Aizawa H, Yoshitake A, Katsunori Y
… +7 more, Kinoshita O, Kumagai Y, Kuroda T, Kanazawa Y, Gatate Y, Gyoten T, Asakura T
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41730659
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PURPOSE: Research regarding Custodiol's safety in minimally invasive mitral valve repair remains limited in Asian populations. We compared Custodiol in minimally invasive mitral valve repair to repetitive cold blood card...PURPOSE: Research regarding Custodiol's safety in minimally invasive mitral valve repair remains limited in Asian populations. We compared Custodiol in minimally invasive mitral valve repair to repetitive cold blood cardioplegia in open mitral valve repair. METHODS: We retrospectively evaluated 98 consecutive patients who underwent minimally invasive mitral valve repair with Custodiol and 70 consecutive patients who underwent open mitral valve repair with repetitive cold blood cardioplegia at our institution between January 2015 and December 2024. The primary endpoints were creatine kinase-myocardial band (MB) levels and left ventricular ejection fraction determined by echocardiography pre- and post-surgery. RESULTS: Maximum creatine kinase-MB levels within 48 h post-surgery were significantly lower in the minimally invasive group than in the open repair group, both in the overall cohort (45.0 vs. 60.7 U/L; p <0.001, respectively) and after excluding patients who underwent Maze procedure or pulmonary vein isolation (42.4 vs. 50.0 U/L; p = 0.009, respectively). Left ventricular ejection fraction pre- and post-surgery was comparable between the minimally invasive and open repair groups (72% vs. 69%; p = 0.426 and 59% vs. 60%; p = 0.204, respectively). CONCLUSION: Custodiol during minimally invasive mitral valve repair provides myocardial protection comparable to repetitive cold blood cardioplegia in open mitral valve repair.
Soma T, Nagai S, Indo T
… +4 more, Ueda S, Imanishi N, Ueda M, Miyamoto Y
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41708075
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PURPOSE: Central airway adenoid cystic carcinoma (CAACC) is a rare malignancy lacking a standard treatment approach and often precluding complete resection. This study assessed the surgical outcomes of patients with CAAC...PURPOSE: Central airway adenoid cystic carcinoma (CAACC) is a rare malignancy lacking a standard treatment approach and often precluding complete resection. This study assessed the surgical outcomes of patients with CAACC treated at a single institution. METHODS: We retrospectively reviewed patients who underwent surgical resection for CAACC between September 2013 and August 2021. RESULTS: Eight patients (mean age: 51.5 years) were included. Tumor locations were bronchus (n = 1), trachea (n = 4), carina and bronchus (n = 2), and carina and trachea (n = 1). Surgical procedures included sleeve lobectomy (n = 1), tracheal resection (n = 4), sleeve pneumonectomy (n = 2), and carinal resection with reconstruction (n = 1). Preoperative radiation and bronchoscopic tumor resection were performed in 1 patient each. One patient died from a postoperative tracheoinnominate artery fistula. Major complications included recurrent laryngeal nerve palsy (n = 3). Adjuvant therapy was provided for positive or uncertain margins. During a median follow-up of 6 years, 2 patients developed recurrence but remained alive at the last follow-up. The 5-year overall survival rate was 72.9%. CONCLUSION: Surgical resection with airway reconstruction and adjuvant therapy can offer long-term disease control in CAACC, though life-threatening complications warrant careful consideration.
Nishibe T, Iwasa T, Kano M
… +4 more, Iwahori A, Koizumi J, Nishibe M, Dardik A
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41692465
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Endovascular aneurysm repair (EVAR) has markedly reduced perioperative morbidity and mortality in the management of abdominal aortic aneurysms. However, its long-term durability remains a concern because of sac expansion...Endovascular aneurysm repair (EVAR) has markedly reduced perioperative morbidity and mortality in the management of abdominal aortic aneurysms. However, its long-term durability remains a concern because of sac expansion, endoleaks, and late rupture. Sac shrinkage serves as a key surrogate marker of procedural success, reflecting favorable remodeling and a lower risk of complications. Sac behavior after EVAR is determined by the interplay between intrasac pressure and aneurysm wall integrity. Although pressure reduction is essential, wall degeneration and stiffness critically influence remodeling outcomes. The presence of simple renal cysts, a localized manifestation of systemic connective tissue degeneration, has been associated with impaired sac shrinkage and may indicate unfavorable remodeling. Arterial stiffness, assessed by pulse wave velocity, also correlates with sac behavior: lower stiffness favors shrinkage, whereas higher stiffness is linked to expansion or lack of shrinkage. These findings suggest that sac remodeling is a multifactorial process not solely dependent on flow exclusion. Future prospective studies integrating artificial intelligence, vascular remodeling inhibition, and stent graft innovation are warranted to refine patient-specific risk stratification, guide individualized surveillance, and promote sac shrinkage, thereby improving outcomes after EVAR.
Farahi K, Abi Akar R, Pitocco F
… +2 more, Achouh P, Poitier B
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41692464
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Interrupted aortic arch (IAA) is a rare congenital anomaly usually diagnosed in infancy and associated with intracardiac defects, making survival into adulthood without repair exceptional. We report the case of a 62-year...Interrupted aortic arch (IAA) is a rare congenital anomaly usually diagnosed in infancy and associated with intracardiac defects, making survival into adulthood without repair exceptional. We report the case of a 62-year-old woman with longstanding hypertension who presented with progressive dyspnea and dysphagia. Computed tomography angiography identified a type B IAA associated with a giant 96-mm aneurysm arising from an aberrant retroesophageal artery connecting the right subclavian artery to the descending thoracic aorta, without associated cardiac abnormalities. Surgical management consisted of isolated resection of the aneurysmal segment and placement of a 14-mm Dacron graft, without reconstruction of the aortic arch given the patient's age and stable hypertension. The postoperative course was uneventful, and follow-up imaging showed stable repair with complete symptom resolution. This case highlights the possibility of long-term survival without restoration of normal aortic anatomy, and suggests that a tailored, complication-focused surgical approach may be appropriate in selected adult patients.
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41581904
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Giant cell tumor of bone (GCTB) rarely metastasizes, but pulmonary lesions pose therapeutic challenges. We report a woman in her 30s who developed multiple bilateral lung nodules 3.5 years after distal ulna GCTB resectio...Giant cell tumor of bone (GCTB) rarely metastasizes, but pulmonary lesions pose therapeutic challenges. We report a woman in her 30s who developed multiple bilateral lung nodules 3.5 years after distal ulna GCTB resection and local recurrences. Denosumab 120 mg every 4 weeks was given for 2.5 years, producing shrinkage, calcification, and stability. Staged, palpation-guided thoracoscopic wedge resections (8 left, 5 right) achieved complete macroscopic clearance with negative margins. Histology showed spindle-cell proliferation with woven bone and depletion of giant cells; H3.3 G34W immunostaining confirmed metastatic GCTB. She remains recurrence-free 7 years and 5 months after metastasectomy. Denosumab displayed site-specific surgical implications-unfavorable at the primary bone site due to peritumoral sclerosis, yet advantageous in the lung where it clarifies margins and enables parenchyma-sparing R0 resection. A surgery-forward strategy that uses time-limited denosumab as a bridge to meticulous thoracoscopic metastasectomy may secure durable control in multifocal pulmonary GCTB.
Matsumoto R, Watanabe T, Kinoshita R
… +1 more, Hirooka K
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41565270
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PURPOSE: This study aimed to evaluate sex-based differences in the clinical characteristics, aortic anatomy, surgical strategies, and outcomes of patients undergoing emergency surgery for acute Stanford type A aortic dis...PURPOSE: This study aimed to evaluate sex-based differences in the clinical characteristics, aortic anatomy, surgical strategies, and outcomes of patients undergoing emergency surgery for acute Stanford type A aortic dissection (AAAD). METHODS: We retrospectively analyzed 148 consecutive patients (82 males and 66 females) who underwent surgery for AAAD at a single center. We compared their backgrounds, entry tear locations, operative procedures, and postoperative outcomes. Kaplan-Meier analysis assessed long-term survival and freedom from re-intervention. RESULTS: Female patients were significantly older than male patients, more likely to have ascending aortic entry tears, and more often treated by hemiarch replacement. Male patients underwent total arch replacement more frequently because of arch or distal entry tears and had a higher incidence of iliac artery involvement, indicating more extensive distal dissection. In-hospital mortality, major postoperative complications, long-term survival, and freedom from re-intervention showed no significant sex-based differences. CONCLUSION: In female patients, the predominance of ascending entry tears allows less extensive surgery without compromising outcomes. Therefore, when dissection patterns are suitable, emergent surgery is appropriate even in elderly female patients.
Beyter MB, Dogan E, Tuncer ON
… +5 more, Ergin F, Kayan-Kasikci G, Ulger Z, Levent E, Atay Y
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41548901
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PURPOSE: This study aimed to assess perioperative features, early postoperative outcomes, and mid-term cardiac function in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) und...PURPOSE: This study aimed to assess perioperative features, early postoperative outcomes, and mid-term cardiac function in children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) undergoing surgical repair. METHODS: A retrospective review of 23 patients treated surgically between 2007 and 2023 was conducted. Patients were categorized into infants (<1 year) and older patients (>1 year). Clinical, operative, and echocardiographic data were analyzed, including left ventricular ejection fraction (LVEF) and mitral regurgitation (MR). Follow-up evaluations were performed at 1 and 6 months postoperatively. RESULTS: The median age at surgery was 9 months. Early mortality occurred in 17.4%, with no late deaths during follow-up. Preoperative LVEF was significantly lower in infants than in older patients (p = 0.013). Among 19 survivors, LVEF improved markedly by 1 month and normalized in all patients by 6 months. MR was present in 89.5% preoperatively, with 47.3% showing moderate to severe grades. At 6 months, MR improved in most cases, with only 2 patients exhibiting residual moderate regurgitation and no severe cases. CONCLUSIONS: ALCAPA is a rare but surgically correctable condition. Early surgical intervention leads to significant recovery of ventricular function and regression of MR within the first 6 postoperative months.
Misumi Y, Yoshioka D, Kawamura T
… +7 more, Kawamura A, Yajima S, Saito S, Yamauchi T, Shimamura K, Miyagawa S, Osaka Cardiovascular Surgery Research (OSCAR) study group
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41535019
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PURPOSE: The internal thoracic artery (ITA) has shown increased production of nitric oxide, which has beneficial effects on ventricular remodeling, among conduits of coronary artery bypass grafting (CABG). However, littl...PURPOSE: The internal thoracic artery (ITA) has shown increased production of nitric oxide, which has beneficial effects on ventricular remodeling, among conduits of coronary artery bypass grafting (CABG). However, little is known about the impact of bilateral ITA strategy on postoperative left ventricle (LV) reverse remodeling as compared with single ITA, especially in patients with severely impaired LV function. METHODS: We retrospectively reviewed 126 propensity-matched patients with advanced ischemic cardiomyopathy (ICM) (left ventricular ejection fraction <40%) who underwent isolated multiple CABG utilizing bilateral (BITA group; n = 65) or single (SITA group; n = 61) ITA. The primary endpoint was postoperative reduction in the indexed left ventricular end-systolic volume index (LVESVI). Baseline covariates were adjusted with propensity score-matching. RESULTS: At baseline, there were no intergroup differences in LVESVI (78 vs. 78 ml/m, P = 0.93) and EuroSCORE II score (3.0% vs. 2.8%, P = 0.70). At 6 months post-surgery, the BITA group reduced LVESVI to a greater degree than the SITA group (-33% vs. -17%, P <0.01), resulting in significantly smaller postoperative LVESVI (49 vs. 63 ml/m, P = 0.03). Multivariable analysis showed that CABG with BITA (P = 0.011) was associated with postoperative LV reverse remodeling. CONCLUSION: In patients with ICM undergoing CABG, the in situ BITA strategy was associated with greater reductions in postoperative LV volume.
Suzuki S, Matsubayashi Y, Sato K
… +4 more, Noritake O, Matsui T, Seto K, Sakakura N
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41535015
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PURPOSE: The superior segment (S6) may differ from the basal segments (BSs) in lymphatic spread, affecting surgical strategy and mediastinal lymph node dissection (LND). We aimed to define lymphatic spread patterns and t...PURPOSE: The superior segment (S6) may differ from the basal segments (BSs) in lymphatic spread, affecting surgical strategy and mediastinal lymph node dissection (LND). We aimed to define lymphatic spread patterns and to guide surgical strategy in S6 non-small cell lung cancer (NSCLC). METHODS: We reviewed 375 patients with cT1a-cT1c N0 lower-lobe NSCLC (S6, 168; BS, 207) who underwent segmentectomy or lobectomy (2012-2024). We analyzed nodal metastasis and recurrence by station. RESULTS: Segmentectomy was more frequent in S6 than in BS. pN1 and pN2 incidence was 8.3% and 2.4% in S6 and 4.3% and 6.8% in BS, respectively. In S6, pN2 metastases were single-station with N1, with no inferior mediastinal involvement. S6 nodal recurrences were confined to #4L/#4R and occurred outside the LND field. In BS, skip pN2 was more frequent and nodal recurrences occurred at #7 within the field. CONCLUSION: In clinical stage IA S6 NSCLC, nodal events occurred in the superior mediastinal stations. All pN2 were single-station with N1, and all nodal recurrences occurred after lobe-specific mediastinal LND. Management should follow intraoperative N1 assessment: if negative, S6 segmentectomy without mediastinal LND; if positive, lobectomy with superior mediastinal and subcarinal LND, omitting inferior mediastinal nodes unless specifically suspected.
Tabata K, Nishigawa K, Shimozawa M
… +2 more, Ono S, Kanemura T
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41526256
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PURPOSE: Surgery for Jehovah's Witness patients with Stanford type A aortic dissection (TAAD) carries a high surgical risk, and few reports have examined outcomes in this patient population. This study evaluated perioper...PURPOSE: Surgery for Jehovah's Witness patients with Stanford type A aortic dissection (TAAD) carries a high surgical risk, and few reports have examined outcomes in this patient population. This study evaluated perioperative outcomes of surgery for TAAD in Jehovah's Witness patients. METHODS: Eight Jehovah's Witness patients who underwent surgery for TAAD at our institution between February 2016 and January 2025 were retrospectively reviewed. No patients were receiving antiplatelet or anticoagulant therapy at the time of surgery. Preoperative characteristics, operative data, and postoperative outcomes were assessed. RESULTS: Emergency ascending aortic replacement was performed in 6 patients, while the 2 patients who underwent elective surgery due to a chronic course or thrombosed false lumen received total or partial arch replacement. Both elective cases received preoperative iron supplementation. The median postoperative nadir hemoglobin was 9.2 (interquartile range, 6.8-9.6) g/dL. One patient died, one was transferred to rehabilitation, and 6 patients (75.0%) were discharged home without major complications. CONCLUSIONS: Perioperative outcomes of surgery for TAAD in Jehovah's Witness patients were favorable. Proper surgical timing and preoperative management are essential to achieving satisfactory results. Further investigation with a larger cohort and longer follow-up is warranted.
Umehara T, Tokunaga T, Takumi K
… +3 more, Kamimura G, Aoki M, Ueda K
Ann Thorac Cardiovasc Surg
· 2026 · PMID 41526255
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PURPOSE: Pulmonary vein stump thrombus (PVST) is a relatively common complication after left upper lobectomy that can cause vital organ embolism. We previously found that patients with PVST on postoperative day 7 show ri...PURPOSE: Pulmonary vein stump thrombus (PVST) is a relatively common complication after left upper lobectomy that can cause vital organ embolism. We previously found that patients with PVST on postoperative day 7 show risky hemodynamic features around the pulmonary vein stump on 4-dimensional (4D) flow magnetic resonance imaging (MRI), which may contribute to thrombus development. However, it remains unclear whether such hemodynamics persist later. METHODS: Eleven patients who underwent left upper lobectomy for lung cancer received 4D flow MRI on postoperative day 7 and again after over 3 months. Hemodynamic parameters were used to classify each case as risky or non-risky for PVST. RESULTS: According to a total of 24 examinations in 11 patients, 7 were classified as risky and 17 as non-risky. PVST developed in 6 patients during various postoperative phases, and all PVST cases developed under the risky conditions. Furthermore, PVST did not develop under non-risky conditions, suggesting that our risk assessment is valid as a predictive marker for PVST. CONCLUSION: Our results suggest that late postoperative hemodynamic assessments, as well as early postoperative assessments, are useful for identifying patients at high risk of PVST. A late postoperative hemodynamic assessment may contribute to determining when to discontinue anticoagulants.
Oishi H, Onodera K, Notsuda H
… +7 more, Watanabe T, Watanabe Y, Suzuki T, Niikawa H, Togo T, Kumata S, Okada Y
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41407370
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PURPOSE: Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative to video-assisted thoracoscopic surgery (VATS) for lobectomy in early-stage non-small cell lung cancer (NSCLC). While perioperative and...PURPOSE: Robotic-assisted thoracoscopic surgery (RATS) has emerged as an alternative to video-assisted thoracoscopic surgery (VATS) for lobectomy in early-stage non-small cell lung cancer (NSCLC). While perioperative and oncologic outcomes have been studied, limited data exist on long-term postoperative pulmonary function. This study compared pulmonary function one year after RATS versus VATS lobectomy. METHODS: We retrospectively analyzed 298 patients who underwent lobectomy for early-stage NSCLC between September 2020 and August 2023. After applying exclusion criteria, 186 patients remained: 128 in the VATS group and 58 in the RATS group. Propensity score matching (1:1) yielded 55 matched pairs. Pulmonary function parameters-%predicted forced vital capacity (%FVC), %predicted forced expiratory volume in one second (%FEV1), %predicted peak expiratory flow (%PEF), and %predicted diffusing capacity for carbon monoxide (%DLco)-were evaluated one year postoperatively. RESULTS: No significant differences were observed between groups in any pulmonary function parameters at one year, both before and after matching. Lung function was similarly preserved. CONCLUSIONS: Despite the use of more ports, RATS lobectomy did not result in inferior pulmonary function compared to VATS. Given its higher cost, VATS may remain the more cost-effective standard, although RATS offers a promising platform for future innovation.
Sumitomo S, Toyokawa G, Cong Y
… +3 more, Kubo T, Saigusa H, Sato M
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41407355
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Cowden syndrome (CS) is a rare hereditary disorder caused by a germline variant of the phosphatase and tensin homolog, associated with multiple hamartomatous lesions occurring in various organs. Additionally, although ra...Cowden syndrome (CS) is a rare hereditary disorder caused by a germline variant of the phosphatase and tensin homolog, associated with multiple hamartomatous lesions occurring in various organs. Additionally, although rare, arteriovenous malformations (AVMs) with CS are found in the skin, brain, and spinal cord; however, peribronchial AVMs have not been previously reported. Herein, we report a rare case of a peribronchial AVM in a 30-year-old man with CS who presented with hemoptysis. Computed tomography (CT) revealed an AVM around the left upper bronchus, which was mainly fed by the left bronchial artery and drained into the left inferior pulmonary vein. Under video-assisted thoracic surgery, ligation of the feeding and draining vessels was performed. The AVM remarkably decreased in size one month after the surgery. This case highlights the need for whole-body contrast-enhanced CT to screen for AVMs and the importance of identifying feeding and draining vessels for optimal treatment methods.
Niwa W, Takami Y, Maekawa A
… +6 more, Yamana K, Akita K, Amano K, Matsuhashi K, Takagi Y, Abe T
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41371632
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PURPOSE: Cryoprecipitate has been covered by Japanese national health insurance since 2020 for cardiopulmonary bypass (CPB)-induced hypofibrinogenemia. This study evaluated the clinical efficacy of in-house cryoprecipita...PURPOSE: Cryoprecipitate has been covered by Japanese national health insurance since 2020 for cardiopulmonary bypass (CPB)-induced hypofibrinogenemia. This study evaluated the clinical efficacy of in-house cryoprecipitate use in patients undergoing CPB. METHODS: A total of 1357 patients were divided into 2 groups before and after cryoprecipitate introduction in February 2020 (Group A, n = 685; Group B, n = 672). Propensity score matching also compared 205 pairs between transfused patients in Group A (Group A', n = 597) and those receiving cryoprecipitate in Group B (Group B', n = 222). RESULTS: Cryoprecipitate was used in 222 patients (37%) in Group B. While overall transfusion rates did not differ significantly, postoperative red blood cell (20% vs 13%, p <0.01) and platelet concentrate (PC) (35% vs 12%, p <0.01) use were significantly lower in Group B. In the matched cohorts, including ~70% undergoing aortic surgery, postoperative PC use was significantly reduced in Group B' (26% vs 18%, p = 0.04). CONCLUSIONS: In-house cryoprecipitate use was associated with reduced postoperative PC transfusion, particularly in aortic surgery involving prolonged CPB and deep hypothermic circulatory arrest. A cryoprecipitate-centered hemostatic strategy, supplementing multiple coagulation factors beyond fibrinogen, may be effective in complex CPB procedures.
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41354430
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PURPOSE: This study aimed to clarify the importance of C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index scores in predicting coronary artery bypass grafting (CABG) outcomes. METHODS: Patients were divided into q...PURPOSE: This study aimed to clarify the importance of C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index scores in predicting coronary artery bypass grafting (CABG) outcomes. METHODS: Patients were divided into quartiles (Q1-Q4) based on their preoperative CALLY index values. Preoperative demographic data, laboratory parameters, operative, and postoperative outcomes were recorded. RESULTS: The CALLY index, a composite marker incorporating CRP, albumin, and lymphocyte levels, increased progressively from Q1 to Q4, showing a statistically significant upward trend (p = 0.001). Operative and postoperative data revealed that intensive care unit (ICU) stay and hospital stay were significantly shorter in Q3 and Q4 compared to Q1 and Q2 groups (p = 0.001 for both). Furthermore, major adverse cardiac and cerebrovascular events (MACCE) rates were significantly reduced in Q3 and Q4 groups (p = 0.001), reinforcing the prognostic utility of the CALLY index. Two-year mortality also demonstrated a statistically significant reduction in the higher quartiles (p = 0.039), while in-hospital mortality did not differ significantly (p = 0.330). Operation time, cross-clamp time, and requirements for inotropic support were similar across all groups (p >0.05). The receiver-operating characteristic curve analysis demonstrated the discriminative ability of the CALLY index in predicting 2-year mortality. Area under the curve was 0.675 (95% confidence interval: 0.607-0.743), indicating moderate predictive performance. CONCLUSION: This study revealed that patients with higher CALLY index scores who underwent CABG had significantly shorter hospital and ICU stays. Moreover, MACCE ratio and mortality rate in the first 2 years after CABG were significantly lower in patients with higher CALLY scores.
González-Ortiz A, Manzur-Sandoval D, Arias-Godínez JA
… +4 more, Posada-Martínez EL, García-Cruz E, Gopar-Nieto R, Rojas-Velasco G
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41338981
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PURPOSE: Cardiovascular surgery entails considerable risk because of its complexity and the frequency of perioperative complications. The right ventricular Tei index (RV-TI) provides an integrated measure of ventricular...PURPOSE: Cardiovascular surgery entails considerable risk because of its complexity and the frequency of perioperative complications. The right ventricular Tei index (RV-TI) provides an integrated measure of ventricular performance, encompassing systolic and diastolic function. Although not widely applied in this setting, its role as a predictor of outcomes is promising. This study evaluated the utility of RV-TI in predicting postoperative complications in patients undergoing diverse cardiovascular surgeries, emphasizing its value for surgical risk stratification and patient management. METHODS: A single-center, cross-sectional study was conducted at the National Institute of Cardiology Ignacio Chávez, Mexico City, including 195 adults who underwent cardiac surgery between June 2022 and April 2023. RV-TI was obtained by transthoracic tissue Doppler, using 0.53 as the abnormal cutoff. One hundred and forty-nine patients had normal RV-TI values, while 46 were classified as abnormal. RESULTS: Abnormal RV-TI correlated with diabetes mellitus, advanced age, and vasoplegic syndrome. These patients experienced higher in-hospital mortality and more severe complications, including the need for renal replacement therapy, pneumonia, delirium, and greater transfusion requirements. CONCLUSION: RV-TI appears to be a valuable adjunct in preoperative risk assessment for cardiac surgery. Its incorporation into clinical practice could improve patient selection and decision-making, contributing to better surgical outcomes.
Hirano A, Hoashi T, Yoshiba S
… +4 more, Hosoda R, Fuchigami Y, Iijima Y, Suzuki T
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41297944
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PURPOSE: The study investigated the importance of left ventricular volume assessment before primary repair in asymptomatic tetralogy of Fallot (TOF) patients. METHODS: Forty-two asymptomatic TOF patients who underwent pr...PURPOSE: The study investigated the importance of left ventricular volume assessment before primary repair in asymptomatic tetralogy of Fallot (TOF) patients. METHODS: Forty-two asymptomatic TOF patients who underwent preoperative cardiac catheterization at a median age of 4.7 months interquartile range [IQR], 4.0-5.3) between 2013 and 2023 were enrolled. Asymptomatic TOF was defined as room air oxygen saturation ≥85% without duct-dependent circulation. Left ventricular end-diastolic volume (LVEDV) as a percentage of predicted normal (LVEDV%N) was measured using the single-plane area-length method. Correlation with echocardiographic parameters was assessed. RESULTS: The median LVEDV%N was 107% (IQR, 87.5-139.5). Five patients (11.6%) had LVEDV%N ≤80%. One patient with the lowest LVEDV%N (62%) underwent a modified Blalock-Taussig shunt instead of primary repair. The remaining four patients had a small pulmonary valve annulus (PVA) (Z-score -4.2 to -6.6) and underwent transannular patch repair. Seven additional patients underwent transannular patch repair due to total conal ventricular septal defect (n = 5) or patent ductus arteriosus with small PVA (n = 2). LVEDV%N showed a weak correlation with 1-month echocardiographic parameters (R = 0.27-0.347). CONCLUSIONS: Left ventricular volume assessment prior to primary repair is essential in asymptomatic TOF patients. There were cases with small LV for whom primary repair was deferred, or whose PVA was also small; therefore, transannular patch repair was selected.
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41285481
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PURPOSE: The objective of this study was to examine the correlation between normalized lactate load (NLL) and the 30-day mortality rate in patients with acute type A aortic dissection (AAAD) patients, as well as its pred...PURPOSE: The objective of this study was to examine the correlation between normalized lactate load (NLL) and the 30-day mortality rate in patients with acute type A aortic dissection (AAAD) patients, as well as its predictive value for prognosis. METHODS: Data were obtained from the Medical Information Mart for Intensive Care-IV database. The Cox model and restricted cubic spline (RCS) were used to assess the relationship between NLL and 30-day mortality in AAAD patients. Receiver-operating characteristic curves were plotted to evaluate the predictive value of NLL for 7-, 14-, and 30-day mortality. Kaplan-Meier (K-M) curves were used to compare 30-day survival across different risk levels. RESULTS: Among 150 AAAD patients, NLL was recognized as a risk factor for 30-day mortality (hazard ratio = 1.83, 95% confidence interval: 1.29-2.58; P <0.001). The RCS analysis showed a linear relationship. NLL showed areas under the curve of 0.781, 0.781, and 0.730 for predicting 7-, 14-, and 30-day mortality, respectively. K-M curves revealed a significant difference in 30-day survival between the high- and low-risk groups (log-rank P = 0.042). CONCLUSION: NLL is a risk factor for 30-day mortality in AAAD patients and shows good predictive value. This study supports NLL as an early-warning biomarker for identifying high-risk AAAD patients.
Kurazumi H, Suzuki R, Nakashima T
… +6 more, Nawata R, Yokoyama T, Matsunaga K, Shirasawa B, Mikamo A, Hamano K
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41242747
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PURPOSE: We aimed to compare the midterm outcomes of the no-touch saphenous vein graft (NT-SVG) as a second conduit with those of other graft types. METHODS: We retrospectively reviewed 549 consecutive patients who under...PURPOSE: We aimed to compare the midterm outcomes of the no-touch saphenous vein graft (NT-SVG) as a second conduit with those of other graft types. METHODS: We retrospectively reviewed 549 consecutive patients who underwent multivessel isolated coronary artery bypass grafting (CABG) with ≥2 distal anastomoses between 2002 and 2024. Five conduit groups for non-LAD grafting were analyzed: in situ internal thoracic artery (ITA), free ITA, conventional saphenous vein graft (cSVG), NT-SVG, and right gastroepiploic artery (rGEA). We analyzed conduit-specific patency and propensity score-matched patency between cSVG and NT-SVG. RESULTS: The mean age was 68.6 ± 9.5 years, and 74% were men. Off-pump CABG was performed in 60.5% of cases, with a mean of 3.3 ± 0.9 distal anastomoses. Hospital mortality was 1.5%. Notably, the 5- and 10-year survival rates were 85.9% and 74.1%, respectively. Among 794 non-LAD grafts, the NT-SVG demonstrated a 5-year patency of 96.4%, which was significantly higher than that of cSVG (89.5%, p = 0.05) and rGEA (87.2%, p = 0.04), and equivalent to in situ ITA (94.4%) and free ITA (95.0%). The propensity score-matched analysis further demonstrated superior graft patency with the NT-SVG. CONCLUSIONS: The NT-SVG achieves a 5-year patency comparable to that of ITA grafts and superior to that of cSVG and rGEA, suggesting its potential as a promising option for non-LAD revascularization, pending further validation.
Sugiyama K, Orimoto Y, Kiryu K
… +5 more, Watanuki H, Tochii M, Kodama A, Ishibashi H, Matsuyama K
Ann Thorac Cardiovasc Surg
· 2025 · PMID 41192872
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PURPOSE: We evaluated patients with acute type A aortic dissection (ATAAD) who were suffering from a collapsed true lumen in the descending aorta. METHODS: Among 146 patients with ATAAD who underwent surgery, 6 (4.1%) wi...PURPOSE: We evaluated patients with acute type A aortic dissection (ATAAD) who were suffering from a collapsed true lumen in the descending aorta. METHODS: Among 146 patients with ATAAD who underwent surgery, 6 (4.1%) with a collapsed true lumen of <10% of the total area at the level of the diaphragmatic transition in the descending aorta were detected. Preoperative and postoperative computed tomography images, preoperative characteristics, surgical techniques, and major adverse aortic events were assessed. RESULTS: Patients with a collapsed true lumen tended to have spinal cord or peripheral malperfusion preoperatively. In two patients, because intraoperative transesophageal echocardiography showed no improvement in the collapsed true lumen after femoral artery cannulation, ascending aortic cannulation was added. Entry resection was achieved in five patients; however, three of them needed thoracic endovascular aortic repair (TEVAR). All six patients survived for one year, and after staged TEVAR, aortic remodeling was achieved. CONCLUSION: Patients with a collapsed true lumen in the descending aorta tended to develop lower body malperfusion, and usual cardiopulmonary bypass may be ineffective. Even if entry resection was achieved, aortic remodeling could not be obtained in some cases; therefore, staged repair with TEVAR can solve this issue.