Ann Thorac Cardiovasc Surg [JOURNAL]
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200 papers
Impact of Pathological Lymphovascular Invasion of Lung Adenocarcinoma after Induction Chemoradiotherapy.
Kabuto T, Menju T, Nishikawa S … +3 more , Terada K, Yoshizawa A, Date H
Ann Thorac Cardiovasc Surg · 2026 · PMID 42386540 · Publisher ↗
PURPOSE: We investigated the clinical significance of lymphovascular invasion (LVI) in locally advanced lung adenocarcinoma after induction chemoradiotherapy (CRT). METHODS: We retrospectively reviewed patients with comp...
PURPOSE: We investigated the clinical significance of lymphovascular invasion (LVI) in locally advanced lung adenocarcinoma after induction chemoradiotherapy (CRT). METHODS: We retrospectively reviewed patients with completely resected lung adenocarcinoma after induction CRT from 2007 to 2021 at our institution. We evaluated the effects of LVI on recurrence-free survival (RFS) and overall survival (OS). RESULTS: Fifty-six patients were included. The reasons for induction CRT were superior sulcus tumor (n = 11, 19.6%), direct invasion of other organs (n = 7, 12.5%), bulky N1 (n = 3, 5.4%), and N2 (n = 35, 62.5%). A pathological complete response was observed in 6 patients (10.7%). LVI was present in 14 patients (25.0%) and absent in 42 (75.0%). The LVI-positive group had significantly worse 5-year RFS (7.8% vs. 49.7%, p <0.001) and OS (35.2% vs. 73.5%, p = 0.003) than the LVI-negative group. Multivariate analysis revealed that LVI was a significant prognostic factor for both RFS (hazard ratio [HR], 3.91; 95% confidence interval [CI], 1.64-9.32, p = 0.002) and OS (HR, 5.75; 95% CI, 1.92-17.20, p = 0.002). CONCLUSIONS: LVI can be a poor prognostic factor and an important biomarker for assessing the effectiveness of multimodal treatment in lung adenocarcinoma.
Left Ventricular Venting during On-Pump Beating-Heart Coronary Artery Bypass Grafting for Advanced Ischemic Cardiomyopathy: A Surgical Strategy to Achieve Complete Revascularization.
Yoshizumi T, Uemura T, Hayashi Y … +4 more , Terazawa S, Tokuda Y, Narita Y, Mutsuga M
Ann Thorac Cardiovasc Surg · 2026 · PMID 42386539 · Full text
We describe a surgical strategy combining on-pump beating-heart coronary artery bypass grafting (OPBH CABG) with left ventricular (LV) venting for patients with advanced ischemic cardiomyopathy (ICM) with severe LV dysfu...
We describe a surgical strategy combining on-pump beating-heart coronary artery bypass grafting (OPBH CABG) with left ventricular (LV) venting for patients with advanced ischemic cardiomyopathy (ICM) with severe LV dysfunction and marked LV dilation. This strategy provides LV decompression, reduces myocardial workload, and improves surgical exposure during coronary anastomosis, facilitating complete revascularization. Between January 2013 and September 2024, 7 patients underwent OPBH CABG with LV venting. Six patients had chronic ICM with dilated ventricles and severe systolic dysfunction, and 1 presented with acute coronary syndrome and impaired LV function. The median age was 65 years (interquartile range [IQR], 61-80). The median left ventricular ejection fraction was 21.7% (IQR, 19.2-27.9), and the median left ventricular end-diastolic diameter was 61.6 mm (IQR, 58.7-69.3). Complete revascularization was achieved in all patients without additional mechanical circulatory support. There were no in-hospital deaths or postoperative complications. This strategy may enable complete revascularization in selected high-risk patients while contributing to myocardial unloading.
Surgical Stabilization of Rib Fractures: Current Evidence and Considerations for Posterior Rib Fractures.
Sumaarsana IKR, Putra IGAMA, Sari NMA
Ann Thorac Cardiovasc Surg · 2026 · PMID 42324145 · Full text
PURPOSE: Posterior rib fractures represent severe thoracic trauma and are associated with a higher risk of complications due to their proximity to vital intrathoracic structures, including the intercostal vessels and lun...
PURPOSE: Posterior rib fractures represent severe thoracic trauma and are associated with a higher risk of complications due to their proximity to vital intrathoracic structures, including the intercostal vessels and lungs. Surgical stabilization of rib fractures (SSRF) has emerged as an operative strategy to restore chest wall stability, improve respiratory mechanics, and reduce pain. However, evidence specifically addressing posterior rib fractures remains limited, and current understanding is largely extrapolated from studies involving general rib fracture populations. METHODS: This literature review evaluates the principles, operative techniques, effectiveness, and limitations of SSRF in posterior rib fractures, with an emphasis on surgical timing, technical challenges, and postoperative rehabilitation. RESULTS: Current evidence suggests that SSRF may reduce respiratory complications and improve outcomes in selected patients. Studies report reductions in pneumonia incidence and up to a 95% decrease in tracheostomy requirements in patients with flail chest. Surgical timing also influences outcomes, with pneumonia reported in 18% of patients undergoing SSRF within 72 h compared with 58% in those receiving delayed stabilization. CONCLUSIONS: SSRF may provide clinical benefits in appropriately selected patients with rib fractures. However, evidence specifically addressing posterior rib fractures remains limited, and further high-quality studies are required to clarify optimal indications and surgical strategies.
Surgical Safety of Uniportal versus Multiportal VATS Segmentectomy during Institutional Adoption: Differential Impact by Lobar Location.
Yabuki H, Miyabe S, Tomiyama F … +1 more , Noda M
Ann Thorac Cardiovasc Surg · 2026 · PMID 42324144 · Full text
PURPOSE: This study aimed to compare surgical safety outcomes of uniportal and multiportal video-assisted thoracoscopic surgery (uVATS and mVATS) segmentectomy during institutional adoption, focusing on differences accor...
PURPOSE: This study aimed to compare surgical safety outcomes of uniportal and multiportal video-assisted thoracoscopic surgery (uVATS and mVATS) segmentectomy during institutional adoption, focusing on differences according to lobar location. METHODS: We retrospectively analyzed 117 patients who underwent thoracoscopic segmentectomy between 2019 and 2024 (uVATS, 49; mVATS, 68). Outcomes included intraoperative pulmonary vessel injury and major postoperative complications, along with operative time, blood loss, and length of hospital stay. Inverse probability of treatment weighting was applied, and analyses were performed overall and stratified by lobe. RESULTS: Pulmonary vessel injury occurred in 12 patients (10.3%), and grade ≥III complications in 10 (8.5%). After adjustment, uVATS showed a higher incidence of vascular injury than mVATS overall (22.8% vs. 5.5%; p = 0.006). No statistically significant differences were observed in upper-lobe segmentectomy. In lower-lobe segmentectomy, uVATS showed higher rates of vascular injury (44.8% vs. 2.2%; p <0.001) and grade ≥III complications (18.8% vs. 0%; p = 0.005). CONCLUSIONS: No statistically significant differences were observed between uVATS and mVATS in upper-lobe segmentectomy. However, during the institutional adoption phase, careful consideration is warranted when performing lower-lobe segmentectomy with uVATS due to a higher incidence of complications related to surgical safety.
Isolated Ascending Aortic Aneurysms: Five-Year Comparative Outcomes between Modified Wrapping Technique and Supracoronary Tube Replacement.
Dubrulle H, Coisne A, Aghezzaf S … +7 more , Bardeesi A, Bical A, Pontana F, Montaigne D, Modine T, Vincentelli A, Koussa M
Ann Thorac Cardiovasc Surg · 2026 · PMID 42309695 · Full text
PURPOSE: This study aimed to compare outcomes of the modified wrapping technique (MWT) and supracoronary tube replacement (STR) for isolated ascending aortic aneurysms, focusing on perioperative safety, 5-year survival,...
PURPOSE: This study aimed to compare outcomes of the modified wrapping technique (MWT) and supracoronary tube replacement (STR) for isolated ascending aortic aneurysms, focusing on perioperative safety, 5-year survival, and arterial stiffness. METHODS: This retrospective, single-center study included 205 patients undergoing MWT (n = 91) or STR (n = 114) between 2006 and 2019 for isolated ascending aortic aneurysms ≥50 mm or rapidly progressing lesions. A prospective substudy evaluated arterial stiffness using the SphygmoCor system in a matched subgroup of 40 patients. The primary endpoint was 5-year survival; secondary endpoints included perioperative outcomes, prosthetic infection, and hemodynamic indices. RESULTS: MWT showed significantly shorter cardiopulmonary bypass and aortic cross-clamp times (p <0.0001) and reduced hospital stay (10.5 ± 0.3 vs. 13.5 ± 0.8 days; p = 0.001). In-hospital mortality tended to be lower with MWT (0% vs. 4.4%; p = 0.06). Five-year survival was comparable between groups (88.1% vs. 83.4%; p = 0.17). Prosthetic infection was significantly lower in the MWT group (1.1% vs. 7.0%; p = 0.04). Hemodynamic assessment demonstrated lower pulse wave velocity and aortic augmentation index in the MWT group. CONCLUSIONS: MWT was associated with shorter operative times and lower prosthetic infection rates while maintaining similar early and mid-term survival compared with STR. These findings suggest MWT as a valuable alternative in selected patients.
The Effect of Closed Incision Negative Pressure Wound Therapy for Prophylactic Use of Postoperative Deep Sternal Wound Infection in Patients Following Coronary Artery Bypass Grafting: A Single-Institutional Study.
Tsutsumi K, Yamanaka N, Tokioka M … +1 more , Ishida O
Ann Thorac Cardiovasc Surg · 2026 · PMID 42289342 · Full text
PURPOSE: The aim of this study was to evaluate the effectiveness of closed-incision negative pressure wound therapy (ciNPWT) as a prophylactic measure to prevent deep sternal wound infection (DSWI) after surgery. METHODS...
PURPOSE: The aim of this study was to evaluate the effectiveness of closed-incision negative pressure wound therapy (ciNPWT) as a prophylactic measure to prevent deep sternal wound infection (DSWI) after surgery. METHODS: A total of 209 patients undergoing isolated coronary artery bypass grafting via median sternotomy were enrolled. The patients were divided into 3 groups according to incisional care. In Group A (n = 63), the wound was covered with sterile gauze dressings alone. In Group B (n = 71), an indwelling subcutaneous drain was placed and the wound was covered with a hydrocolloid dressing. In Group C (n = 75), an indwelling subcutaneous drain was placed and the wound was covered with a ciNPWT device (PICO; Smith & Nephew). The incidence of DSWI occurring within 60 postoperative days was compared among the 3 groups. RESULTS: There were no significant differences in preoperative, operative, or postoperative variables among the groups. Postoperative DSWI occurred in 11.1% (7/63) of patients in Group A and 5.6% (4/71) of patients in Group B, whereas no patients in Group C developed DSWI. CONCLUSIONS: Immediate application of NPWT was associated with a reduced rate of wound infection. This treatment may represent an effective preventive strategy.
Effect of Right Middle-to-Lower Lobe Fixation on Postoperative Lung Volume after Right Upper Lobectomy.
Song SY, Lee KS, Yun JS
Ann Thorac Cardiovasc Surg · 2026 · PMID 42270431 · Full text
PURPOSE: Cranial migration of the right middle lobe (RML) after right upper lobectomy may cause bronchial angulation and alter postoperative lung volume distribution. We investigated whether RML fixation techniques affec...
PURPOSE: Cranial migration of the right middle lobe (RML) after right upper lobectomy may cause bronchial angulation and alter postoperative lung volume distribution. We investigated whether RML fixation techniques affect postoperative lobar volume and pulmonary function. METHODS: This retrospective single-center study included 96 patients who underwent right upper lobectomy for non-small cell lung cancer (2009-2020). Patients were classified into 3 groups: no fixation, normal fixation, and sliding (anterior-caudal) fixation of the RML to the right lower lobe (RLL). Lobar volumes were assessed using 3-dimensional computed tomography volumetry, and postoperative pulmonary function tests were analyzed when available. RESULTS: Both lower lobes showed significant compensatory expansion, with the RLL demonstrating the largest increase. Overall, RML volume did not change significantly. However, RML volume increased in the normal fixation group (+58.9 ± 78.2 mL) but decreased in the sliding-fixation (-29.0 ± 92.6 mL) and no-fixation groups (-16.9 ± 118.9 mL), with significant differences among groups (p <0.001). Postoperative changes in forced vital capacity and forced expiratory volume in 1 second did not differ among groups, and RML volume change was not correlated with pulmonary function. CONCLUSIONS: Normal RML fixation preserved RML volume after right upper lobectomy, but did not improve postoperative pulmonary function. Further studies are warranted.
Salvage Pneumonectomy for Rapidly Progressive Destroyed Lung during Durvalumab Maintenance after Chemoradiotherapy.
Watanabe SN, Kimura D, Saito Y … +4 more , Taima K, Aoki M, Kurose A, Minakawa M
Ann Thorac Cardiovasc Surg · 2026 · PMID 42270378 · Full text
Durvalumab maintenance therapy following chemoradiotherapy is the standard treatment for patients with unresectable stage III non-small-cell lung cancer. Immune checkpoint inhibitors can alter host immunity, potentially...
Durvalumab maintenance therapy following chemoradiotherapy is the standard treatment for patients with unresectable stage III non-small-cell lung cancer. Immune checkpoint inhibitors can alter host immunity, potentially amplifying inflammatory responses during opportunistic infections. We report a rare case of rapidly progressive destroyed lung caused by invasive pulmonary aspergillosis during durvalumab therapy, which was successfully managed with salvage pneumonectomy. A 53-year-old man with locoregionally recurrent lung adenocarcinoma received chemoradiotherapy followed by durvalumab treatment. Invasive pulmonary aspergillosis developed on day 74. Despite intensive antifungal therapy and corticosteroid administration, the right lung developed extensive liquefactive necrosis beyond the irradiated field within 5 weeks. Given the risk of fatal hemoptysis and sepsis, an emergency right pneumonectomy was performed. The frozen hilum required intrapericardial vascular control and reinforcement of the bronchial stump. Recovery was uneventful, and pathological examination confirmed aspergillosis without residual malignancy. Prompt recognition of medical refractoriness and timely surgery are critical for survival.
Radical Resection Using the Commando Procedure for Recurrent Cardiac Intimal Sarcoma in a Young Adult: A Case Report.
Komagamine M, Yamasaki Y, Kono T … +4 more , Tomita M, Kinebuchi S, Tomimoto D, Nawata K
Ann Thorac Cardiovasc Surg · 2026 · PMID 42236171 · Full text
Primary cardiac intimal sarcoma is an extremely rare, high-grade malignancy characterized by rapid progression and high early recurrence rates. We report the case of a 28-year-old male who underwent emergency resection f...
Primary cardiac intimal sarcoma is an extremely rare, high-grade malignancy characterized by rapid progression and high early recurrence rates. We report the case of a 28-year-old male who underwent emergency resection for a large left atrial intimal sarcoma (10 × 8 cm). Follow-up imaging at 6 months revealed a 15-mm recurrent tumor infiltrating the left atrial septum, despite an initially stable recovery. We prioritized radical resection over surgical risk, given the patient's youth and the aggressive behavior of the tumor. Therefore, a "Commando" procedure consisting of radical tumor resection, double valve replacement, and reconstruction of the intervalvular fibrosa using the Manouguian technique was performed. Histopathological examination confirmed recurrent intimal sarcoma with negative surgical margins. Despite its high invasiveness, the Commando procedure is viable for primary treatment for recurrent cardiac intimal sarcomas in young patients. Aggressive surgical reconstruction remains the only viable option to improve the prognosis of this otherwise fatal malignancy.
A Rare Case of Spontaneous Closure of Tracheomediastinal Fistula Formed after Chemotherapy for Diffuse Large B-Cell Lymphoma.
Kobayashi T, Horikiri A, Yokota N … +4 more , Taki T, Takase Y, Kanai Y, Tsubochi H
Ann Thorac Cardiovasc Surg · 2026 · PMID 42219309 · Full text
Tracheomediastinal fistula is a rare but potentially life-threatening complication associated with malignant lymphoma. We report a case of spontaneous closure of a tracheomediastinal fistula that developed after chemothe...
Tracheomediastinal fistula is a rare but potentially life-threatening complication associated with malignant lymphoma. We report a case of spontaneous closure of a tracheomediastinal fistula that developed after chemotherapy for mediastinal diffuse large B-cell lymphoma (DLBCL). A 70-year-old man presented with airway compression caused by a large mediastinal tumor. After airway stabilization with a Dumon Y stent and subsequent R-CHOP chemotherapy, the tumor markedly regressed. Following stent removal, a fistula developed in the anterior tracheal wall, communicating with a necrotic mediastinal space. Because no clinical or laboratory signs of mediastinitis were observed, conservative management without antibiotics or invasive intervention was adopted. The fistula gradually decreased in size and closed completely within 10 weeks. This case suggests that tracheomediastinal fistulas without mediastinitis may be managed conservatively under careful observation. Treatment strategies should be individualized based on anatomical location and the presence or absence of infection.
Histology-Based Induction Chemoradiotherapy Followed by Surgery for Stage IIIA-N2 Non-Small Cell Lung Cancer: A Prospective Observational Study.
Ishibashi H, Asakawa A, Sugita Y … +6 more , Ishikawa Y, Wakejima R, Honda T, Miyazaki Y, Yoshimura R, Okubo K
Ann Thorac Cardiovasc Surg · 2026 · PMID 42128831 · Full text
PURPOSE: Although immune checkpoint inhibitor-based perioperative therapy has become the standard for resectable stage IIIA-N2 non-small cell lung cancer (NSCLC), not all patients are eligible for this approach. This stu...
PURPOSE: Although immune checkpoint inhibitor-based perioperative therapy has become the standard for resectable stage IIIA-N2 non-small cell lung cancer (NSCLC), not all patients are eligible for this approach. This study evaluated long-term outcomes of histology-based induction chemoradiotherapy (CRT) followed by surgery. METHODS: This prospective observational study enrolled 48 consecutive patients with pathologically confirmed stage IIIA-N2 NSCLC between April 2010 and May 2025. Patients with squamous cell carcinoma (Sq) received cisplatin/vinorelbine, while those with non-squamous cell carcinoma (non-Sq) received cisplatin/pemetrexed, both with concurrent radiotherapy (50 Gy), followed by surgery. RESULTS: All 48 patients (25 Sq, 23 non-Sq) completed induction CRT; 45 (93.8%) underwent surgery, with 97.8% achieving complete resection. Median follow-up was 48.8 months. The 5-year overall survival/disease-free survival (DFS) rates were 77.9%/77.3% for Sq and 70.5%/33.7% for non-Sq cohorts. Grade 3/4 toxicities were more frequent in Sq patients (80.0% vs. 21.7%, p <0.001). Exploratory analysis revealed inferior DFS in epidermal growth factor receptor (EGFR)-mutated non-Sq patients, though overall survival remained favorable with subsequent tyrosine kinase inhibitor therapy. CONCLUSION: Histology-based induction CRT followed by surgery demonstrated feasibility and favorable outcomes, particularly for Sq and EGFR-negative non-Sq NSCLC. These findings provide a reference for patients ineligible for immune checkpoint inhibitor-based therapy.
Transcervical Dumon Stenting via Longitudinal Tracheotomy for Recurrent Upper Tracheal Restenosis after Failed Resection.
Lin MC, Chen YY
Ann Thorac Cardiovasc Surg · 2026 · PMID 42108097 · Full text
Post-tuberculosis airway stenosis can cause fixed cicatricial narrowing and long-term disability. We report a female patient with recurrent upper tracheal restenosis despite 2 prior resections, who presented decades late...
Post-tuberculosis airway stenosis can cause fixed cicatricial narrowing and long-term disability. We report a female patient with recurrent upper tracheal restenosis despite 2 prior resections, who presented decades later with respiratory failure; intubation was impossible, necessitating emergency tracheostomy. Imaging and bronchoscopy revealed pinhole stenosis near the second tracheal ring and left main bronchial stenosis with a destroyed left lung. The patient remained tracheostomy-dependent and aphonic after infection control. Because repeat resection was high-risk and endoscopic stent delivery was infeasible, a Dumon silicone stent was inserted via transcervical longitudinal tracheotomy under direct vision. Airway patency and phonation improved, and follow-up showed a stable stent without major complications. This open approach may serve as a salvage surgery when endoscopic delivery is impossible.
Fatal Aortoesophageal Fistula after Esophagectomy for Esophageal Cancer: A Single-Center Retrospective Analysis.
Zhao L, Zhang Z, Gao H … +3 more , Shi G, Ai J, Wei Y
Ann Thorac Cardiovasc Surg · 2026 · PMID 42021024 · Full text
PURPOSE: Aortoesophageal fistula (AEF) after esophagectomy is a rare but catastrophic complication, often occurring after anastomotic leakage and mediastinal contamination. Evidence regarding fatal trajectories and rescu...
PURPOSE: Aortoesophageal fistula (AEF) after esophagectomy is a rare but catastrophic complication, often occurring after anastomotic leakage and mediastinal contamination. Evidence regarding fatal trajectories and rescue failure points remains limited. METHODS: We performed a retrospective, single-center study among esophageal cancer patients who developed AEF after esophagectomy between 2013 and 2024. Cases were identified from institutional databases and mortality records, followed by manual screening. Clinical course, antecedent complications, diagnostic workup, rescue interventions, and causes of death were summarized descriptively. RESULTS: Among 5543 esophagectomies, 17 patients (0.31%) developed AEF: 16 fatal (94.1%) and 1 survivor (5.9%). All were male, median age 63 years. Anastomotic leak occurred in 16 patients (94.1%), all with mediastinal infection. Sentinel bleeding preceded hemorrhage in 14 patients (82.4%); the median interval to fatal hemorrhage was 1 day. CONCLUSIONS: Post-esophagectomy AEF is highly lethal. Sentinel bleeding represents a critical intervention window. Prompt recognition and multidisciplinary escalation may enable survival even in high-risk patients.
Pericardial Closure Using Donor Pericardium in Deceased-Donor Lung Transplantation.
Ryo T, Ohsumi A, Sakanoue I … +5 more , Kayawake H, Tanaka S, Yutaka Y, Nakajima D, Date H
Ann Thorac Cardiovasc Surg · 2026 · PMID 42021023 · Full text
PURPOSE: The optimal method of pericardial closure in lung transplantation remains controversial. This study aimed to evaluate the technical feasibility and procedural simplicity of pericardial closure using donor perica...
PURPOSE: The optimal method of pericardial closure in lung transplantation remains controversial. This study aimed to evaluate the technical feasibility and procedural simplicity of pericardial closure using donor pericardium. METHODS: We retrospectively reviewed 70 adult patients who underwent deceased-donor bilateral lung transplantation with cardiopulmonary bypass or central extracorporeal membrane oxygenation between December 2010 and January 2024 at Kyoto University Hospital. Patients were divided into the Donor pericardium group (n = 21) and the Autologous tissue group (n = 49). Pericardial closure time was assessed as an indicator of procedural simplicity, and postoperative complications within 1 year were descriptively evaluated. RESULTS: Baseline characteristics did not differ between the groups. Mean pericardial closure time was significantly shorter in the Donor pericardium group than in the Autologous tissue group (13 ± 2.4 vs 19 ± 1.6 min, P = 0.03). No clinically concerning differences in postoperative complications were observed during short- to mid-term follow-up. CONCLUSION: Pericardial closure using donor pericardium enables technically simpler and faster closure without apparent short-term safety concerns.
Surgical Management of Primary and Metastatic Cardiac Malignancies: A 20-Year Single-Center Experience.
Nakanishi R, Kawakami H, Tanabe N … +5 more , Tamaoka K, Takeuchi A, Kyo S, Taki T, Tsuneyoshi H
Ann Thorac Cardiovasc Surg · 2026 · PMID 41987379 · Full text
PURPOSE: Malignant cardiac tumors are rare and have a poor prognosis. Surgical resection is performed for symptom relief and survival benefit, but its efficacy is limited. We reviewed our 20-year single-institution exper...
PURPOSE: Malignant cardiac tumors are rare and have a poor prognosis. Surgical resection is performed for symptom relief and survival benefit, but its efficacy is limited. We reviewed our 20-year single-institution experience with primary and metastatic malignant cardiac tumors. METHODS: We retrospectively reviewed 15 patients who underwent resection for histologically confirmed malignant cardiac tumors between 2006 and 2025. Data included tumor characteristics, resection status, and survival outcomes. RESULTS: Of 15 patients, 7 (46.7%) had primary tumors (most common: angiosarcoma) and 8 (53.3%) had metastatic lesions. The right atrium was the most frequent site (60.0%). Complete (R0) resection was achieved in only 3 cases (20.0%). Median overall survival (OS) for the cohort was 11 months. Patients with angiosarcoma had particularly poor outcomes (median OS: 5 months). One patient with metastatic thymic carcinoma achieved long-term survival (>15 years) following multimodal therapy. Adjuvant therapy was administered in 7 patients (46.7%). No 30-day postoperative mortality occurred. CONCLUSION: Surgical resection of malignant cardiac tumors is feasible with acceptable perioperative safety. Although R0 resection is rarely attainable and long-term outcomes remain poor, particularly for high-grade sarcomas, a multimodal approach is essential to optimize outcomes in selected patients.
CT-Derived Aortic Plaque Characteristics Predict MRI-Detected Silent Cerebral Infarction after Total Aortic Arch Replacement.
Yamana F, Shimamura K, Shijo T … +4 more , Maeda K, Yamashita K, Sakaniwa R, Miyagawa S
Ann Thorac Cardiovasc Surg · 2026 · PMID 41987378 · Full text
PURPOSE: Silent cerebral infarctions are common after aortic arch surgery; however, the predictive value of preoperative computed tomography (CT)-derived plaque characteristics remains unclear. We investigated the incide...
PURPOSE: Silent cerebral infarctions are common after aortic arch surgery; however, the predictive value of preoperative computed tomography (CT)-derived plaque characteristics remains unclear. We investigated the incidence, distribution, and risk factors for new cerebral infarction lesions (NCILs) after total aortic arch replacement (TAR), focusing on low-attenuation plaque (LAP, 0-60 Hounsfield units [HU], a surrogate of lipid-rich vulnerable plaque) burden. METHODS: Among 82 consecutive TAR patients, 41 underwent both pre- and postoperative brain diffusion-weighted magnetic resonance imaging (MRI). Clinical profiles, CT-derived atheroma grade and plaque attenuation, operative details, and outcomes were compared between NCIL-positive and NCIL-negative groups. The primary multivariable model simultaneously included arch atheroma grade and LAP area, adjusted for age and sex. RESULTS: NCILs were detected in 25/41 patients (61%): 23 silent and 2 symptomatic. All NCILs exhibited embolic imaging features without watershed or hypoperfusion patterns. NCIL-positive patients had significantly greater arch LAP area (63.9 vs. 17.7 mm, p <0.01). On multivariable analysis, arch LAP remained the only independent predictor (OR per 10 mm, 3.01; 95% confidence interval [CI] 1.50-8.75; p = 0.012), whereas atheroma grade was not. CONCLUSION: More than half of TAR patients developed MRI-detected, predominantly silent NCILs. Preoperative arch LAP was the sole independent predictor. LAP assessment may refine intraoperative risk stratification and guide tailored neuroprotective strategies.
Association between Creatinine Trajectories and All-Cause Mortality in Elderly Patients after Cardiac Surgery: A Retrospective Cohort Study Based on MIMIC-IV.
Fan Y, Yang Z, Wei J … +1 more , Li Q
Ann Thorac Cardiovasc Surg · 2026 · PMID 41936436 · Full text
PURPOSE: Conventional monitoring of serum creatinine at isolated time points is suboptimal for reflecting disease progression. We therefore evaluated the prognostic value of distinct serum creatinine trajectories for pre...
PURPOSE: Conventional monitoring of serum creatinine at isolated time points is suboptimal for reflecting disease progression. We therefore evaluated the prognostic value of distinct serum creatinine trajectories for predicting all-cause mortality in this patient population. METHODS: We conducted a retrospective cohort study of elderly patients undergoing cardiac surgery, using data from the Medical Information Mart for Intensive Care database (MIMIC-IV). Kaplan-Meier analysis compared survival outcomes among the identified classes. Multivariable logistic and Cox proportional hazards models determined the independent associations of these trajectories with in-hospital and 1-year all-cause mortality. RESULTS: A total of 5145 patients undergoing cardiac surgery were included in the analysis. Three distinct creatinine trajectories were identified: low-stable (Class 1), persistent-increase (Class 2), and transient-increase (Class 3). Class 1 had the lowest in-hospital and 1-year mortality rates. Using Class 1 as the reference, Class 2 demonstrated the highest mortality risk, followed by Class 3. CONCLUSION: Distinct creatinine trajectory patterns conferred independent prognostic value for postoperative outcomes in elderly patients after cardiac surgery. A persistently high trajectory was independently associated with significantly increased mortality compared to the low-stable trajectory class.
Material Use for Air Leakage Prevention Post-Lung Resection: Insights from Real-World Data in Japan.
Kumamaru H, Nishimura S, Miyata H … +4 more , Mussi P, Miyoshi K, Maki A, Tanaka Y
Ann Thorac Cardiovasc Surg · 2026 · PMID 41922273 · Full text
PURPOSE: Lung resection is a standard treatment for localized lung cancer, but prolonged air leakage is a common complication with health and economic burdens. Interventions such as staplers, sealants, and adjunctive mat...
PURPOSE: Lung resection is a standard treatment for localized lung cancer, but prolonged air leakage is a common complication with health and economic burdens. Interventions such as staplers, sealants, and adjunctive materials are used, yet real-world data describing their utilization remain limited. METHODS: Using a hospital database with claims and discharge summaries from 393 hospitals in Japan, we identified patients undergoing lobectomy, segmentectomy, or partial resection for primary lung cancer between 2015 and 2020. We evaluated intraoperative use of staple-line buttresses, fibrin glue, polyglycolic acid (PGA) sheets, and other materials. Patient characteristics and comorbidities were compared across material-use categories, and the incidence of prolonged postoperative drainage (≥7 days) was assessed. RESULTS: Among 33094 lobectomy, 5443 segmentectomy, and 8242 partial resection patients, buttress use was uncommon (2.2%, 3.5%, and 6.4%). Patients receiving buttresses or PGA plus fibrin glue had higher prevalences of emphysema and interstitial pneumonia than those in the stapler-only group. Prolonged drainage remained frequent (6.9% in stapler-only vs. 24.8% in buttress among lobectomy patients) and was associated with nearly doubled postoperative in-hospital costs. CONCLUSIONS: Prolonged air leakage remains a major complication following lung resection, associated with clinical and economic burden. This study provided a nationwide overview of real-world utilization patterns of adjunctive materials.
Surgical Outcomes and Prognostic Impact of Lung Cancer Associated with Cystic Airspaces: A Retrospective Analysis of 75 Cases.
Machida Y, Suzuki K, Ino M … +3 more , Sonokawa T, Kawasaki N, Usuda J
Ann Thorac Cardiovasc Surg · 2026 · PMID 41813165 · Full text
PURPOSE: The present study reviewed surgical cases of lung cancer associated with cystic airspace (LCCA) and examined the imaging and clinicopathological features of these cases. METHODS: A total of 75 patients with lung...
PURPOSE: The present study reviewed surgical cases of lung cancer associated with cystic airspace (LCCA) and examined the imaging and clinicopathological features of these cases. METHODS: A total of 75 patients with lung cancer associated with cystic airspace, who underwent lung cancer surgery in our hospital between January 2017 and December 2020, were included. We retrospectively analyzed the association between postoperative recurrence of lung cancer and lung cancer associated with the cystic airspace using the Cox proportional hazards model. RESULTS: Patients with LCCA had a worse prognosis than those with non-LCCA. Furthermore, a univariate analysis showed a significant difference between sex, smoking, differentiation, tumor size, Stage, and LCCA, while a multivariate analysis showed a significant difference between Stage and LCCA. LCCA cases were classified into four categories, as reported in a previous study. Types I and III showed more adenocarcinomas, while Type IV tended to show squamous cell carcinomas. CONCLUSIONS: LCCA has a poor prognosis. It is often difficult to determine which of the T factors of the TNM classification are applied. Therefore, further studies are needed to accumulate more LCCA cases.
Preoperative Low Serum Basophil Levels Predict Poor Prognosis for the Patients with Esophageal Squamous Cell Carcinoma.
Shiratori F, Yajima S, Suzuki T … +4 more , Oshima Y, Yamakawa T, Ohtsuka Y, Shimada H
Ann Thorac Cardiovasc Surg · 2026 · PMID 41780937 · Full text
PURPOSE: A decrease in peripheral basophil count has recently been suggested as a potential marker of poor prognosis in malignancies. This study aimed to determine the optimal cutoff value for basophil count and assess i...
PURPOSE: A decrease in peripheral basophil count has recently been suggested as a potential marker of poor prognosis in malignancies. This study aimed to determine the optimal cutoff value for basophil count and assess its clinicopathological and prognostic significance in esophageal squamous cell carcinoma (ESCC). METHODS: We retrospectively analyzed 194 patients with ESCC (157 men, 37 women; mean age, 67 years [range, 34-88]) who underwent curative surgery between 2010 and 2020, including 100 who received neoadjuvant chemotherapy. Receiver-operating characteristic curve analysis identified an optimal basophil cutoff value of 17.4/μL. Patients were divided into low- and high-basophil groups, and clinicopathological factors and prognosis were assessed using univariate and multivariate analyses. RESULTS: Low-basophil counts were significantly correlated with low neutrophil counts but not with C-reactive protein level. Multivariate analysis to predict overall survival identified deep invasion, elevated C-reactive protein, and low-basophil count as independent predictors of a poor prognosis (P <0.05). CONCLUSION: Low preoperative basophil count is an independent adverse prognostic factor in ESCC. As basophil count was not correlated with C-reactive protein, it may provide prognostic value beyond conventional inflammation-based markers and could represent a simple, low-cost biomarker to aid risk stratification in the preoperative setting.
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