Xiao B, Li M, Liu L
… +21 more, Shi J, Zhang H, Meng X, Chen L, Zhang X, Ma L, Dong N, Shang X, Yang J, Liu Y, Wang P, Xiao Y, Pan X, Wang J, Zhu D, Guo H, Liu J, Wang D, Xu Z, Song Z, Guo Y
OBJECTIVES: We evaluated the safety and efficacy of transcatheter aortic valve replacement (TAVR) up to 1-year follow-up for patients with severe pure aortic valve regurgitation (AR) or mixed severe aortic valve regurgit...OBJECTIVES: We evaluated the safety and efficacy of transcatheter aortic valve replacement (TAVR) up to 1-year follow-up for patients with severe pure aortic valve regurgitation (AR) or mixed severe aortic valve regurgitation and aortic valve stenosis (AR+AS) using a novel self-expandable bioprosthesis. METHODS: From 2021 and 2022, transapical TAVR using Ken-Valve (Jenscare Biotechnology Ltd, Ningbo, China) was performed in 142 symptomatic patients (mean age 70.3 ± 5.5 years) with pure AR (n = 109) or AR+AS (n = 33) across 15 hospitals in China. All patients were considered high-risk or inoperable after heart team evaluation, with a mean Society of Thoracic Surgeons score of 5.9 ± 3.0%, and 99.3% in NHYA class III/IV. Procedural characteristic, echocardiography data and clinical outcomes up to 1 year were analyzed. RESULTS: Technical success was achieved in 97.2% of cases. Two (1.4%) patients were converted to open surgery due to unsuitable anatomy or valve migration during the procedure. New permanent pacemakers were implanted in 20(14.1%) patients. Three (2.1%) patients had stroke, and 3(2.1%) patients had major bleeding. 30-day mortality was 2.1%, and all-cause mortality at 1-year was 5.6% (8/142). Mean aortic valve gradient and effective orifice area (EOA) at 1 year postoperatively were 9.4 ± 5.4 mmHg and 1.9 ± 0.6cm2, respectively. Significant improvement in clinical symptoms, positive left ventricular remodelling, and quality-of-life were observed up to 1-year. There was no significant difference in mortality, complications, and haemodynamic performance between patients with pure AR and AR+AS at 1-year. CONCLUSIONS: TAVR using the Ken-Valve was safe and effective in patients with pure AR or mixed AR+AS in mid-term.Transapical transcatheter valve implantation for aortic regurgitation: a multicentre, prospective trial.
Aerts L, Kawczynski MJ, Verberkmoes NJ
… +16 more, Van Brakel T, Luermans JGLM, Heuts S, Verbeek E, Cocchieri R, Salzberg SP, Gruwez H, Gutermann H, Pison L, Elesin D, Bogachev-Prokophiev A, Shelest O, Troitskiy A, Khabazov R, Zotov A, Maesen B
Eur J Cardiothorac Surg
· 2026 May · PMID 42046233
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OBJECTIVES: This study aimed to evaluate the long-term efficacy and safety of isolated and hybrid thoracoscopic atrial fibrillation (AF) ablation using a bipolar irrigated radiofrequency clamp in a multicentre registry....OBJECTIVES: This study aimed to evaluate the long-term efficacy and safety of isolated and hybrid thoracoscopic atrial fibrillation (AF) ablation using a bipolar irrigated radiofrequency clamp in a multicentre registry. METHODS: A retrospective multicentre registry of patients undergoing AF ablation using the bipolar clamp was conducted over the past 13 years (2010-2023). The primary efficacy outcome was freedom of atrial tachyarrhythmias (ATAs), with and without the use of Class I/III antiarrhythmic drugs (AADs). Antiarrhythmic drug use during follow-up was not uniformly documented across centres. The primary safety outcome was the rate of periprocedural complications. RESULTS: The cohort of 678 patients consisted of a minority of female patients (17.4%), with most patients having longstanding persistent AF (LSPAF) (66.7%), a mean duration of 61 months of AF duration and 33.3% had undergone prior catheter ablation. Freedom from ATA while allowing Class I/III AAD use was 82.3%, 71.5%, and 52.4% at 1, 3, and 5 years, respectively. Freedom from ATA off Class I/III AAD declined from 71.7% at 1 year to 44.2% at 5 years, underscoring the progressive nature of AF and the need for long-term rhythm strategies. Women presented with a more advanced cardiovascular risk profile than men, including older age (60.3 vs 57.3 years), higher CHA2DS2-VA-scores, and more comorbidities. Despite these differences, there were no significant sex-based differences in long-term ATA freedom. There were no significant unadjusted differences in long-term ATA freedom between paroxysmal AF (PAF) and non-PAF. Major complication rate was low. CONCLUSIONS: Isolated and hybrid thoracoscopic AF ablation using the Gemini Clamp demonstrated favourable outcomes with a low complication rate. However, variability in ATA detection methods among centres may have influenced the primary outcome and should be considered when interpreting long-term efficacy results. CLINICAL TRIAL REGISTRY NUMBER: METC-number 2022-3561.
OBJECTIVES: Functional tricuspid regurgitation in the setting of right ventricular (RV) remodelling remains one of the least standardized challenges in valvular surgery. Surgeons are often confronted with complex anatomy...OBJECTIVES: Functional tricuspid regurgitation in the setting of right ventricular (RV) remodelling remains one of the least standardized challenges in valvular surgery. Surgeons are often confronted with complex anatomy and limited formal training in advanced tricuspid reconstruction. This review seeks to consolidate the evolving surgical knowledge base and provide a structured reference for the full spectrum of repair strategies beyond annuloplasty. METHODS: A targeted literature review was performed to identify key reports on surgical tricuspid valve (TV) interventions. These were synthesized narratively to outline the principles, indications, and anatomical rationale for current techniques, including edge-to-edge repair, leaflet augmentation, papillary muscle relocation, approximation, suspension, bundling, and annular repositioning. RESULTS: Collectively, these approaches form a growing surgical armamentarium aimed at restoring normal leaflet geometry and subvalvular alignment in the setting of RV dilatation. Understanding the interplay between annular, leaflet, and subvalvular distortion is essential for achieving functional and durable repair that can rival evolving transcatheter options. CONCLUSIONS: This review unifies previously scattered concepts into a practical framework for anatomy-guided tricuspid reconstruction, offering surgeons an accessible reference for managing complex, RV-dependent TV disease.
OBJECTIVES: To develop a novel porcine lung model with pulmonary artery pulsation for anatomic lung resection training that overcomes the limitations of traditional excised models, particularly pulmonary oedema caused by...OBJECTIVES: To develop a novel porcine lung model with pulmonary artery pulsation for anatomic lung resection training that overcomes the limitations of traditional excised models, particularly pulmonary oedema caused by simulated perfusion. METHODS: Porcine heart-lung complexes were connected to a custom-made pulse generator to induce physiologic pulsation using pseudoblood. To reduce the pulmonary oedema, the pulmonary arteries were prefilled with microbeads to prevent parenchymal perfusion. Oedema prevention was assessed by measurement of lung weight over 20 min of pulsation. Eight surgical trainees performed lobectomy and vascular repair procedures using the model. Operative time and haemostatic proficiency were compared between the first and second attempts. Training effectiveness was evaluated via a questionnaire. RESULTS: Microbead infusion significantly reduced pulmonary oedema, with a mean weight gain of 16.4 (7.0 g) versus 457.0 (72.3 g) in the controls (P = .027). All 8 trainees completed the training. Surgical time for lobectomy decreased significantly from 39 min 17 s (6 min 20 s) to 32 min 52 s (7 min 33 s) (P = .012), with all trainees showing improvement. In the questionnaire, 75% of the trainees rated the vascular manipulation as realistic, and all rated the training as beneficial. CONCLUSIONS: This pulsatile porcine lung model was evaluated as a pilot study involving 8 trainees, and the findings should be interpreted accordingly. The model provides a reproducible platform for simulating pulmonary vessel dissection and haemostasis under pulsatile conditions.
Pabst von Ohain J, Arnold L, Jacob KA
… +22 more, Barron DJ, Drury NE, Farooqi M, Hraska V, Asfour B, Vergnat M, Arkhipov A, Nichay NR, Belli E, Abdullah J, Mattila IP, Sairanen HI, Kostolny M, Kalfa D, Prêtre R, Rosser B, Tlaskal T, Yemets I, Romanyuk AN, Heinisch PP, Kadner A, Hörer J
OBJECTIVES: Patients with congenitally corrected transposition of the great arteries (ccTGA) may undergo physiologic repair, leaving the right ventricle systemic, or anatomic repair, correcting the double discordance. We...OBJECTIVES: Patients with congenitally corrected transposition of the great arteries (ccTGA) may undergo physiologic repair, leaving the right ventricle systemic, or anatomic repair, correcting the double discordance. We compared both strategies in an international study using propensity-score matching. METHODS: Patients from 12 European centres, aged <18 years, who underwent either physiologic or anatomic repair between 1990 and 2010 were included (n = 266). Patients were matched by optimal pair matching on ventricular septal defect, subpulmonary left ventricular outflow tract obstruction, ≥mild systemic tricuspid valve regurgitation, age, and gender, resulting in a 1:1 matched cohort of 162 patients. The resulting groups were compared for long-term survival, reoperations, and function of the systemic ventricle and atrioventricular valve. RESULTS: Transplant-free survival at 10 and 15 years was 87 ± 4%, 95% confidence interval (CI) [79%-95%] and 80 ± 6% [68%-93%] for the physiologic group and 85 ± 5% [78%-96%] and 85 ± 5% [78%-96%] for the anatomic group (P = .568). Freedom from cardiac reoperation at 10 and 15 years was 73 ± 6% [62%-85%] and 56 ± 8% [41%-75%] for the physiologic group and 61 ± 8% [47%-76%] and 36 ± 9% [26%-62%] for the anatomic group (P = .279). Tricuspid valve regurgitation at final follow-up was present in 57% (27/47) vs 17% (12/72), respectively (P < .001). CONCLUSIONS: Long-term survival and reoperation rates are similar in comparable patients following physiologic and anatomic repair of ccTGA in childhood. Tricuspid valve function may deteriorate when left in the systemic position following physiologic repair. In contrast, patients with tricuspid regurgitation may benefit from anatomic repair, with improved function in the subpulmonary position.
Engelhardt S, Kostiuchik G, Bezak B
… +11 more, Chacko J, Daeter E, Fallouh H, Grieshaber P, Hussein N, Meyer A, Quattroni P, Romano G, Sadeghi AH, Hazekamp M, Beyersdorf F
Myagmardorj R, Fortuni F, Mantegazza V
… +14 more, van Wijngaarden AL, Wu HW, Palmen M, Pepi M, Fusini L, Muratori M, Essayagh B, Tribouilloy C, Tourneau TL, Bohbot Y, Michelena HI, Enriquez-Sarano M, Bax JJ, Marsan NA
Eur J Cardiothorac Surg
· 2026 May · PMID 41967857
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OBJECTIVES: The progression of extra-mitral valve (MV) cardiac damage in patients with primary mitral regurgitation (MR) following surgical repair has not been described. We aimed to investigate the evolution of extra-MV...OBJECTIVES: The progression of extra-mitral valve (MV) cardiac damage in patients with primary mitral regurgitation (MR) following surgical repair has not been described. We aimed to investigate the evolution of extra-MV cardiac damage after MV repair and to assess its prognostic significance. METHODS: Patients with severe primary MR undergoing surgical repair at 5 referral centres were included when echocardiographic follow-up assessment was available. Based on echocardiographic parameters at baseline and at a median follow-up of 7 (interquartile range [IQR] 4-11) months after MV repair, patients were hierarchically classified as follows: stage 0: no cardiac damage; stage 1: left ventricular dilatation and/or dysfunction; stage 2: left atrial dilatation and/or atrial fibrillation; stage 3: pulmonary hypertension and/or significant tricuspid regurgitation. The primary outcome was all-cause mortality. RESULTS: A total of 764 patients (mean age 62 ± 13 years, 70% men) were included. Compared to baseline, 43% improved at least 1 stage, 49% remained unchanged, and 8% worsened at least 1 stage during follow-up after MV repair. At a median follow-up of 91 months after MV repair, 94 patients (12%) died. By multivariate Cox regression analysis, after adjusting for potential confounders, extra-MV cardiac damage staging at follow-up (HR per-1-stage-increase = 1.571; P = .009) and cardiac damage evolution (improved group, HR = 0.467; P = .034; worsened group, HR = 2.481, P = .037) were independently associated with all-cause mortality and had incremental prognostic value over preprocedural assessment. CONCLUSIONS: Extra-MV cardiac damage improves significantly after MV repair, and its evolution is independently associated with all-cause mortality, suggesting the importance of comparative echocardiographic assessment following MV repair to improve risk stratification.
Pooth JS, Böhmerle T, Krawczyk K
… +12 more, Schleicher E, Günther A, Ayekoi A, Bork M, Brixius SJ, Czerny M, Fischer M, Pernice K, Schäfer R, Trummer G, Vetter L, Beyersdorf F
OBJECTIVES: Cardiac surgery perturbs oxidative metabolism, increasing reactive oxygen species (ROS) and reduces various endogenous antioxidants. Yet, most clinical studies rely on indirect oxidative stress markers. We as...OBJECTIVES: Cardiac surgery perturbs oxidative metabolism, increasing reactive oxygen species (ROS) and reduces various endogenous antioxidants. Yet, most clinical studies rely on indirect oxidative stress markers. We assessed whether direct perioperative ROS measurement is feasible and whether vitamin C supplementation is associated with altered ROS dynamics. METHODS: We quantified highly reactive oxidants in venous blood of cardiac surgery patients (n=37) and healthy controls (N=38) using electron paramagnetic resonance (EPR) spectroscopy with X-band EMX-nano spectrometer. Patients were sampled preoperatively (T1), at the end of surgery (T2), on postoperative day (POD) 1 (T3), and POD 7 (T4). Serum zinc, selenium, vitamins A/C/E, and coenzyme Q10 were measured by standardized laboratory methods. Patients were grouped by perioperative intravenous vitamin C supplementation (C+, n = 22; C-, n = 15). Clinical variables were extracted from medical records. RESULTS: Patients had higher preoperative ROS than controls (5.40 ± 2.94 vs 1.49 ± 0.89 µM; p < 0.001) and reduced antioxidant reserves, with 23-47% showing subnormal zinc, selenium, or vitamin C. Zinc, selenium, vitamin A, and coenzyme Q10 declined further during and after surgery. ROS were consistently lower in C+ than C- with greatest difference at T2 (p = 0.054) and significance at T3 (p = 0.027). Serum vitamin C inversely correlated with ROS (r = -0.47; p < 0.00001). CONCLUSIONS: Perioperative ROS measurement by EPR can be performed in routine clinical practice. Cardiac surgery patients have elevated preoperative oxidative burden that worsens perioperatively. Vitamin C supplementation is associated with lower perioperative ROS, supporting targeted perioperative redox interventions.
Vad R, Gosvig K, Beetham R
… +3 more, Hansson NH, Whitlock R, Riber LPS
Eur J Cardiothorac Surg
· 2026 May · PMID 41965066
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OBJECTIVES: Surgical left atrial appendage closure (LAAC) is recommended as a concomitant procedure during cardiac surgery in patients with atrial fibrillation to reduce stroke risk, but the methods and criteria used to...OBJECTIVES: Surgical left atrial appendage closure (LAAC) is recommended as a concomitant procedure during cardiac surgery in patients with atrial fibrillation to reduce stroke risk, but the methods and criteria used to evaluate procedural success remain poorly standardized. This systematic review aims to identify and describe the imaging modalities, evaluation criteria, and validation methods used to assess the success of surgical LAAC. METHODS: A systematic literature search was conducted in Embase, MEDLINE, and the Cochrane Library. Clinical studies reporting intraoperative or postoperative evaluation of surgical LAAC were included. Data were extracted on imaging modality, timing of assessment, criteria for procedural success, measurement techniques, validation efforts, and reported success rates. RESULTS: Eighty studies comprising 7517 patients and 10 375 imaging examinations were included. Transesophageal echocardiography was the most frequently used imaging modality (83%), primarily for intraoperative assessment, while cardiac computed tomography was used in 44% of studies for postoperative evaluation. Seventeen different definitions of procedural success were identified. The most commonly applied definitions were absence of persistent flow between the left atrium and LAA and a residual stump length <10 mm. The overall procedural success rate across all modalities, timings, and criteria was 92.8%. Success rates were highest intraoperatively (96.8%) and declined with increasing postoperative time. CONCLUSIONS: There is substantial heterogeneity in the evaluation of procedural success following surgical LAAC. The lack of standardized imaging protocols and success definitions limits comparability across studies and interpretation of reported clinical outcomes. Establishing uniform evaluation criteria is essential to improve reproducibility and to clarify the relationship between technical success and clinical benefit. PROSPERO REGISTRATION NUMBER: Prospective Register of Systematic Reviews in Health and Social Care (PROSPERO) registration number: CRD42024617540.
OBJECTIVES: Proximal anastomotic new entry tear (PANE) after surgical repair of acute type A aortic dissection (ATAAD) remains poorly characterized. This study aimed to determine the incidence, anatomical distribution, p...OBJECTIVES: Proximal anastomotic new entry tear (PANE) after surgical repair of acute type A aortic dissection (ATAAD) remains poorly characterized. This study aimed to determine the incidence, anatomical distribution, perioperative risk factors, and long-term impact of PANE. METHODS: We retrospectively analysed 532 consecutive patients who underwent open aortic repair for ATAAD at our institution between 2003 and 2023. Patients without postoperative contrast-enhanced computed tomography (CT) or those who underwent root procedures were excluded. PANE was defined as true-false lumen communication or pseudoaneurysm formation at the proximal anastomosis on CT. Risk factors were assessed using multivariable logistic regression. Long-term outcomes were evaluated using Kaplan-Meier and Fine-Gray competing risk analyses. RESULTS: The final study cohort included 425 patients; PANE occurred in 50 (11.8%), predominantly at the noncoronary sinus (70% isolated, 88% including adjacent sinuses) and colocalized with preoperative dissection sites in 96% of cases. Independent risk factors were preoperative severe aortic regurgitation (OR 3.69, 95% CI 1.23-11.1, P = .020) and surgery by less experienced surgeons (OR 3.75, 95% CI 1.53-9.23, P = .004), whereas biological glue use was protective (OR 0.37, 95% CI 0.19-0.70, P = .002). Long-term survival was not significantly different between groups (P = .086). PANE significantly increased proximal reoperation risk (10-year cumulative incidence 14.2% vs 2.2%; subdistribution HR 8.39, 95% CI 3.35-21.0, P < .001). CONCLUSIONS: PANE affected 12% of ATAAD repairs and significantly increased reoperation risk without affecting survival. Prevention may require experienced surgical teams and optimized anastomotic techniques. All patients warrant early postoperative CT imaging to aid identification and guide surveillance strategies. CLINICAL REGISTRATION NUMBER: 4667.
Benli O, Avşar MK, Şen A
… +3 more, Önsel İÖ, Kırat B, Zeybek C
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41934620
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OBJECTIVES: To report early and mid-term outcomes after extracardiac total cavopulmonary connection (EC-TCPC) and to evaluate prespecified subgroup comparisons, including calendar-time era effects (Era I vs Era II), sele...OBJECTIVES: To report early and mid-term outcomes after extracardiac total cavopulmonary connection (EC-TCPC) and to evaluate prespecified subgroup comparisons, including calendar-time era effects (Era I vs Era II), selective fenestration, conduit-size categories, and late-era computational fluid dynamics (CFD)-guided conduit sizing. METHODS: This multicentre retrospective cohort study included 788 patients who underwent EC-TCPC between 2009 and 2025. Patients were prespecified into Era I (2009-2016) and Era II (2017-2025) for calendar-time comparisons reflecting evolving pathway-based management; the CFD-guided subcohort was restricted to late-era patients. Survival and event-related outcomes were analysed using Kaplan-Meier, competing-risk methods, and multivariable regression models. RESULTS: Early mortality was 2.4%. During a median follow-up of 8.2 years, overall survival was 97.2% at 1 year, 95.0% at 5 years, and 92.5% at 10 years. Freedom from major adverse events (MAEs) was 95.6%, 84.3%, and 75.3% at the same time points; the 10-year cumulative incidence of thromboembolism was 6.8% and of MAEs was 23.6%. In the prespecified era comparison, Era II was associated with shorter pleural drainage duration and lower rates of prolonged pleural effusion. Fenestrated patients showed higher event rates, consistent with confounding by indication. In Era II, CFD-guided conduit sizing was associated with improved early postoperative haemodynamics but did not independently reduce mid-term clinical events after adjustment. CONCLUSIONS: A physiology-driven extracardiac Fontan strategy provides low early mortality and preserved mid-term survival. Selective fenestration and geometry-aware conduit sizing support individualized surgical planning, whereas CFD-guided optimization should be regarded as a decision-support tool rather than a causal determinant of outcome.