European Journal Of Cardio-thoracic Surgery[JOURNAL]
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200 papers
Preoperative Renal Function Strongly Predicts Postoperative Outcomes in Aortic Arch Surgery with Circulatory Arrest.
Piperata A, Di Marco L, Snaidero S … +7 more , Fabbri E, Rucci P, Castagnini S, Bianco E, Mariani C, Murana G, Pacini D
Eur J Cardiothorac Surg · 2026 Feb · PMID 41564320 · Publisher ↗
OBJECTIVES: To evaluate the impact of preoperative renal function on early clinical outcomes of patients undergoing aortic arch surgery with hypothermic circulatory arrest and visceral ischaemia. METHODS: This single-cen...
OBJECTIVES: To evaluate the impact of preoperative renal function on early clinical outcomes of patients undergoing aortic arch surgery with hypothermic circulatory arrest and visceral ischaemia. METHODS: This single-centre retrospective study included 1077 consecutive patients who underwent aortic arch surgery between 1996 and 2024 at the University Hospital of Bologna. Patients were stratified by preoperative estimated glomerular filtration rate into 4 stages. Regression analysis, including adjustment for confounders and cubic splines, was applied to assess the impact of estimated glomerular filtration on 30-day mortality and major complications. RESULTS: A lower estimated glomerular filtration value was significantly associated with increased 30-day mortality (-0.015; CI: -0.025; -0.005), prolonged intubation (-0.018; CI: -0.024; -0.012), higher incidence of temporary dialysis (-0.021; CI: -0.032; -0.011), and gastrointestinal complications (-0.014; CI: -0.025; -0.003) in univariate logistic regression models, and after adjustment for confounders these associations remained significant. CONCLUSIONS: Preoperative renal function is a powerful predictor of early morbidity and mortality following aortic arch surgery. The preoperative estimated glomerular filtration value is a key factor in surgical risk stratification and the development of tailored intraoperative strategies.
Is Ventilatory Equivalent for Carbon Dioxide (VE/VCO2) Slope the Key to Reduce Mortality in Patients Undergoing Pneumonectomy?
La Paglia D, Ciacco C, Grispi C … +7 more , Rudella S, Russo A, Marcaccini M, Sobrero S, Vaisitti F, Errico L, Leo F
Eur J Cardiothorac Surg · 2026 Jan · PMID 41557475 · Publisher ↗
OBJECTIVES: Cardiopulmonary exercise testing (CPET) definition of peak oxygen uptake (VO2 peak) is useful in detecting patients with an acceptable risk for pneumonectomy. Nevertheless, postoperative mortality remains hig...
OBJECTIVES: Cardiopulmonary exercise testing (CPET) definition of peak oxygen uptake (VO2 peak) is useful in detecting patients with an acceptable risk for pneumonectomy. Nevertheless, postoperative mortality remains high. CPET allows to define another promising parameter, the ventilatory equivalent for carbon dioxide (VE/VCO2 slope) that could further improve patients selection. We tested the hypothesis that VE/VCO2 slope values may identify patients with a prohibitive risk. METHODS: A retrospective analysis was performed on a cohort of patients who underwent pneumonectomy for lung cancer from March 2000 to March 2024. Postoperative morbidity and mortality were analysed according to VO2 peak and VE/CO2 slope values, and their risk was compared to patients who did not underwent preoperative CPET. RESULTS: Out of 277 patients who underwent pneumonectomy, preoperative CPET was performed in 144 cases (52%). In this group, mortality and respiratory morbidity were 4% and 15%, respectively, compared to 6% and 14% in patients who did not undergo preoperative CPET. VE/VCO2 slope would have been effective in detecting patients with prohibitive risk. In fact, using a slope cutoff value of 35, postoperative respiratory complications and mortality were 33% and 17%, respectively, in patients with a slope above 35 compared to 13% and 2% in those having a slope lower than 35 (P <.05). CONCLUSIONS: When VO2 peak suggests that pneumonectomy is feasible, values of VE/VCO2 slope deserve attention, as the risk becomes prohibitive when excessive CO2 retention is recorded during the test. The study suggested that a slope cut-off value of 35% may be useful to reduce postoperative adverse events.
Impact of Fenestration Patency on Long-Term Fontan Outcomes.
Horie S, Shikata F, Oka N … +10 more , Okamura T, Kondo R, Kaneko M, Takei T, Matsunaga Y, Matsui K, Hataoka T, Konaka H, Ono M, Miyaji K
Eur J Cardiothorac Surg · 2026 Feb · PMID 41557473 · Publisher ↗
OBJECTIVES: Routine creation of a fenestration during Fontan completion is our policy to stabilize early circulation. This study evaluated its validity by examining the impact of fenestration patency at 1 year on long-te...
OBJECTIVES: Routine creation of a fenestration during Fontan completion is our policy to stabilize early circulation. This study evaluated its validity by examining the impact of fenestration patency at 1 year on long-term outcomes. METHODS: Among 112 patients who underwent fenestrated total cavopulmonary connection at 4 institutions, 105 with 1-year catheterization and ≥3 years of follow-up were analysed. Patients were classified by fenestration status at 1 year: patent (Group F, n = 43) and closed (Group C, n = 62). Preoperative and 1-year catheter data and long-term complications-Fontan-associated liver disease (FALD), protein-losing enteropathy (PLE), and catheter interventions excluding veno-venous collaterals-were compared. RESULTS: The median age at Fontan was 23 months (interquartile range [IQR]: 15-33). Preoperative haemodynamics showed no differences between the groups. At postoperative 1 year, systemic ventricular end-diastolic pressure (SVEDP) was higher in Group F (F: 8 [5-9] vs C: 6 [5-8] mmHg, P = .007). Protein-losing enteropathy was significantly more common in the Group C (F: 5.0% vs C: 27.0%, P = .038). In contrast, there was no significant difference in the cumulative incidence of FALD between the 2 groups (F: 12.5% vs C: 9.7%, P = .69). CONCLUSIONS: Although patent fenestration was associated with an increased SVEDP at 1 year postoperatively, it may improve long-term outcomes including PLE. As predicting eventual fenestration patency from preoperative data is difficult, our policy of routine fenestration creation appears to be a valid strategy. CLINICAL REGISTRATION NUMBER: Kitasato University, No. B23-130; February 7, 2024.
Impact of Surgical Ablation of Atrial Fibrillation on Ventricular Function and Remodelling After Aortic Valve Replacement.
Kim JH, Kim JB, Kim HR … +5 more , Yoo JS, Jung SH, Chung CH, Lee JW, Kim HJ
Eur J Cardiothorac Surg · 2026 Jan · PMID 41557472 · Publisher ↗
OBJECTIVES: While aortic valve replacement (AVR) improves left ventricular (LV) function and promotes LV remodelling, it remains uncertain whether surgical ablation (SA) provides additional functional and structural bene...
OBJECTIVES: While aortic valve replacement (AVR) improves left ventricular (LV) function and promotes LV remodelling, it remains uncertain whether surgical ablation (SA) provides additional functional and structural benefit in patients with atrial fibrillation (AF). We aimed to evaluate the association of SA with LV function, remodelling, and clinical outcomes in AF patients undergoing AVR. METHODS: We analyzed AF patients undergoing AVR between 2000 and 2023. Inverse-probability-of-treatment weighting (IPTW) was used to adjust for baseline differences. Temporal changes in LV ejection fraction (LVEF) and LV mass index (LVMI) were assessed using nonlinear mixed-effect models based on 1974 echocardiographic measurements. RESULTS: Among 389 patients (aged 68.8 ± 8.2 years), 258 (66.3%) underwent SA. In the IPTW-adjusted cohort, SA was not associated with increased operative mortality (P = .262). During a median follow-up of 5.2 years, all-cause mortality (P = .174) and stroke (P = .580) were similar between groups. In longitudinal analyses, SA showed a non-significant trend towards higher LVEF in the overall cohort (inter-group P = .055) and no significant differences in LVMI (P = .158). In patients with ≥3 echocardiograms (n = 248), between-group differences became significant, with higher LVEF (5-year difference +3.0%; 95% confidence interval [CI], +0.3 to +5.4; P = .031, inter-group P = .003), and lower LVMI (1-year difference -13.0 g/m2; 95% CI, -20.4 to -5.4; P = .003, inter-group P = .032). Associations were more pronounced in patients with aortic stenosis. CONCLUSIONS: SA during AVR was associated with modestly more favourable LV remodelling without increasing operative or long-term clinical risks. Given small absolute differences, these findings should be interpreted cautiously, and further studies with longer follow-up are warranted.
Fate of the Aortic Root After Reconstruction With Felt Neomedia for Acute Type A Aortic Dissection.
Gillinov LA, Kapoor SR, Sperry AE … +8 more , Lao J, Bazianos D, Goel NJ, Berezowski M, Brown CR, Lawrence KM, Szeto WY, Desai ND
Eur J Cardiothorac Surg · 2026 Jan · PMID 41557464 · Publisher ↗
OBJECTIVES: We sought to characterize the durability of aortic root reconstruction with felt neomedia for acute type A aortic dissection (ATAAD). METHODS: Of 894 patients undergoing type A aortic dissection repair betwee...
OBJECTIVES: We sought to characterize the durability of aortic root reconstruction with felt neomedia for acute type A aortic dissection (ATAAD). METHODS: Of 894 patients undergoing type A aortic dissection repair between 2010 and 2024 at a single institution, 537 underwent aortic root reconstruction with felt neomedia and aortic valve resuspension (median age 64 years, 37.2% female). Median follow-up was 4.3 years. Outcomes included survival, proximal aortic reintervention, greater than moderate aortic insufficiency, and root dilatation. Predictors of a composite outcome-defined as proximal aortic reintervention, greater than moderate aortic insufficiency, or root dilatation ≥ 50 mm-were evaluated. RESULTS: Preoperatively, 19.9% of patients had greater than moderate aortic insufficiency, and median root diameter was 39.0 mm. Thirty-day mortality was 12.8%, and 10-year survival was 52.3%. The cumulative incidence of proximal aortic reintervention at 1, 5, and 10 years was 0.4%, 2.4%, and 5.5%. During follow-up, 13 patients developed greater than moderate aortic insufficiency and 16 developed root dilatation ≥ 50 mm. Freedom from the composite outcome was 98.8% at 1 year and 91.9% at 5 years. On multivariable analysis, preoperative aortic insufficiency and baseline root diameter ≥ 45 mm were independent predictors of the composite outcome. CONCLUSIONS: Aortic root reconstruction with felt neomedia and aortic valve resuspension is a durable technique for ATAAD. Patients with preoperative aortic insufficiency or root dilatation are at increased risk for root-related events and warrant close surveillance.
Surgical Management of Unexpected Thymic Anatomical Variations During Thoracoscopic Thymectomy.
Abdellateef A, Bastawisy A, Saied A … +2 more , Elsorogy H, Keshta M
Eur J Cardiothorac Surg · 2026 Jan · PMID 41555504 · Publisher ↗
OBJECTIVES: Complete thoracoscopic thymic resection is crucial for achieving sternotomy-comparable outcomes in myasthenia gravis patients. Thymic anatomy varies significantly, presenting features like retro-left brachioc...
OBJECTIVES: Complete thoracoscopic thymic resection is crucial for achieving sternotomy-comparable outcomes in myasthenia gravis patients. Thymic anatomy varies significantly, presenting features like retro-left brachiocephalic vein (LBCV) horns and thymic ring. Surgeons encountering these variations may miss abnormal thymic tissue or face intraoperative challenges. This research aims to report on the thoracoscopic management of thymic variations, illustrating their perioperative outcomes. METHODS: This retrospective observational study was conducted from September 2016 to September 2024. A total of 255 myasthenic patients underwent thoracoscopic thymectomy and were categorized into Normal (n = 227) and Variant (n = 28) groups based on intraoperative anatomical variations. Primary outcomes were operative time and blood loss. Secondary outcomes included hospital stay and postoperative outcomes. Perioperative data were compared between groups. RESULTS: In the Variant group, the most commonly identified anatomical variations were thymus with "more than 2 horns" (12 patients, 42.9%), followed by retro-LBCV horns (9 patients, 32.2%). The mean operative time was significantly longer in the Variant group (209.36 ± 53.69 minutes) compared to the Normal group (177.26 ± 57.41 minutes) (P = .005). Otherwise, both groups did not exhibit significant differences regarding other perioperative data and neurological outcomes. CONCLUSIONS: Thoracoscopic thymectomy can be safely and effectively performed even in the presence of thymic anatomical variations, especially when they are preoriented by the surgeon. While these variations may lead to longer operative times, they do not compromise completeness of resection and other short-term postoperative outcomes.
Major Vascular Complications After Percutaneous Transfemoral Approach for Transcatheter Aortic Valve Implantation in Propensity-Matched Cohort: Impact on Clinical Outcomes and Survival.
Eid M, Ducroix A, Dang Van S … +11 more , Ammi M, Rineau E, Binuani P, Bénard T, Delépine S, Chausseret L, Rouleau F, Picquet J, Baufreton C, Pinaud F, Fouquet O
Eur J Cardiothorac Surg · 2026 Jan · PMID 41555499 · Publisher ↗
OBJECTIVES: Transfemoral transcatheter aortic valve implantation (TAVI) has become the preferred approach for treating aortic stenosis in patients over 70 years. Despite advancements in technology and operator experience...
OBJECTIVES: Transfemoral transcatheter aortic valve implantation (TAVI) has become the preferred approach for treating aortic stenosis in patients over 70 years. Despite advancements in technology and operator experience, major vascular complications (MVCs) remain a concern, potentially affecting outcomes. This study aimed to assess the incidence, risk factors, and clinical impact of MVCs following transfemoral TAVI using propensity score matching. METHODS: We retrospectively analysed patients who underwent transfemoral TAVI. Patients were divided into 2 groups: patients who developed MVCs (MVC group) and those who did not present the complication (No-MVC group). The primary end-point was the 30-day mortality. A 1:1 propensity score matching was performed, and clinical outcomes were compared at 30 days and up to 2 years. RESULTS: Between 2012 to 2023, a total of 2296 underwent a percutaneous-transfemoral approach. Major vascular complications occurred in 6.6% (n = 151) and were associated with increased transfusion requirement, major bleeding, reinterventions, and longer hospital stays. Female sex, obesity, higher STS score, use of the Manta closure device, and post-implantation balloon valvuloplasty were independently associated with MVCs. The 30-day mortality was similar between groups (P = .723). The long-term survival was lower in the MVC group (P = .016). Two-year survival after propensity score matching did not differ between groups (P = .08). CONCLUSIONS: Major vascular complications after transfemoral transcatheter valve implantation are associated with worse clinical outcomes and reduced long-term survival despite similar at 30-day mortality. Recognizing high-risk patients, optimizing procedural planning, and considering alternative access routes may help reduce vascular complications.
Waitlist mortality in children with EXCOR support: An analysis of the Japan Excor registry.
Hoashi T, Asase M, Sakaguchi H … +10 more , Narita J, Ishido M, Urata S, Toda K, Murakami T, Hirata Y, Hirata Y, Ono M, Ueno T, Fukushima N
Eur J Cardiothorac Surg · 2026 Jan · PMID 41555485 · Publisher ↗
OBJECTIVES: To reveal the prognostic outcomes of ventricular assist device (VAD) therapy with EXCOR paediatric® in Japan. METHODS: Patients who underwent EXCOR paediatric implantation as a bridging therapy to transplant...
OBJECTIVES: To reveal the prognostic outcomes of ventricular assist device (VAD) therapy with EXCOR paediatric® in Japan. METHODS: Patients who underwent EXCOR paediatric implantation as a bridging therapy to transplant between August 2012 and March 2025 were enrolled. The following risk factors were evaluated for their potential to influence waitlist mortality: early surgical era, primary diagnosis, age at implantation, weight at implantation, biventricular VAD support, preoperative extracorporeal membrane oxygenation support, and preoperative mechanical ventilator support. RESULTS: The total number of 137 patients was identified. The median age and weight at the time of implantation were 15.4 months (interquartile range: 7.3-43.2) and 7.2 kg (5.5-10.9), respectively. The primary diagnosis was dilated cardiomyopathy in 100 patients (72.9%), congenital heart disease in 20 patients (14.6%), and restrictive cardiomyopathy in 8 patients (5.8%). Of those, 70 (51.0%) were supported for a period exceeding one year, and the one-year survival rate was found to be 92.9%. A weight of less than 5 kg at the time of Excor implantation was identified as the sole risk factor for mortality on the waitlist (p = 0.039, Hazard ratio: 2.43, 95% confidence interval: 1.05-5.68). In particular, the mortality rate of patients on the waiting list for congenital heart disease and restrictive cardiomyopathy was comparable to that of patients with dilated cardiomyopathy (p = 0.390, hazard ratio: 1.29, 95% confidence interval: 0.72-2.33). CONCLUSIONS: An analysis of JEXCOR registry data demonstrated that the prognostic outcome of bridge-to-transplant therapy with Excor paediatric was favorable in Japan.
Annulus-guided Neochord Length Setting for Anterior Mitral Leaflet Repair.
Nasso G, Marchese A, Santarpino G … +6 more , Bonifazi R, Loizzo T, Greco E, Fiore F, Contegiacomo G, Speziale G
Eur J Cardiothorac Surg · 2026 Jan · PMID 41546376 · Full text
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Optimizing Mediastinal Lymph Node Dissection by Integrating Tumour Location, Consolidation Tumour Ratio, and Size for Lung Cancer.
Jiang C, Deng C, Deng P … +6 more , Fu F, Tang H, Lin H, Li Y, Zhang Y, Chen H
Eur J Cardiothorac Surg · 2026 Jan · PMID 41530589 · Publisher ↗
OBJECTIVES: Several mediastinal lymph node dissection strategies have been proposed for non-small-cell lung cancer based on prognostic analysis. However, as the lymph metastatic pattern of non-small-cell lung cancer has...
OBJECTIVES: Several mediastinal lymph node dissection strategies have been proposed for non-small-cell lung cancer based on prognostic analysis. However, as the lymph metastatic pattern of non-small-cell lung cancer has not been fully revealed, there are still needs for optimization of lymph node management. METHODS: Data on 7067 invasive non-small-cell lung cancer patients who underwent pulmonary resection with systematic lymph node dissection were retrospectively analysed. The tumour size, location, and consolidation tumour ratio (CTR) were identified with computed tomography scans. Other clinical features including visceral pleural invasion were also gathered. RESULTS: None of the tumours with CTR ≤ 0.5 had lymph node involvement. For tumours with CTR between 0.5 and 1.0, if the tumour size ≤ 2 cm, we found no inferior mediastinal lymph metastases in all the upper lobe tumours, and no superior mediastinal lymph metastases in the lower lobe tumours as well. If the size is ≤ 1 cm, inferior mediastinal lymph metastasis was not found in upper lobe tumours, and superior mediastinal lymph metastasis was not found in lower lobe tumours. CONCLUSIONS: In clinical practice, we can reliably predict a minimal risk of lymph node metastases by assessing various clinical features. Based on these findings, we laid the foundation for proposing an innovative strategy for mediastinal lymph node dissection in addition to our previous work.
Outcomes of Transcatheter Mitral Valve Implantation for Failed Bioprostheses and Annuloplasty Rings.
Lee CB, Schweiger V, Schwarzkopf D … +7 more , Kukucka M, Kempfert J, Falk V, Dreger H, Klein C, Hinkov H, Unbehaun A
Eur J Cardiothorac Surg · 2026 Jan · PMID 41530556 · Publisher ↗
OBJECTIVES: Transcatheter mitral valve implantation (TMVI) is increasingly used in failed bioprostheses and annuloplasty rings as a less invasive alternative to redo-surgery in selected patients, with promising results....
OBJECTIVES: Transcatheter mitral valve implantation (TMVI) is increasingly used in failed bioprostheses and annuloplasty rings as a less invasive alternative to redo-surgery in selected patients, with promising results. This retrospective single-centre study aims to provide additional insight into clinical outcomes and its determinants following TMVI. METHODS: Data of all TMVI procedures (n = 88) performed between February 2014 and June 2024 were retrospectively analysed. The primary end-points were 1-year mortality and the Mitral Valve Academic Research Consortium (MVARC) composite end-points. Secondary outcomes included complications and echocardiographic outcomes. RESULTS: Overall, in-hospital, 30-day, and 1-year mortality rates were 6.8%, 5.8%, and 16.5%, respectively. No significant differences were observed between transseptal and transapical approach (20.0 vs 13.2%, P = .439) or between valve-in-valve and valve-in-ring procedure (16.3 vs 18.2%, P = .828). At 1-year follow-up, only one patient presented with mitral regurgitation ≥ grade 2. However, a post-procedural mean pressure gradient (MPG) ≥5 mm Hg was observed in 51 patients (58%). In multivariate analysis, higher post-procedural MPG was associated with increased mortality risk (P = .047; hazard ratio [HR] = 1.23; 95% CI, 1.00-1.51), whereas technical success was associated with reduced mortality risk (P = .014; HR = 0.12; 95% CI, 0.02-0.65). CONCLUSIONS: Transcatheter mitral valve implantation provided acceptable mid-term mortality irrespective of procedure type and access route, with excellent technical success. Furthermore, mid-term follow-up showed near-complete elimination of mitral regurgitation. However, a high rate of post-procedural relevant mitral stenosis was observed, which may have an impact on mortality. In the light of the anticipated increase in TMVI procedures, we advocate for larger prospective studies to investigate the long-term determinants of mortality. CLINICAL TRIAL REGISTRATION: As this study was retrospective and based on previously collected clinical data, clinical trial registration was not required.
Comparative Evaluation of ARCH and GERAADA Scores for Mortality Prediction in Acute Type A Aortic Dissection.
Uzdenov M, Kletzer J, Berger T … +7 more , Kondov S, Pingpoh CP, Zientara A, Bockelmann D, Eschenhagen M, Czerny M, Kreibich M
Eur J Cardiothorac Surg · 2026 Jan · PMID 41530391 · Publisher ↗
OBJECTIVES: To compare the predictive performance of the German Registry for Acute Aortic Dissection Type A (GERAADA) and new ARCH (Arch Reconstruction under Circulatory Arrest with Hypothermia) scores for in-hospital mo...
OBJECTIVES: To compare the predictive performance of the German Registry for Acute Aortic Dissection Type A (GERAADA) and new ARCH (Arch Reconstruction under Circulatory Arrest with Hypothermia) scores for in-hospital mortality in patients undergoing urgent surgery for acute type A aortic dissection (ATAAD). METHODS: Between January 2019 and June 2024, 192 patients were surgically treated for ATAAD at a single centre. Scores were calculated and compared. Model performance was assessed by discrimination (area under the receiver operating characteristic curve, AUC), calibration (Hosmer-Lemeshow test, calibration plots), and accuracy (Brier score, mean absolute error). RESULTS: Median age was 69 years (interquartile range [IQR] 59-77), and 50.5% were male. Median GERAADA risk score was 19.3% (IQR 11.7-29.6), and actual in-hospital mortality was 14.8%. GERAADA score: AUC 0.791 (95% confidence interval [CI], 0.694-0.887), Brier score 0.118, Hosmer-Lemeshow P = .11. ARCH score: AUC 0.748 (95% CI, 0.641-0.856), Brier score 0.114, Hosmer-Lemeshow P = .17. The GERAADA score demonstrated more consistent calibration and slightly higher, not statistically significant, discrimination, while the ARCH score showed marginally better overall accuracy but underestimated mortality in higher-risk patients. CONCLUSIONS: This is the first validation of the ARCH score specifically in patients undergoing surgery for ATAAD. Both GERAADA and ARCH scores provide an acceptable prediction of early in-hospital mortality after ATAAD surgery. The GERAADA score achieved marginally higher, but statistically non-significant, discrimination, particularly in identifying high-risk patients, whereas the ARCH score provides slightly more accurate individual risk estimates but less effective separation of survivors from non-survivors.
Surgical Strategy and Outcomes in Prenatally Diagnosed Neonates With Epstein's Anomaly and Circular Shunt.
Harada T, Nagase H, Matsuda K … +1 more , Nakano T
Eur J Cardiothorac Surg · 2026 Jan · PMID 41528012 · Publisher ↗
OBJECTIVES: This study was performed to evaluate surgical outcomes in patients prenatally diagnosed with severe Ebstein's anomaly and a circular shunt. METHODS: This retrospective study included 13 patients diagnosed wit...
OBJECTIVES: This study was performed to evaluate surgical outcomes in patients prenatally diagnosed with severe Ebstein's anomaly and a circular shunt. METHODS: This retrospective study included 13 patients diagnosed with severe Ebstein's anomaly accompanied by a circular shunt on foetal echocardiography between 2012 and 2024 at our institution. All patients were delivered by planned caesarean section. Foetal hydrops was present in 4 patients. At birth, chest radiographs showed cardiothoracic ratios ranging from 90% to 100%, and echocardiography demonstrated severe pulmonary and tricuspid regurgitation in all cases. Surgical strategies-including main pulmonary artery ligation and the modified Starnes procedure-were evaluated based on perioperative clinical course, incorporating chest X-rays, echocardiograms, laboratory data, and urine output. The median follow-up after the modified Starnes procedure was 3.46 years (interquartile range, 2.9 years). RESULTS: All patients underwent surgical intervention on the day of birth: main pulmonary artery ligation in 7 and a modified Starnes procedure in 6. Of those who initially underwent ligation, 4 patients required conversion to the modified Starnes procedure on postoperative day 1, 2 patients on day 3, and 1 patient on day 6. One patient died of infection after the Glenn procedure. Of the remaining 12 patients, 7 completed Fontan circulation, and 5 were awaiting the Fontan. The 5-year postoperative survival rate was 92.3%. CONCLUSIONS: Surgical outcomes for severe Ebstein's anomaly with a circular shunt were excellent. However, the main pulmonary artery ligation as an initial palliation did not stabilize haemodynamics. Early implementation of the modified Starnes procedure appears critical to overcoming the haemodynamically unstable period immediately after birth.
Prognostic Impact of Preoperative Osteopenia for Patients with Resected Non-Small Cell Lung Cancer.
Nakanishi Y, Kinoshita F, Matsubara T … +6 more , Akamine T, Kohno M, Ozono K, Ishigami K, Takenaka T, Nakamura M
Eur J Cardiothorac Surg · 2026 Jan · PMID 41527282 · Publisher ↗
OBJECTIVES: Osteopenia is an independent risk factor for a poor prognosis in several malignant tumours. However, its significance in lung cancer is unclear. In this retrospective cohort study, we aimed to evaluate the pr...
OBJECTIVES: Osteopenia is an independent risk factor for a poor prognosis in several malignant tumours. However, its significance in lung cancer is unclear. In this retrospective cohort study, we aimed to evaluate the prognostic impact of preoperative osteopenia in patients with surgically resected non-small cell lung cancer. METHODS: We included 546 patients who underwent curative resection for clinical stage I-IIIA non-small cell lung cancer at our institute during 2013-2018. Bone mineral density was evaluated with computed tomographic measurement of pixel density in the core at the bottom of the 11th thoracic vertebra. The cutoff value was 148 and 111 Hounsfield units for men and women, respectively, based on the time-dependent receiver operating characteristic curve for overall survival. Patients were divided into osteopenia and non-osteopenia groups, and the associations of osteopenia with clinicopathological features and prognosis were analyzed. RESULTS: Two hundred fifty-one patients (46.0%) were classified into the osteopenia group. The rates of patients ≥70 years old and ever-smokers in the osteopenia group were higher than those in the non-osteopenia group. The 5-year overall survival (77.1% vs 91.5%) and recurrence-free survival (63.7% vs 80.0%) rates of the osteopenia group were worse than those of the non-osteopenia group. Multivariable analysis revealed that osteopenia was an independent poor prognostic factor for overall survival (hazard ratio [HR]: 2.2, 95% confidence interval [CI], 1.38-3.51, P < .001) and recurrence-free survival (hazard ratio: 1.5, 95% CI, 1.05-2.11, P = .024). CONCLUSIONS: Preoperative osteopenia is an independent poor prognostic factor for patients with resected clinical stage I-IIIA non-small cell lung cancer.
Outcomes of Hemiarch Versus Zone 2 Arch Replacement for DeBakey Type I Aortic Dissection.
Kelly JJ, Gillinov LA, Zhao Y … +9 more , Sperry AE, Goel NJ, Berezowski M, Kapoor SR, Bavaria JE, Brown CR, Lawrence KM, Szeto WY, Desai ND
Eur J Cardiothorac Surg · 2026 Jan · PMID 41525355 · Publisher ↗
OBJECTIVES: The objective of this study was to compare perioperative and long-term outcomes of hemiarch versus zone 2 arch replacement for DeBakey type I acute aortic dissection. METHODS: From 2002 to 2023, 743 patients...
OBJECTIVES: The objective of this study was to compare perioperative and long-term outcomes of hemiarch versus zone 2 arch replacement for DeBakey type I acute aortic dissection. METHODS: From 2002 to 2023, 743 patients underwent surgical repair for DeBakey type I acute aortic dissection with either hemiarch (N = 605, 81.4%) or zone 2 arch replacement (N = 138, 18.6%). 4:1 propensity-score matching yielded a cohort of 437 hemiarch patients (76.1%) and 137 zone 2 patients (23.9%). Key outcomes included 30-day mortality, 10-year survival, and distal reintervention. RESULTS: In the matched cohort, 30-day mortality was 11.9% for hemiarch and 8.0% for zone 2 arch replacement (P = .198). On multivariable analysis, zone 2 arch replacement was not associated with increased risk of 30-day mortality. Ten-year survival was similar between groups, at 56.2% (50.6%-62.6%) in the hemiarch group and 59.8% (46.4%-77.1%) in the zone 2 group. Distal reintervention was more common after zone 2 arch replacement (46.7% vs 15.8%), though the majority of reinterventions in the zone 2 group were thoracic endovascular aortic repair procedures (95.3%). In contrast, over half (53.6%) of distal reinterventions after hemiarch repair were open procedures. CONCLUSIONS: Zone 2 arch replacement resulted in comparable early and late survival to hemiarch replacement. Although distal reinterventions were more common after zone 2 arch replacement, these were predominantly low-risk thoracic endovascular aortic repair procedures. In appropriately selected patients, zone 2 arch replacement may enable more complete aortic repair without added perioperative risk.
Left Atrial Volume Index as a Risk Predictor in Isolated Surgical Aortic Valve Replacement: Results from the Multicentre Aortic Valve Replacement Registry.
Handa K, Maeda K, Pak K … +13 more , Yanagino Y, Ohmori T, Ohtani A, Taguchi T, Kumagai K, Inoue K, Yamada S, Misumi Y, Yamashita K, Kawamura A, Yoshioka D, Shimamura K, Miyagawa S
Eur J Cardiothorac Surg · 2026 Mar · PMID 41525340 · Publisher ↗
OBJECTIVES: Aortic stenosis (AS) induces left ventricular diastolic dysfunction, which is associated with left atrial (LA) dysfunction. However, the prognostic impact of LA dysfunction in the surgical intervention for AS...
OBJECTIVES: Aortic stenosis (AS) induces left ventricular diastolic dysfunction, which is associated with left atrial (LA) dysfunction. However, the prognostic impact of LA dysfunction in the surgical intervention for AS remains unclear. METHODS: Among the 812 patients who underwent isolated surgical aortic valve replacement (SAVR) for AS at 8 institutions between 2016 and 2021, 366 with available preoperative left atrial volume index (LAVI) were included. Based on the optimal value of 40 mL/m2-derived from receiver operating characteristic curve analyses-patients were stratified into a LA enlargement group (n = 219) and a non-enlargement group (n = 147), and 5-year outcomes were investigated. RESULTS: Age (76.0 vs 76.0 years, P = .489) and sex (male 44.3% vs 50.3%, P = .256) were comparable, while the LA enlargement group showed lower estimated glomerular filtration rate (eGFR) (52.3 vs 59.2 mL/min/1.73 m2, P = .002), serum albumin (3.9 vs 4.0 g/dL, P = .003), and ejection fraction (65.0% vs 70.0%, P < .001), as well as a higher tendency for atrial fibrillation (20.1% vs 12.2%, P = .066), and higher Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) (3.10% vs 2.91%, P = .029). The 5-year incidence of cardiac mortality was higher in the LA enlargement group (13.4% vs 2.6%, P = .001). Multivariable analysis identified preoperative LA enlargement (LAVI ≥ 40 mL/m2) as an independent predictor of cardiac mortality (adjusted hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.01-4.82; P = .041). Left atrial enlargement was also associated with higher all-cause mortality and heart failure readmission (17.4% vs 7.6%, P = .002; and 11.0% vs 2.8%, P = .013, respectively). CONCLUSIONS: In patients with severe AS undergoing isolated SAVR, a preoperative LAVI ≥ 40 mL/m2 was associated with midterm mortality and heart failure, suggesting that SAVR before significant LA enlargement may improve prognosis.
How Should Primary Pulmonary Sarcoma be Staged? Results of an International Multicentre Analysis.
Stork T, Adamkova D, Aigner C … +22 more , Bravio I, Brunello A, Cerbone L, Clermidy H, De Cock L, Gasperoni S, Girard N, Mariuk-Jarema A, Lefering R, Melis E, Marquina G, Mazzeo F, Mykoliuk I, Okumus Ö, Penel N, Schildhaus HU, Strippoli S, Vincenzi B, Watson S, Blay JY, Bauer S, Collaud S
Eur J Cardiothorac Surg · 2026 Feb · PMID 41514168 · Publisher ↗
OBJECTIVES: Primary pulmonary sarcomas (PPS) are rare, accounting for 1% of all pulmonary malignancies. No dedicated staging system for PPS is available. We tested the value of lung cancer and Trunk and Extremity Soft Ti...
OBJECTIVES: Primary pulmonary sarcomas (PPS) are rare, accounting for 1% of all pulmonary malignancies. No dedicated staging system for PPS is available. We tested the value of lung cancer and Trunk and Extremity Soft Tissue Sarcoma (STS) staging systems for PPS. METHODS: An international multicentre retrospective study including patients with PPS was performed through a network of sarcoma expert centres. Data on demographics, staging, multimodality treatment including surgery, and outcomes were retrieved. Patients were staged according to TNM for lung cancer (eighth edition) and American Joint Committee on Cancer (AJCC) Staging for Trunk and Extremity STS. Overall survivals (OS) were compared. RESULTS: A total of 173 patients with PPS from 18 centres from 9 European countries were included. Of these, 115 patients (66%) underwent curative-intent surgery. Median tumour size was 85 mm. Sixty-nine patients had grade 3 PPS (72%). Eleven patients had nodal involvement (16%). Five-year OS was 49%. Median follow-up was 33 months. According to TNM for lung cancer, 15 (13%) patients had stage I, 15 (13%) had stage II, 45 (40%) had stage III, and 22 (19%) had stage IV. Five-year OS were 90%, 55%, 48%, and 22%, respectively (P = .001). According to AJCC staging for Trunk and Extremity STS 3 (3.4%) patients had stage I, 19 (21.6%) had stage II, 39 (44.3%) had stage III, and 27 (30.7%) had stage IV (Table 1). Five-year OS were 100% 74% 50%, and 24%, respectively (P = .005). CONCLUSIONS: In our cohort of patients with curative-intent surgery for PPS, AJCC staging for Trunk and Extremity STS is more reliable than lung cancer staging system.
A novel magnetically levitated intrapericardial left ventricular assist system in advanced heart failure-2-year results from a prospective, multi-centre study.
Wang X, Chen H, Du J … +14 more , Zhou X, Zou L, Huang J, Chen L, Cheng Z, Dong N, Chen X, Liu J, Yang Y, Wang C, Yang Y, Shen Z, Wang H, Hu S
Eur J Cardiothorac Surg · 2026 Jan · PMID 41512307 · Publisher ↗
OBJECTIVES: Left Ventricular Assist Devices have become an important therapy for advanced heart failure. We present 2-year results of the prospective, multicentre clinical trial in China, showing long-term efficacy and s...
OBJECTIVES: Left Ventricular Assist Devices have become an important therapy for advanced heart failure. We present 2-year results of the prospective, multicentre clinical trial in China, showing long-term efficacy and safety of a novel miniaturized magnetically levitated, continuous-flow left ventricular assist system. METHODS: Patients were adults with a left ventricular ejection fraction <30% and a cardiac index < 2.0 L/min/m2 without inotropic, or dependence on continuous intravenous inotropes. Clinical data, including survival status, laboratory parameters, adverse events, and functional status, were collected at baseline and at 3, 6, 12, and 24 months and analysed. The primary end-point was the composite of survival at 2 years (on device support, transplant, or recovery), free of disabling stroke or device replacement. RESULTS: A total of 50 patients were enrolled in 12 centres between January 2022 and July 2022. At the 2-year follow-up, 39 patients (78%) remained on device support, 3 patients (6%) received heart transplants, and 1 patient (2%) had the device explanted due to cardiac recovery. The 2-year event-free survival was 86% (95% Confidence Interval [CI]: 73.3% - 94.2%). Major adverse events included right heart failure (n = 2, 4%), stroke (n = 3, 6%), driveline infection (n = 6, 12%), and gastrointestinal bleeding (n = 2, 4%). No haemolysis or device malfunction occurred. CONCLUSIONS: This study demonstrates promising long-term effectiveness and safety of the Corheart 6 left ventricular assist system for circulatory support in patients with advanced heart failure.ClinicalTrials.gov: NCT05353816.
Serum Cytokeratin 19 Fragment Antigen 21-1 as a Diagnostic and Prognostic Biomarker for Thymic Carcinoma in Thymic Masses.
Shen Z, Liu Y, Zhu T … +7 more , Zhu X, Zheng Y, Qiu J, Teng M, Fan P, Ji S, Zhang P
Eur J Cardiothorac Surg · 2026 Jan · PMID 41512303 · Publisher ↗
OBJECTIVES: The accurate differentiation of thymic masses, particularly thymic carcinoma (TC), is imperative for guiding optimal treatment selection. This study investigated potential non-invasive biomarkers for discerni...
OBJECTIVES: The accurate differentiation of thymic masses, particularly thymic carcinoma (TC), is imperative for guiding optimal treatment selection. This study investigated potential non-invasive biomarkers for discerning thymic malignancies and evaluated their clinical applicability. METHODS: Clinicopathological data from 1897 patients who underwent surgical resection for thymic masses across 2 institutions were retrospectively analysed. Associations between serum tumour markers and TC diagnosis were assessed using the area under the receiver operating characteristic curve (AUC). The clinical utility of the identified tumour markers was further evaluated. RESULTS: In the discovery cohort from Shanghai Pulmonary Hospital (SPH), cytokeratin 19 fragment antigen 21-1 (CYFRA 21-1) levels were significantly higher in the TC group compared to both the thymoma group and the non-thymic epithelial tumour (non-TET) group (median of 2.38 ng/mL vs 1.39 ng/mL or 1.28 ng/mL, both P < .001), with AUC value of 0.778 (95% CI: 0.735-0.822) compared to thymoma and 0.808 (95% CI: 0.766-0.849) compared to non-TET group. Validation in the cohort from Renmin Hospital of Wuhan University further demonstrated significant discrimination of CYFRA 21-1 for TC diagnosis (vs thymoma: AUC = 0.681 [95% CI: 0.518-0.843]; vs non-TET: AUC = 0.801 [95% CI: 0.622-0.980]). Furthermore, high CYFRA 21-1 levels were also correlated with a shorter median disease-free survival compared to the low CYFRA 21-1 group (10.0 years vs 14.9 years, P < .001) in patients with TET in the SPH cohort. CONCLUSIONS: CYFRA 21-1 emerges as a reliable diagnostic biomarker for distinguishing TC from other thymic masses. Moreover, it holds promise for prognosis evaluation and potentially for recurrence surveillance.
Automated Suture Securing Technology in Mitral Valve Surgery: A Strategy to Reduce Prosthetic Dehiscence?
Kahrovic A, Herkner H, Werner P … +8 more , Angleitner P, Coti I, Osipenko K, Lagler H, Kocher A, Ehrlich M, Zimpfer D, Andreas M
Eur J Cardiothorac Surg · 2026 Jan · PMID 41512298 · Full text
OBJECTIVES: This study aimed to assess long-term outcomes of automated titanium fasteners versus hand-tied knots in mitral valve surgery. METHODS: In this retrospective, single-centre analysis, 2678 adult patients who un...
OBJECTIVES: This study aimed to assess long-term outcomes of automated titanium fasteners versus hand-tied knots in mitral valve surgery. METHODS: In this retrospective, single-centre analysis, 2678 adult patients who underwent mitral valve repair or replacement between November 2008 and November 2024 at the Medical University of Vienna were included. Patients were grouped according to the suture-securing technique used: automated titanium fasteners versus hand-tied knots. The primary endpoint was prosthetic dehiscence (either mitral annuloplasty ring or valve replacement prosthesis) requiring reintervention. Secondary endpoints comprised ischaemic stroke, intracranial bleeding, and all-cause mortality during the follow-up period. RESULTS: Among the study population, 1072 (40%) underwent mitral valve surgery using an automated titanium fastener device, and 1606 (60%) with conventional hand-tied sutures. A total of 31 patients (1.2%) had prosthetic dehiscence during the follow-up period. The risk of prosthetic dehiscence was significantly lower in the automated titanium fastener group in both univariable (crude sub-hazard ratio [sHR] 0.32; 95% confidence interval [CI], 0.12-0.86, P = .023) and multivariable competing risk regression analysis (adjusted sHR 0.34; 95% CI, 0.12-0.91, P = .033). Automated titanium fastener group was not associated with an increased risk of ischaemic stroke (adjusted sHR 0.92; 95% CI, 0.67-1.27, P = .600), intracranial bleeding (adjusted sHR 0.89; 95% CI, 0.52-1.52, P = .675), or all-cause mortality (adjusted hazard ratio 0.93; 95% CI, 0.74-1.18, P = .559). CONCLUSIONS: The use of an automated titanium fastener device seems to be associated with a lower risk of prosthetic dehiscence in mitral valve surgery. Due to the limited number of prosthetic dehiscence events and the potential for residual confounding, the results should be interpreted with caution.
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