Gaal J, Diaz-Gil D, von Mueffling A
… +10 more, Zajac C, Weixler V, Lee U, Caracioni AA, Gierlinger G, Photiadis J, Mayer JE, Emani SM, Del Nido PJ, Friehs I
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41934096
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OBJECTIVES: Patients with pulmonary atresia/critical pulmonary stenosis with intact ventricular septum (PA/cPS-IVS) show fibrous subendocardial tissue of unclear origin accompanied by right ventricular (RV) hypoplasia. W...OBJECTIVES: Patients with pulmonary atresia/critical pulmonary stenosis with intact ventricular septum (PA/cPS-IVS) show fibrous subendocardial tissue of unclear origin accompanied by right ventricular (RV) hypoplasia. While in hypoplastic left heart syndrome, it is known that flow-induced endothelial-to-mesenchymal transition (EndMT) of endocardial endothelial cells (EECs) is the source of this fibrous tissue, it remains unclear whether similar mechanisms exist in PA/cPS-IVS. METHODS: We analysed 13 PA/cPS-IVS patients who underwent staged ventricular rehabilitation surgery aimed at preserving RV function between March 2021 and July 2025 at Boston Children's Hospital. Resected tissue was examined for the degree of fibrosis and elastin and the presence of active EndMT by histology, immunohistochemistry, and flow cytometry. To mimic human disease conditions, isolated EECs were exposed to pathological flow and compared with physiological flow conditions. RESULTS: Flow disturbances across the pulmonary and/or tricuspid valves were present in all patients. Resected RV tissue revealed an active subendocardial fibroelastic remodelling process, infiltrating into the underlying myocardium. Patients showed RV diastolic dysfunction, as evidenced by elevated filling pressures, suggesting a pathophysiological role of fibroelastic remodelling of the endocardium. Mimicking the human disease, exposure of isolated EECs to pathological flow conditions induced loss of endothelial characteristics and transition towards a mesenchymal phenotype through EndMT. CONCLUSIONS: In PA/cPS-IVS patients, restrictive RV physiology and diastolic dysfunction are likely driven by infiltrative fibroelastic remodelling caused by localized fibrogenic activation of EECs through EndMT in response to flow disturbances from valvular defects. Fibrogenic pathway activation may represent a promising therapeutic target in PA/cPS-IVS.
OBJECTIVES: The role of adjuvant therapy in ypT0-2N0M0 oesophageal squamous cell carcinoma (OSCC) remains controversial. This study aimed to assess the impact of adjuvant therapy on overall survival (OS) and disease-free...OBJECTIVES: The role of adjuvant therapy in ypT0-2N0M0 oesophageal squamous cell carcinoma (OSCC) remains controversial. This study aimed to assess the impact of adjuvant therapy on overall survival (OS) and disease-free survival (DFS) and to develop prognostic nomogram models. METHODS: Patients with ypT0-2N0M0 followed by radical oesophagectomy between 2011 and 2024 were reviewed. Propensity score matching (PSM) was applied to adjust for baseline imbalances between treatment groups. OS and DFS were estimated using the Kaplan-Meier method. Prognostic factors were evaluated using the Cox proportional hazards model, and nomogram models were developed. RESULTS: A total of 363 patients were enrolled in the study, of whom 67 received adjuvant therapy. Patients who received adjuvant therapy had significantly poorer OS and DFS compared with those who did not, both before and after PSM (P < .05). Multivariate analyses identified adjuvant therapy as an independent adverse prognostic factor for OS and DFS (P < .05). The nomogram demonstrated good discrimination for OS, with time-dependent areas under the receiver operating characteristic curve (AUCs) of 0.729 (95% CI, 0.623-0.835) and 0.716 (95% CI, 0.642-0.790) at 1 and 3 years, respectively, and acceptable discrimination for DFS, with corresponding AUCs of 0.673 (95% CI, 0.596-0.751) and 0.659 (95% CI, 0.589-0.728). CONCLUSIONS: In patients with ypT0-2N0M0 OSCC, adjuvant therapy may not be associated with improved OS or DFS. The developed nomogram models demonstrated good performance in predicting individualized OS and DFS.
OBJECTIVES: Minimally invasive cardiac surgery (MICS) offers significant advantages over conventional sternotomy, including reduced trauma and faster recovery. Preoperative planning is crucial, with computed tomography (...OBJECTIVES: Minimally invasive cardiac surgery (MICS) offers significant advantages over conventional sternotomy, including reduced trauma and faster recovery. Preoperative planning is crucial, with computed tomography (CT) emerging as an essential imaging tool. This systematic review aims to evaluate CT's role in MICS planning, focusing on imaging protocols, surgical guidance, and patient outcomes. METHODS: This study included studies published between January 2003 and January 2025 that examined the role of CT imaging in planning minimally invasive valvular heart surgery. A comprehensive search was conducted in Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Excerpta Medica Database (EMBASE) using predefined keywords and medical subject headings (MeSH) terms related to CT imaging, angiography, minimally invasive surgery, robotic surgery, aortic valve surgery, and mitral valve surgery. RESULTS: Initial search found 378 studies, and 17 studies were included in the review. The studies highlight CT's value in assessing surgical feasibility, vascular access, and risk stratification. CT aids in selecting arterial cannulation sites, guiding aortic occlusion strategies, and optimizing port placement. It also identifies contraindications, such as extensive atherosclerosis and anatomical abnormalities, that may necessitate sternotomy. CONCLUSIONS: Current evidence underscores CT's critical role in optimizing MICS planning and enhancing patient safety.
OBJECTIVES: This study aimed to compare operative outcomes between patients undergoing thoraco-abdominal aortic aneurysm (TAAA) repair for degenerative disease and chronic dissected aneurysm. METHODS: A retrospective ana...OBJECTIVES: This study aimed to compare operative outcomes between patients undergoing thoraco-abdominal aortic aneurysm (TAAA) repair for degenerative disease and chronic dissected aneurysm. METHODS: A retrospective analysis was conducted on consecutive patients who underwent elective TAAA repair for chronic dissection or degenerative disease between 1997 and 2025. The primary outcome measure was operative mortality, while secondary outcomes included major adverse events (MAE). Factors associated with mortality or MAE were identified using multivariable analysis. RESULTS: A total of 734 patients underwent open TAAA repair, with 339 (46%) having atherosclerotic disease and 395 (54%) having chronic dissection. The degenerative disease group was characterized by older age (71.2 ± 10.2vs.58.9 ± 13.7, P < .001), higher comorbidity burden (such as ischaemic heart disease, pulmonary disease, diabetes, and renal impairment), and lower rates of connective tissue disorders (2.4%vs 26.1%, P < .001), and Extent I or II TAAA (57.5% vs 84.3%, P < .001). The overall operative mortality rate for the entire cohort was 5.9% and was higher in the chronic dissection group [OR, 2.54 (1.15-5.69), P = .022]. Incidence of paraplegia (either immediate or delayed) was higher in the degenerative group (2.8% vs. 0.8%, P = .028). Both groups had a similar risk of MAE [OR, 1.49 (0.90-2.45), P = .119]. Factors that were associated with MAE included older age [OR, 1.02 (1.00-1.04), P = .050], preoperative renal impairment [OR, 1.83 (1.17-2.85), P = .007], Extent I or II TAAA [OR, 1.76 (1.17-2.65), P = .007], and lower preoperative FEV1 [OR, 0.97 (0.95-0.99), P = .001]. CONCLUSIONS: Chronic dissection aetiology was associated with higher adjusted operative mortality following open TAAA repair, likely reflecting greater anatomical complexity, with similar risk of MAE.
Lauk O, Battilana B, Held U
… +12 more, Rodrigues CL, Haberecker M, Chiffi K, Verbelen T, de Perrot M, Yildizeli B, Michael L, Moser B, Schwarz S, Awada HN, Petersen RH, Opitz I
Eur J Cardiothorac Surg
· 2026 Jun · PMID 41896198
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OBJECTIVES: Pulmonary artery sarcoma (PAS) is a rare and aggressive malignancy often mimicking pulmonary embolism, leading to diagnostic delays and poor outcomes. This study aims to describe the clinical characteristics,...OBJECTIVES: Pulmonary artery sarcoma (PAS) is a rare and aggressive malignancy often mimicking pulmonary embolism, leading to diagnostic delays and poor outcomes. This study aims to describe the clinical characteristics, diagnostic pathways, treatment modalities, and outcomes of PAS patients in a multicentre cohort. METHODS: This retrospective cohort study included patients from 7 institutions between 1994 and 2024. Clinical, radiological, histological, and treatment data were collected via a standardized REDCap-based platform. All patients underwent either multimodal treatment or single therapy approach, including systemic therapy, surgery, and/or radiotherapy. Kaplan-Meier survival analysis and log-rank testing were performed to assess overall survival (OS) and progression-free survival (PFS). RESULTS: 84 patients from 7 international centres were analysed. The mean age was 54.4 years, and 43.8% of patients were female. The most common presenting symptoms were dyspnoea (81.2%) and chest pain (50.0%). Pulmonary embolism was the most frequent initial misdiagnosis (49.1%). Histologically, PAS was diagnosed in 46 cases. Tumours were bilateral in 58.1% of patients with surgery only. Most commonly, endarterectomy was performed in 59.5%. After a median follow-up time of 39 months, 19 were excluded as they either had no treatment information or received monotherapy only. Additionally, 11 patients were excluded due to missing date of diagnosis and 17 due to missing overall follow-up date. There was moderate evidence that OS differed between treatment groups (75th quantile: 34 months for multimodal [95% CI, 26 to not reached] vs 11 months for surgery only [95% CI, 7-21]; log-rank P = .022). There was no evidence that PFS differed between treatment groups (median 19 months for multimodal [95% CI, 14-39] vs 16 months surgery only [95% CI, 11-21]; log-rank P = .69). CONCLUSIONS: This study represents the largest reported PAS cohort to date and underscores the diagnostic challenges and poor prognosis associated with this disease. Our findings offer evidence that multimodal treatment provides significant prognostic benefits. However, further prospective studies are warranted to establish standardized diagnostic and therapeutic protocols.
Khargi SDM, Grashuis P, Veen KM
… +6 more, Kluin J, Cornette JMJ, Johnson MR, Roos-Hesselink JW, Takkenberg JJM, Mokhles MM
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41886348
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OBJECTIVES: To investigate the optimal valve substitute for young women requiring aortic valve replacement (AVR), allowing improved future valve-related outcomes for mother and foetus during pregnancy. METHODS: A systema...OBJECTIVES: To investigate the optimal valve substitute for young women requiring aortic valve replacement (AVR), allowing improved future valve-related outcomes for mother and foetus during pregnancy. METHODS: A systematic search was performed for publications between 1998 and 2025 reporting women experiencing pregnancy after AVR with a pulmonary autograft (Ross-procedure), homograft, bioprosthesis (xenograft), or mechanical valve. Pooled proportions were calculated to determine maternal, valvular and foetal outcomes during pregnancy using generalized linear mixed models. RESULTS: Thirteen studies reporting 356 pregnancies in 251 women (pooled mean age at pregnancy 29.1 ± 4.8 years) after AVR with a pulmonary autograft (70 women, 119 pregnancies), homograft (73 women, 99 pregnancies), bioprosthesis (37 women, 50 pregnancies), or mechanical valve (71 women, 88 pregnancies) were included. During pregnancy, valve-related reintervention in women with a bioprosthesis was 2.7% (95% CI, 0.4-16.9) at 5.1 ± 2.5 years after AVR. This was not observed in women with pulmonary autografts (7.7 ± 4.2 years after AVR) and homografts (4.1 ± 3.3 years after AVR). Reintervention for valve thrombosis (4.9% [95% CI, 1.6-14.0]) and maternal death (1.1% [95% CI, 0.2-7.6]) occurred only in women with mechanical valves (8.1 ± 4.5 years after AVR). Pooled probability of liveborn delivery was 71.7% (95% CI, 59.2-81.6) in women with a mechanical valve, compared to 90.6% (95% CI, 72.4-97.3), 92.3% (95% CI, 56.0-99.1), and 82.9% (95% CI, 53.3-95.4) in women with an autograft, homograft, and bioprosthesis respectively. CONCLUSIONS: Maternal mortality and valve thrombosis during pregnancy occurred only in women with mechanical valves. Although no statistical comparisons were made, pregnancies in women with pulmonary autograft, homograft or bioprosthesis showed acceptable maternal and foetal outcomes. These descriptive findings provide foundations for further investigation of tissue-valve function before, during and after pregnancy, aiming for more support of current guidelines.
Chan J, Comanici M, Dong T
… +2 more, Narayan P, Angelini GD
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41886338
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OBJECTIVES: Data on hospital readmission and secondary care utilization after coronary artery bypass grafting (CABG) beyond 30 days remain limited. We aim to address this gap by reporting cardiovascular and procedure-rel...OBJECTIVES: Data on hospital readmission and secondary care utilization after coronary artery bypass grafting (CABG) beyond 30 days remain limited. We aim to address this gap by reporting cardiovascular and procedure-related readmission rates in the 60 months after primary isolated surgical revascularization in the United Kingdom. METHODS: All patients who underwent isolated CABG from January 2013 to April 2025 from the UK National Adult Cardiac Surgery Audit dataset were included. All cause readmissions to any NHS hospital during the first 60 months of follow-up were analysed from the Hospital Episode Statistics dataset. The relation to the time before, during, and after the COVID-19 pandemic was also investigated. Finally, the primary and secondary diagnoses, as well as any procedure(s) undertaken during readmission, were evaluated. RESULTS: A total of 101,759 patients were identified (84% male, median age 66.9 years [first and third quartile: 59.7, 73.6]). Of these 69,426 patients, required readmission for any cause. The cumulative incidence of readmission at 12 and 60 months was 42.0% and 68.2%, respectively. The overall readmission rate during the first lockdown to the third lockdown relaxation of the COVID-19 pandemic was 42.0% (ranged: 40.7%-45.0%). No significant differences in readmission rates were observed during the COVID-19 pandemic. At 12 months, cardiovascular-related readmissions accounted for 15% (n = 13 529) of all readmissions, with arrhythmia 25%, heart failure 19% and acute coronary syndrome 15.2%. The primary diagnoses between 13 and 60 months 24.7% (n = 17 162) were arrhythmia, 22.2%, angina pectoris, 19.4%, heart failure 17.1%. The overall incidence of urgent repeat revascularization during readmission at 12 and 60 months was 1.71% and 4.20%, respectively. The primary readmission diagnoses related to the surgical procedure (excluding cardiovascular-related) in the first 12 months was 25.5% (n = 23 047), with non-cardiac chest pain 30.1%, surgical wound disruption/infection 16.8% and anaemia 15.0%. Between 13 and 60 months, procedure-related primary diagnoses accounted for 26.1% (n = 18 143), of which non-cardiac chest pain 35.6%, anaemia 26.2%, and respiratory tract infection 20.8%. CONCLUSIONS: Analysis of this unselected UK cohort reveals that cardiovascular-related readmission represented one-quarter of all readmissions at 5 years after the index CABG. This high readmission rate underscores the need for further research to understand the underlying causes and implement strategies to optimize resource use.
van Steenwijk QCA, Dijkgraaf MGW, Oosterhuis W
… +6 more, Susa D, Bolmers MDM, Kortekaas RTJ, Dickhoff C, Braun J, van den Broek FJC
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41885401
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OBJECTIVES: "Enhanced recovery after thoracic surgery" is increasingly implemented following surgery for primary spontaneous pneumothorax (PSP). Historically, postoperative chest tubes are left in place for several days...OBJECTIVES: "Enhanced recovery after thoracic surgery" is increasingly implemented following surgery for primary spontaneous pneumothorax (PSP). Historically, postoperative chest tubes are left in place for several days to ensure adequate pleurodesis and prevent recurrence. Prompt chest tube removal upon cessation of air leakage may enhance recovery but potentially increases risk of recurrence. We evaluated progressive chest tube management following surgical pleurodesis for PSP. METHODS: Retrospective multicentre study of patients undergoing surgical pleurodesis for PSP between 2020 and 2023. Hospitals with implemented progressive chest tube management (removal upon cessation of air leakage <8 hours) were compared against hospitals with conservative management (removal after 1-2 days). Outcome measures, corrected for bias using directed acyclic graphs, were postoperative length of stay (LOS), chest tube duration, complications, and ipsilateral recurrences. RESULTS: A total of 183 patients from 5 hospitals were included: 99 patients in the progressive and 84 in the conservative group. Follow-up and baseline characteristics were comparable, except for surgical indication, pleurodesis technique, and use of postoperative chest X-ray. Progressive management significantly reduced LOS (Δ1 day), chest tube duration (Δ2 days), and complications (9.1 vs 21.4%). After correction for pleurodesis technique, persistent air leakage, and chest X-ray, LOS was reduced by 1.03 day (P < .001). Recurrences (6.6%) were similar across groups (P = .388). CONCLUSIONS: Progressive chest tube management reduces LOS, chest tube duration, and complications without increasing the risk of recurrence in this retrospective comparative study. A prospective study is necessary to validate these findings before considering widespread implementation.
Tsuboi M, Wakelee H, Garassino MC
… +18 more, Gao S, Luft A, Chen KN, Spicer JD, Zhu Y, Saji H, Okada M, Vanakesa T, Chen H, Zhao G, Ikeda N, Jones DR, Weksler B, Huang CS, Jensen E, Keller SM, Samkari A, Liberman M
Eur J Cardiothorac Surg
· 2026 Mar · PMID 41875364
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OBJECTIVES: Perioperative pembrolizumab plus neoadjuvant chemotherapy significantly improved outcomes versus neoadjuvant chemotherapy alone in early-stage, resectable, non-small-cell lung cancer (NSCLC) in the phase 3 KE...OBJECTIVES: Perioperative pembrolizumab plus neoadjuvant chemotherapy significantly improved outcomes versus neoadjuvant chemotherapy alone in early-stage, resectable, non-small-cell lung cancer (NSCLC) in the phase 3 KEYNOTE-671 study. We report outcomes in participants with baseline clinical stage II disease. METHODS: Participants with untreated, resectable, stage II-IIIB (N2) NSCLC were randomized 1:1 to receive pembrolizumab 200 mg or placebo every 3 weeks plus chemotherapy for 4 cycles, followed by surgery and adjuvant pembrolizumab or placebo for 13 cycles (∼9 months). Exploratory analyses were performed in participants with clinical stage II disease. RESULTS: Of 797 randomized participants, 239 had stage II disease (pembrolizumab plus chemotherapy, n = 118; chemotherapy only, n = 121). Median study follow-up at data cutoff (August 19, 2024) was 49.9 (range, 32.2-75.3) months. Among participants who underwent surgery, 94/99 (94.9%) had R0 resections in the pembrolizumab arm and 89/103 (86.4%) in the neoadjuvant chemotherapy only arm. Event-free survival (hazard ratio [HR], 0.50; 95% CI, 0.34-0.74), overall survival (HR, 0.69; 95% CI, 0.43-1.11), major pathological response (difference, 25.7%; 95% CI, 15.3-35.9), and pathological complete response (difference, 21.3%; 95% CI, 13.2-30.2) were improved in the pembrolizumab arm. Grade 3-4 treatment-related adverse events (AEs) occurred in 50.0% of participants treated with pembrolizumab plus chemotherapy and 40.5% with chemotherapy; no treatment-related AEs led to death. CONCLUSIONS: In participants with stage II NSCLC, perioperative pembrolizumab improved efficacy outcomes with manageable safety versus neoadjuvant chemotherapy alone, consistent with the overall KEYNOTE-671 population. These results support the use of this regimen in patients with stage II disease. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03425643, registered/first posted on February 7, 2018 (https://www.clinicaltrials.gov/study/NCT03425643).
OBJECTIVES: To assess whether tricuspid valve surgery (TVS) during HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation affects long-term survival and outcomes. METHODS: The ELEVATE registry enrolled 540...OBJECTIVES: To assess whether tricuspid valve surgery (TVS) during HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation affects long-term survival and outcomes. METHODS: The ELEVATE registry enrolled 540 HM3 patients across 26 centres; 463 undergoing primary LVAD implantation and at least mild tricuspid regurgitation (TR) formed this analysis. Concomitant TVS was performed in 70 (15.1%) patients. Five-year outcomes (survival, functional capacity, end-organ function, adverse events) were compared with those with similar severity of TR not receiving TVS in both overall population (with TVS n = 70 vs without TVS n = 264) and matched groups (each group n = 67, primary analysis cohort). RESULTS: In the matched cohort, baseline demographics of patients with or without TVS showed no differences in age (57.9 ± 10.8 vs 57.3 ± 10.0; P = .728), sex (male, 92.5% vs 94.0%; P = 1.000), preoperative short-term mechanical circulatory support rate (6.0% vs 9.0% P = .744), New York Heart Association (NYHA) class and quality of life (QoL) score, and end-organ function. Preoperatively, patients with TVS had shorter 6-minute walk distances (6MWD; 58.0 ± 109.0 m vs 105.3 ± 154.0 m; P = .081). At 5 years, patients with TVS showed no differences in survival (69.0% vs 59.3%, P = .67), 6MWD (311.1 ± 129.5 m vs 295.6 ± 137.7 m, P = .758), QoL score, or end-organ function while presented a lower risk of right heart failure (EPPY 0.038 vs 0.092, P = .03). CONCLUSIONS: In the ELEVATE registry, concomitant TVS during HM3 implantation was not associated with differences in 5-year survival; however, it may have a positive effect on functional capacity and right heart function. CLINICAL REGISTRATION NUMBER: NCT02497950.
Kari FA, Ortac E, Michel SG
… +10 more, Cleuziou J, Heinisch PP, Alalawi Z, von Scheidt F, Kienmoser D, Ono M, Kämmerer H, Meisner H, Lange R, Hörer J
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41863344
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OBJECTIVES: The Senning and Mustard atrial switch procedures, once the standard surgical treatment for transposition of the great arteries, carry the long-term risks linked to a systemic right ventricle. METHODS: A retro...OBJECTIVES: The Senning and Mustard atrial switch procedures, once the standard surgical treatment for transposition of the great arteries, carry the long-term risks linked to a systemic right ventricle. METHODS: A retrospective follow-up study was conducted to characterize long-term outcomes focusing on survival, baffle-related, and non-baffle-related reoperations. RESULTS: N = 417 patients with d-transposition of the great arteries (d-TGA) (70% male) were treated with an atrial switch operation in one centre (n = 88 Mustard, n = 329 Senning, treated in 1974-2001). The mean follow-up time was 29.7 (SD 14.2) years, with a median follow-up of 34.2 years (range 10-50 years). The average age of the patients at the last follow-up was 30.9 (SD 14.1) years. Overall survival at 40 years was 78.3% (95% CI, 74.0%-82.8%) with n = 128 patients under observation. Forty-year survival was 81.6% (95% CI, 77.0%-86.5%, n = 91 at risk) after Senning and 66.7% (95% CI, 57.2%-77.8%, n = 37 at risk) after Mustard (log-rank P < .001). Freedom from reoperation at 40 years was 73.1% (95% CI, 68.4%-78.0%). After the Senning, long-term survival over 4 decades was slightly inferior to survival of a general population sample. CONCLUSIONS: Given a survival up to the fifth life decade only slightly inferior to a normal population and superiority of the Senning over the Mustard operation, the Senning should remain in the congenital cardiac surgeons' armamentarium for late presentation of TGA, ccTGA, and other indications. CLINICAL REGISTRATION NUMBER: The study is designed as a retrospective study.
OBJECTIVES: Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral regurgitation (MR) who are not suitable for surgery or edge-to-edge repair. The impact of TMVR on right ven...OBJECTIVES: Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral regurgitation (MR) who are not suitable for surgery or edge-to-edge repair. The impact of TMVR on right ventricular (RV) function and RV-pulmonary artery (PA) coupling remains poorly understood. We aimed to investigate the prognostic significance of right heart function and RV-PA coupling in TMVR recipients. METHODS: This study evaluated patients from the multicentre TENDER registry entailing transapical TMVR with the Tendyne valve. We assessed RV systolic function, tricuspid regurgitation (TR), systolic PA pressure (sPAP), and the tricuspid annulus plane systolic excursion (TAPSE)/sPAP ratio as a marker of RV-PA coupling before and 1 year after TMVR. RESULTS: Among 195 patients, 57.4% had impaired RV-PA coupling (TAPSE/sPAP < 0.4) at baseline. One year after TMVR, sPAP and TR severity significantly improved, while TAPSE slightly declined. The TAPSE/sPAP ratio increased modestly. Patients with preserved baseline RV-PA coupling experienced numerically lower rates of mortality and heart failure hospitalization at 1 year, although the differences did not reach the statistical significance. Reversal of pulmonary hypertension was associated with lower mortality or rehospitalization risk. CONCLUSIONS: RV dysfunction and impaired RV-PA coupling are frequent among TMVR candidates. They may inform risk stratification and carry prognostic significance. TMVR is associated with haemodynamic improvements that could benefit RV-PA coupling. Patients with secondary MR, with baseline association of impaired coupling and severe TR, or failed reversal of pulmonary hypertension may require closer clinical follow-up. Further studies are warranted to validate these findings.
Huang Y, Liu Y, Fang C
… +7 more, Wu J, Li Z, Chen J, Xie X, Yang H, Luo K, Fu J
Eur J Cardiothorac Surg
· 2026 Apr · PMID 41851983
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OBJECTIVES: Neoadjuvant chemoradiotherapy (NCRT) remains the standard for locally advanced oesophageal squamous cell carcinoma. Emerging evidence on neoadjuvant immunochemotherapy (NICT) has shown promising short-term ef...OBJECTIVES: Neoadjuvant chemoradiotherapy (NCRT) remains the standard for locally advanced oesophageal squamous cell carcinoma. Emerging evidence on neoadjuvant immunochemotherapy (NICT) has shown promising short-term efficacy, although it is associated with lower pathological complete response rates. The retrospective study aims to compare recurrence patterns and survival outcomes of satisfactory tumour response (ypStage I/ypT0-2N0M0) after either modality followed by surgery. METHODS: We analysed ypStage I patients who underwent McKeown oesophagectomy at Sun Yat-sen University Cancer Center (July 2009-July 2022). Propensity score matching (1:1) balanced baseline characteristics. Overall survival (OS), disease-free survival (DFS), and recurrence patterns were analysed. RESULTS: Totally, 156 cases of NCRT, 63 cases of NICT were included. After matching (63 pairs), recurrence patterns diverged significantly: the NICT group had predominant regional lymph node recurrence (100% vs 22.73%, P < .001), larger recurrent lesions (median 41 vs 24 mm, P = .011), and lower distant metastasis (42.86% vs 86.36%, P = .021). It also showed superior 3-year OS (90.07% vs 83.44%, P = .021), 3-year DFS (88.89% vs 76.03%, P = .011), and better conditional survival beyond 2 years (P = .032, P = .008). CONCLUSIONS: Recurrence patterns differ between the two modalities in ypStage I patients. NICT was associated with better survival. Studies comparing the two modalities should focus more on survival rather than tumour response in oesophageal squamous cell cancer.