = 7) if there is a significant depression at the sternal body. Follow-up outpatient visits were every 3 to 6 months.All of the patients tolerated the surgery very well. The mean length of the surgery was 118 minutes. The mean hospital length of stay was 5.6 days. One patient experienced pericardial and right pleural effusion 2 weeks after surgery, which was resolved by anti-inflammatory treatment. The mean time to return to daily activity was 12 days. The mean follow-up was 42 months. All patients indicated the postoperative results as very good or excellent.Repair of arcuatum deformity can be performed in adults with low morbidity, short hospital stay, and satisfactory cosmetic results even in complex cases.
Midterm Outcomes of Transcatheter Closure of Anastomotic Leak after Ascending Aortic Surgery.
Yang CW, Ma WG, Liu H … +4 more , Li X, Peng ML, Huang LJ, Sun LZ
Thorac Cardiovasc Surg · 2026 Jun · PMID 40555403 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the safety and durability of transcatheter closure of anastomotic leak (AL) after ascending aortic (AAo) surgery. METHODS: From 2016 to 2021, we performed transcatheter closure for...
OBJECTIVE: This study aimed to evaluate the safety and durability of transcatheter closure of anastomotic leak (AL) after ascending aortic (AAo) surgery. METHODS: From 2016 to 2021, we performed transcatheter closure for 22 patients aged 56.9 ± 12 years (19 male, 86.4%) who sustained anastomotic leak in the ascending aorta (AAoAL) after AAo surgery. Access and device were selected according to the presence of a patent Cabrol (perigraft-to-right atrium) shunt ( = 16, 72.7%) and leak size. RESULTS: Fifteen patients had tricuspid regurgitation (TR; 68.2%), 13 were symptomatic (59.1%), and 11 were in the New York Heart Association (NYHA) functional class III/IV (50%). Mean AAoAL diameter was 3.3 ± 1.5 mm. Mean procedural time was 141 ± 53 minutes. Procedural success rate was 86.4% (19/22, 14 with Cabrol shunt). AAoAL was directly closed or coiled in 12 patients. Follow-up was complete in 100% at a mean duration of 4.9 ± 1.1 years (range 3.6-8.1). All patients were alive, and two underwent reoperation. Freedom from death and reoperation was 94.7% at 2 years and 89.5% through 8 years. AAoAL was obliterated in 11, while a trace residual shunt was seen in 8 patients. The aorta at the leak shrank significantly in all (49.1-41.4 mm, = 0.010). Patients with Cabrol shunt showed a significant shrinkage of the right atrium (46.9 ± 8.8 mm vs. 39.1 ± 8.2 mm, = 0.030) and right ventricle (41.4 ± 4.7 mm vs. 30.4 ± 6.2 mm, < 0.001), along with improved heart function (NYHA class III 4/12, IV 5/12 vs. class III 4/12, IV 0/12, = 0.032) and alleviation of TR (moderate 6/14, severe 3/14 vs. moderate 2/14, severe 1/14, = 0.081). CONCLUSION: Transcatheter closure may be a feasible, safe, and effective approach to anastomotic leak after ascending aortic surgery in selected patients, which can achieve favorable short- to midterm outcomes.
Effectiveness of Gentamicin-Collagen Sponges in Preventing Sternal Wound Infections.
Glam R, Ronai T, Makhoul M … +6 more , Friedman T, Raad M, Adler Z, Cohen O, Medalion B, Bolotin G
Thorac Cardiovasc Surg · 2025 Jun · PMID 40523630 · Publisher ↗
This study aimed to evaluate whether the combined use of gentamicin-collagen sponges and topical vancomycin reduces the incidence of sternal wound infections (SWIs) in patients at high risk for infection following cardia...
This study aimed to evaluate whether the combined use of gentamicin-collagen sponges and topical vancomycin reduces the incidence of sternal wound infections (SWIs) in patients at high risk for infection following cardiac surgery.A single-center, retrospective study compared two groups of high-risk cardiac surgery patients from June 2018 to September 2021. High-risk patients, identified through departmental consensus, had multiple SWI risk factors. The study group (278 patients) received gentamicin-collagen sponges plus topical vancomycin, whereas the control group (309 patients) received only topical vancomycin. The primary outcome was SWI incidence.The incidence of SWI was significantly lower in the study group, with 2.8% (8/278) compared with 9% (28/309) in the control group ( = 0.002). After adjusting for known risk factors, the odds of infection in the control group were 4.64 times higher (95% confidence interval [CI]: 1.63-13.21) than in the study group. The rate of deep sternal wound infections (DSWI) was 1.8% in the study group versus 4.2% in the control group ( = 0.09), with adjusted odds of DSWI being 4.1 times higher in the control group (95% CI: 0.99-16.86). Although the -value was borderline ( = 0.05), no significant differences in mortality rates were observed between the two groups.The use of gentamicin-collagen sponges as part of a prophylactic regimen significantly reduces the incidence of SWI in high-risk cardiac surgery patients, suggesting its potential benefit as an adjunctive treatment in preventing postoperative infections.
"Vetus Sed Utilis": Open Window Thoracostomy after Lung Surgery.
Mazzella A, Bardoni C, Bertolaccini L … +4 more , Casiraghi M, Girelli L, Iacono GL, Spaggiari L
Thorac Cardiovasc Surg · 2026 Jun · PMID 40473252 · Publisher ↗
INTRODUCTION: Open window thoracostomy (OWT) is an ancient surgical intervention, born for managing chronic thoracic infectious diseases. Our goal is to report our 25-year experience in the management of these patients,...
INTRODUCTION: Open window thoracostomy (OWT) is an ancient surgical intervention, born for managing chronic thoracic infectious diseases. Our goal is to report our 25-year experience in the management of these patients, focusing on its feasibility and usefulness in our modern era. METHODS: We retrospectively reviewed our database (1999-2024), reporting all clinical preoperative, intraoperative, and postoperative data of patients undergoing OWT for treating chronic empyema, linked to broncho-pleural fistula after lung resection, or not. Data were collected on the type of original surgical intervention, perioperative and postoperative management, 30- and 90-day mortality, overall survival, and following reintervention to close OWT. RESULTS: Sixty-six OWTs were performed to treat acute and chronic septic complications due to original lung intervention for cancer. OWT was performed for treating a late broncho-pleural fistula after pneumonectomy (56 cases; 85%) or after lobectomy (8 cases; 12%) or pleural chronic empyema (2 cases; 3%). Thirty- and 90-day mortality after OWT following pneumonectomy was 3% (2 patients) and 6% (4 patients), respectively. No 30- and 90-day death was observed in the other patients. In 15 out of 66 patients (22.7%), OWT was closed by muscle, skin, or omentum flaps. No statistical differences were observed comparing the survival of the patients undergoing or not undergoing OWT closure, after pneumonectomy ( = 0.59). CONCLUSION: OWT is a safe, feasible, and sometimes mandatory technique for the management of chronic infectious issues linked to broncho-pleural fistula (BPF) after lung surgery. It is well tolerated by guaranteeing an appropriate quality of life.
Totally Thoracoscopic Ablation for Atrial Fibrillation: All-Box Clamping.
Doll N, Doll A, Horvath G … +6 more , Mönnig G, Pott C, Hanke T, Ouarrak T, Senges J, Wehbe M
Thorac Cardiovasc Surg · 2025 Jun · PMID 40461046 · Publisher ↗
Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight m...
Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight modifications to the thoracoscopic maze procedure, totally thoracoscopic all-box clamping may facilitate the performance of epicardial thoracoscopic ablation, while maintaining good results.Between December 2023 and December 2024, 42 patients underwent thoracoscopic all-box clamping at a single center. All-box clamping uses commercially available bipolar radiofrequency clamps for isolation of the ipsilateral pulmonary veins and posterior left atrial wall through right and then left-sided thoracoscopic access. The left atrial appendage is occluded using a clip device, and the ligament of Marshall is transected. Assessment of a bidirectional block confirmed electrical isolation. Data from the CASE-AF registry were analyzed retrospectively. Short-term results pertaining to efficacy and safety are provided.All-box clamping was successfully offered to all patients by three surgeons. There were no reported major or minor complications. The median hospital stay was 6 days (interquartile range 5-6). At discharge, a sinus rhythm was observed in 92.9%, and in 76.1% of patients off any class I/III antiarrhythmic drugs.Surgical ablation with a modified thoracoscopic technique is safe and feasible for the treatment of atrial fibrillation.
A Novel Sheath Aligning Method of Left Subclavian Artery Revascularization in TEVAR.
Zhang Y, Wang H, Liu J … +1 more , Xue S
Thorac Cardiovasc Surg · 2026 Jun · PMID 40461024 · Publisher ↗
Concomitant left subclavian artery (LSA) fenestration is recommended in thoracic endovascular aortic repair (TEVAR) for revascularization when the LSA is covered. However, the sheath alignment lacks an accurate and effic...
Concomitant left subclavian artery (LSA) fenestration is recommended in thoracic endovascular aortic repair (TEVAR) for revascularization when the LSA is covered. However, the sheath alignment lacks an accurate and efficient positioning method due to the angulation of LSA anatomy. We developed a novel method for sheath aligning characterized by the guiding catheter's front junction (J.) with the graft stent and descending (D.) aorta proceeding. It forms a curved traction system that drags the puncture needle to the center of LSA orifice. A 93.8% endoleak-free rate was observed during the 9.0 (4.0-17.5) months follow-up in 137 patients. No reintervention or mortality was observed. Our sheath aligning method can be safely performed in LSA fenestration, which simplifies the surgical procedure and may help to avoid iatrogenic complications.
Ebstein Repair in a High-Altitude Setting ≥2,500 m: First Experience from Bolivia.
Weber SC, Alvensleben IV, Vadiunec V … +4 more , Iben A, Berger F, Sallmon H, Photiadis J
Thorac Cardiovasc Surg · 2025 Jan · PMID 40419259 · Publisher ↗
Contemporary surgical approaches for Ebstein anomaly are based on a paradigm shift towards earlier surgery in order to avoid the deleterious effects of chronic right ventricular (RV) volume overload. In addition, RV dysf...
Contemporary surgical approaches for Ebstein anomaly are based on a paradigm shift towards earlier surgery in order to avoid the deleterious effects of chronic right ventricular (RV) volume overload. In addition, RV dysfunction may worsen in the setting of high altitude, and to date, no results on Ebstein anomaly surgery have been reported from a high-altitude setting.We herein present first postoperative results from Ebstein anomaly patients who underwent cone reconstruction (with or without bidirectional Glenn anastomosis) in Cochabamba, Bolivia (>2,500 m above sea level) using a specific high-altitude protocol for prophylactic medical treatment of presumed pulmonary hypertension (PH), including sildenafil, iloprost, and higher FiO.Four patients underwent surgical correction of Ebstein anomaly (median age 9 years, range 4-12 years, all female). Ebstein anomaly was classified as Carpentier type C in three and as Carpentier Type B in one patient. All patients showed some degree of atrial shunting while one patient exhibited an additional perimembranous ventricular septal defect. All underwent cone reconstruction of the tricuspid valve. Due to massive intraoperative bleeding, which required rethoracotomy, subsequently causing impaired RV function, one patient underwent concomitant "one and a half ventricle" repair. All other patients showed an uncomplicated postoperative course and all were alive with a good and/or improved RV function and only minimal-to-mild tricuspid regurgitation after 1 year.Cone reconstruction in children with Ebstein anomaly is feasible in a high-altitude setting when using a dedicated protocol to prophylactically manage PH.
Experimental Comparison of Esmolol- and Blood-Based Cardioplegia for Long Aortic Clamping Times.
Böning A, Chapugi B, Heep M … +3 more , Gärtner U, Niemann B, Taghiyev ZT
Thorac Cardiovasc Surg · 2026 Mar · PMID 40404136 · Publisher ↗
After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservat...
After cardiac surgery, long aortic clamping times and extracorporeal circulation times are associated with worse outcomes. This study compares hemodynamic performance, myocardial metabolism, and ultrastructural preservation in rat hearts after applying esmolol crystalloid cardioplegia (ECCP) or Calafiore blood cardioplegia (Cala).Hearts from 18 Wistar rats were perfused in a Langendorff system. Following 120 minutes of ischemia at 36 °C, hearts received either ECCP at 32 °C for 3 minutes or Cala at 36 °C for 2 minutes every 20 minutes. During 90 minutes of reperfusion, coronary blood flow (CF), left ventricular developed pressure (LVDP), and contraction/relaxation velocities (±dp/dt) were recorded. Myocardial oxygen consumption, lactate production, and troponin I levels were measured. Electron microscopy was used for ultrastructural assessment.Baseline (BL) values of LVDP, CF, and ±dp/dt were similar between the two groups. After 90 minutes of reperfusion, CF was significantly higher in the ECCP group: 85 ± 43% of BL in the ECCP group versus 42 ± 24% of BL in the Cala group ( = 0.002). At the end of reperfusion, hearts exposed to ECCP had higher LVDP (91 ± 40%) values than Cala (43 ± 10%), indicating improved cardiac recovery with ECCP. Myocardial contraction and relaxation were notably better in the ECCP group: dLVP/dt was 111 ± 40% versus 59 ± 13% in the Cala group ( = 0.002), and dLVP/dt was 88 ± 34% versus 40 ± 7% ( = 0.001). Troponin I levels measured in Cala hearts at the end of reperfusion were higher than in ECCP hearts (Cala 1,102.6 ± 361.3 ng/mL vs. ECCP 442.3 ± 788.4 ng/mL, = 0.036).In rat hearts, ECCP offers better hemodynamic recovery and protects the myocardium from ischemia/reperfusion-related damage, better than Cala blood cardioplegia, even with aortic clamping times of 120 minutes.
Impact of SGLT2 Inhibitor Therapy on Patients Undergoing Cardiac Surgery.
Taghiyev ZT, Beier LM, Leweling C … +4 more , Gunkel S, Sadowski KM, Assmus B, Boening A
Thorac Cardiovasc Surg · 2026 Apr · PMID 40393690 · Publisher ↗
Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are nephroprotective in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease, but their potential influence during cardiac...
Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are nephroprotective in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease, but their potential influence during cardiac surgery is unclear. Currently, discontinuation of SGLT2i at least 2 days before surgery is recommended.Between March 2022 and December 2023, 53 cardiac surgical patients on SGLT2i therapy in addition to standard medical treatment for HF were compared with 447 other HF patients from the same period. After 1:1 covariate adjustment, 33 patients with SGLT2i treatment were matched with 33 controls. The primary endpoint was a change in estimated glomerular filtration rate (eGFR) 36 hours after surgery. Secondary endpoints were changes in eGFR, cumulative urine output, diuretic efficacy, and albuminuria over seven postoperative days.Mean baseline eGFR was similar between the groups ( = 0.973). Thirty-six hours postoperatively, eGFR was significantly higher in the SGLT2i group by a mean difference (MD) of 11.8 mL/min (95% CI [3.12-20.44]; = 0.009) compared with the control group. The mean urinary albumin level was 18.1 mg/mL lower in the SGLT2i group (95% CI [-42.5-6.33]; = 0.143). There were numerically positive changes in urine output and diuretic efficacy in the SGLT2i group without significant difference: MD 131.4 mL/24 hours (95% CI [-366.7-629.5]; = 0.600) and MD 11.3 mL/mg (95% CI [-12.2-34.7]; = 0.301), respectively, although the dosage of diuretics was higher in controls (30.6 ± 43.7 vs. 51.3 ± 130.1 mg/24 hours; = 0.268, respectively).SGLT2i may have nephroprotective effects in patients undergoing heart surgery with extracorporeal circulation. More evidence is needed to determine whether SGTL2i needs to be discontinued before surgery.
Do P-Wave Indices Manifest Atrial Fibrillation after Postoperative Atrial Fibrillation?
Rau C, Salzmann-Djufri M, Böning A … +2 more , Rohrbach S, Niemann B
Thorac Cardiovasc Surg · 2026 Jan · PMID 40393689 · Publisher ↗
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up.We conducted a prospe...
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. We investigated how POAF affects the manifestation of atrial fibrillation (AF) during long-term follow-up.We conducted a prospective all-comers investigation involving patients undergoing cardiac surgery. In propensity score-matched cohorts (POAF vs. sinus rhythm [SR]), ECGs were evaluated regarding P-wave duration (PWD), amplitude (PWA), morphology, variability, and their dynamics preoperatively pre-POAF and at follow-up. Predictive value of these parameters regarding the development of manifest AF after POAF was analyzed.Of 212 patients included, 50 patients (23.6%) developed POAF. Ninety patients underwent propensity score matching (PSM), 64 (71%) participated in follow-up, 21 (23%) died prior to follow-up (POAF: 13 vs. SR: 8), and 5 (6%) withdrew consent. No patient developed persistent AF. In nine patients, paroxysmal AF (pAF) events were detected (POAF: 6 vs. SR: 3). PWD, P-dispersion (PD), PWA, and interatrial block differed between POAF and SR. From pre- to postoperative ECGs, PD and P-wave peak time (PWPT) increased, and P-amplitude decreased in these. Preoperative β-blockers had only minor modulating potency. P-wave modulation was pronounced in POAF patients.Patients with POAF are prone to episodes of pAF. P-wave indices and perioperative dynamics of these indices may indicate a higher risk of manifest AF initiation among POAF patients.
Delayed Sternal Closure in Heart Surgery: Outcomes and Quality of Life.
Heuer H, Song Z, Hegner P … +8 more , Truong A, Wiesner S, Terrazas A, Larisch C, Aigner HC, Floerchinger B, Schmid C, Li J
Thorac Cardiovasc Surg · 2026 Jan · PMID 40368422 · Publisher ↗
Delayed sternal closure (DSC) is a well-established strategy used to manage patients with hemodynamic instability and perioperative coagulopathy following cardiac surgery. The study aims to present our 15-year surgical e...
Delayed sternal closure (DSC) is a well-established strategy used to manage patients with hemodynamic instability and perioperative coagulopathy following cardiac surgery. The study aims to present our 15-year surgical experiences with DSC.Between 2007 and 2022, DSC was performed in 227 out of 14,210 patients (1.7%) who underwent cardiac surgery at our institution. Perioperative data, outcomes, and long-term survival were analyzed. Quality of life (QoL) was assessed utilizing the EuroQol-5D-5L questionnaire.Indications for DSC included low cardiac output syndrome (LCOS) (44.1%) and coagulopathy during the index procedure (32.2%), as well as postoperative tamponade (22.9%). In coronary artery bypass grafting, LCOS was the primary indication for DSC (72.7%), whereas in acute type A aortic dissection, coagulopathy was the leading indication (70.6%). For other procedures, DSC indications were more evenly distributed. The overall 30-day survival was 57.5%, with survival rates of 43.3% for LCOS, 72.0% for coagulopathy, and 65.4% for tamponade. Multivariate logistic regression identified body mass index, postoperative renal replacement therapy, aggravated heart failure, and intraoperative packed red blood cell transfusion as negatively associated with 30-day survival. The mean follow-up period was 6.58 ± 3.19 years. Younger patients and DSC patients upon bleeding related indications reported higher QoL in comparison to older patients and patients with LCOS. Longer follow-up interval correlated with higher QoL.The study emphasizes the significant impact of LCOS on outcomes in patients undergoing DSC. We provide QoL data demonstrating good rehabilitation potential upon survival of the acute phase.
Normothermic Circulatory Arrest with Antegrade Cerebral Perfusion for Type A Aortic Dissection.
Rings L, Boulos R, Ntinopoulos V … +3 more , Haeussler A, Rodriguez Cetina Biefer H, Dzemali O
Thorac Cardiovasc Surg · 2026 Jun · PMID 40315859 · Publisher ↗
BACKGROUND: Deep hypothermic circulatory arrest is the standard approach for the surgical repair of acute type A aortic dissection. This study aimed to evaluate the feasibility and outcomes of normothermic circulatory ar...
BACKGROUND: Deep hypothermic circulatory arrest is the standard approach for the surgical repair of acute type A aortic dissection. This study aimed to evaluate the feasibility and outcomes of normothermic circulatory arrest using antegrade cerebral perfusion as an alternative technique. METHODS: A retrospective propensity score-matched analysis was conducted on patients undergoing surgery for acute type A aortic dissection between 2007 and 2023 at a single center. Outcomes were compared between patients who underwent normothermic (>35°C) versus mild hypothermic (28-34°C) circulatory arrest. The primary outcomes were 30-day mortality, new neurological deficits, and the intraoperative and postoperative parameters. RESULTS: After propensity score matching, 20 pairs were analyzed. The normothermic group (NTCA) had significantly shorter aortic cross-clamp times (47.5 vs. 66.5 minutes, = 0.013) and trends toward shorter cardiopulmonary bypass times (68 vs. 95 minutes, = 0.066), ICU stays (4.5 vs. 5 days, = 0.4), and intubation times (6 vs. 8 hours, = 0.4). There were no significant differences in new neurological deficits ( = 6 [NTCA] vs. 4, = 0.7), delirium ( = 5 [NTCA] vs. 6, = 0.6), or mortality ( = 1 [NTCA] vs. 3, = 0.6) between the groups. The normothermic group required less prothrombin complex concentrate ( = 0.0012). CONCLUSION: In this pilot study, NTCA with antegrade cerebral perfusion appears feasible and safe for hemiarch repair in acute type A aortic dissection, with potential benefits of shorter operative times and improved coagulation profiles compared with mild hypothermia. Larger prospective studies are needed to confirm these findings.
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