Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
The lowest mitral valve area successfully treated by PTMC: a rare case.
Mansouri MH, Jazi MH, Najafabdian B … +4 more , Tavassoli A, Zavar R, Sadeghi AM, Behjati M
J Cardiothorac Surg · 2026 Jul · PMID 42399969 · Full text
We present a detailed case of a 39-year-old male patient with severe, symptomatic rheumatic mitral stenosis who was successfully treated with percutaneous transvenous mitral commissurotomy (PTMC) at Milad Hospital in Isf...
We present a detailed case of a 39-year-old male patient with severe, symptomatic rheumatic mitral stenosis who was successfully treated with percutaneous transvenous mitral commissurotomy (PTMC) at Milad Hospital in Isfahan, Iran. The patient presented with chronic dyspnea on exertion (New York Heart Association class III) and fatigue, and pre-procedural two-dimensional and three-dimensional echocardiography confirmed a critically low mitral valve area (MVA) of 0.36 cm[Formula: see text] (3D planimetry with multiplanar reconstruction) and a challenging valve morphology, as assessed by a high Wilkins score of 10 and a 3D echocardiographic score of 8. The PTMC procedure, performed with an Inoue balloon, was uneventful and resulted in a marked improvement in valve function, with the MVA increasing to [Formula: see text] and the systolic pulmonary artery pressure decreasing from 45 mmHg to 30 mmHg. Mitral regurgitation remained trivial/mild (grade 1+) throughout. At one-month follow-up, the patient was in NYHA class II and the MVA remained stable. This case highlights that PTMC remains a highly effective and safe intervention for severe mitral stenosis, even in patients with high-risk valve morphology, when performed by experienced operators in a specialized tertiary care center and guided by a multidisciplinary Heart Team.
Evaluating inferior vena cava reflux and RV/LV ratio as predictors of acute pulmonary thromboembolism severity.
Goudarzi E, Akbarzadeh D, Aghajani S … +3 more , Sabbagh Alvani MA, Faghihi Langroudi T, Khaheshi I
J Cardiothorac Surg · 2026 Jul · PMID 42393787 · Full text
PURPOSE: This study aimed to evaluate the predictive value of inferior vena cava (IVC) reflux and the right ventricle to left ventricle ratio (RV/LV ratio) in risk stratification of acute pulmonary thromboembolism (APTE)...
PURPOSE: This study aimed to evaluate the predictive value of inferior vena cava (IVC) reflux and the right ventricle to left ventricle ratio (RV/LV ratio) in risk stratification of acute pulmonary thromboembolism (APTE) patients. METHODS: In this retrospective, cross-sectional study, eighty-six patients diagnosed with APTE underwent computed tomography pulmonary angiography (CTPA). The pulmonary arterial obstruction index (Qanadli score) was evaluated by an experienced radiologist, along with the RV/LV ratio and IVC reflux grading (1-6) based on CTPA. Correlations between the Qanadli score, IVC reflux grade, and RV/LV ratio were analyzed. Linear regression was performed after confirming regression assumptions. Additionally, IVC reflux grade and Qanadli score were compared between patients with RV/LV ratios below and above 0.9. RESULTS: The mean Qanadli score was 7.20 ± 8.04. A significant correlation was found between the Qanadli score and IVC reflux grade (r = 0.601, p < 0.001), whereas no significant correlation was observed between the Qanadli score and RV/LV ratio (r = 0.131, p = 0.230). Further analysis demonstrated a significant linear association between the Qanadli score and IVC reflux grade, with a regression coefficient of 3.98 ± 0.55 (p < 0.001) and an adjusted R² of 0.38. However, patients with an RV/LV ratio > 0.9 did not show a significant difference in IVC reflux grade (p = 0.176) or Qanadli score (p = 0.439). CONCLUSION: Our study highlights IVC reflux as a potential valuable imaging marker for assessing APTE severity, while also pointing out the limitations of relying solely on the RV/LV ratio for risk stratification.
MiR-32-3p improves ISO induced AC16 myocardial cell injury by targeting ATF4.
Chen D, Hu D, Wang X … +3 more , Chen B, Lou W, Chen Y
J Cardiothorac Surg · 2026 Jul · PMID 42393729 · Full text
BACKGROUND: Pathological myocardial hypertrophy is a key risk factor for heart failure and cardiovascular death. MicroRNAs (miRNAs), as a key post transcriptional regulator of gene expression, play an increasingly import...
BACKGROUND: Pathological myocardial hypertrophy is a key risk factor for heart failure and cardiovascular death. MicroRNAs (miRNAs), as a key post transcriptional regulator of gene expression, play an increasingly important role in myocardial hypertrophy and injury. This study aimed to investigate the expression, function, and mechanism of miR-32-3p through the miR-32-3p/ATF4 axis in ISO induced injury of human AC16 cardiomyocytes. METHODS: A cell injury model was established by treating AC16 cells with 1 µM ISO. miR-32-3p mimic/inhibitor were transfected. Gene expression levels were detected using qRT-PCR; cell proliferation was evaluated via the CCK-8 assay; the levels of inflammatory cytokines (IL-6, TNF-α, IL-1β) were detected by ELISA; changes in oxidative stress levels (MDA, SOD, ROS) were analyzed using reagent kits; and the binding site between miR-32-3p and ATF4 was predicted through TargetScanHuman.; The miR-32-3p/ATF4 target relationship was validated using dual luciferase assays. RESULTS: ISO induced downregulation of miR-32-3p expression (P < 0.0001), inhibition of AC16 cell proliferation (P < 0.0001), upregulation of myocardial hypertrophy markers ANP and β-MHC, as well as increased levels of inflammatory cytokines IL-6, TNF-α, IL-1β and oxidative stress (all P < 0.0001). When the miR-32-3p mimic was added, these changes were reversed. The dual luciferase assay confirmed that bioinformatics predicted miR-32-3p to directly target the 3'UTR of ATF4. The rescue experiment showed that overexpression of ATF4 eliminated the protective effect of miR-32-3p (P < 0.05). CONCLUSIONS: miR-32-3p alleviates ISO induced AC16 cell damage by targeting ATF4, regulating inflammation and oxidative stress.
Association of red cell distribution width and lymphocyte count with the presence and severity of calcific aortic valve stenosis.
Gitmez M, Akboga MK
J Cardiothorac Surg · 2026 Jul · PMID 42387535 · Full text
BACKGROUND: Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease in the elderly, with pathogenesis involving chronic inflammation and oxidative stress. Identifying reliable, low-cost biomarkers...
BACKGROUND: Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease in the elderly, with pathogenesis involving chronic inflammation and oxidative stress. Identifying reliable, low-cost biomarkers for disease presence and severity remains a clinical priority. OBJECTIVE: To evaluate the prognostic significance of red cell distribution width (RDW) and lymphocyte count (LC) in assessing the presence and severity of CAVS. METHODS: In this retrospective study, 377 patients with echocardiographically confirmed CAVS and 309 healthy controls were analyzed. CAVS severity was stratified as mild, moderate, or severe. RDW and LC were measured from routine blood tests. Associations with CAVS severity were examined using correlation and logistic regression analyses. ROC curve analysis assessed the predictive performance of RDW and LC for severe CAVS. RESULTS: RDW levels increased progressively with CAVS severity (13.0%, 14.6%, and 15.5% for mild, moderate, and severe groups; p < 0.001), while LC decreased. RDW positively correlated with systolic transaortic gradient (r = 0.319, p < 0.001); LC was inversely correlated (r = -0.262, p < 0.001). Multivariate analysis identified RDW (OR: 2.519; 95% CI: 2.058-3.083; p < 0.001) and LC (OR: 0.261; 95% CI: 0.150-0.454; p < 0.001) as independent predictors of CAVS. RDW yielded an AUC of 0.774; LC had an AUC of 0.323. CONCLUSION: Elevated RDW and reduced LC are independently associated with the presence and severity of CAVS. These findings suggest that these hematological indices may reflect underlying systemic processes and could serve as adjunct markers in the clinical assessment of disease burden, although their prognostic utility requires further validation.
Trem1 exacerbates myocardial infarction-induced heart failure by inactivating the Rap1 pathway.
Liu J, Kou Z, Cao P … +2 more , Chen T, Zhang W
J Cardiothorac Surg · 2026 Jun · PMID 42381078 · Full text
Heart failure (HF) after myocardial infarction (MI) involves adverse cardiac remodeling. Trem1 may be a potential therapeutic target for MI, but its role in the HF process remains unclear. Our work aimed to investigate t...
Heart failure (HF) after myocardial infarction (MI) involves adverse cardiac remodeling. Trem1 may be a potential therapeutic target for MI, but its role in the HF process remains unclear. Our work aimed to investigate the effect of Trem1 on myocardial remodeling in MI-induced HF and the downstream molecular mechanism. The HF mouse model was established by left anterior descending (LAD) ligation, and cardiac function, hypertrophy markers, and fibrosis were measured. Additionally, Mouse cardiac fibroblasts (MCFs) were stimulated with angiotensin II (Ang II), and cell phenotypes, including proliferation and fibrosis, were detected. The regulation of Trem1 on the Rap1 pathway was evaluated using bioinformatics and western blot. We found that Trem1 was upregulated in HF mice (mean fold-change at RNA level was 4.68 and at protein level was 4.43) and AngII-treated MCFs (mean fold-change at RNA level was 6.28 and at protein level was 4.01). Trem1 knockdown improved cardiac function, as indicated by an increase in left ventricular ejection fraction (LVEF) from 36.45% to 58.62% and left ventricular fractional shortening (LVFS) from 18.78% to 30.19%, reduced hypertrophy (heart weight/body weight fold reduced from 6.40 to 4.85 and ANP and BNP mRNA expression was downregulated), and reduced collagen volume fraction from 30.47% to 14.33% in vivo. In AngII-stimulated MCFs, Trem1 silencing decreased cell viability by 48.76%, reduced EdU-positive cells by 46.92%, and downregulated fibrosis-related marker expression. Mechanistically, silencing of Trem1 promoted Rap1 pathway activation, manifested as an increase of 3.79 folds in Epac1, 1.90 folds in active Pap1, and 5.56 folds in Rac1 protein levels. Inhibition of Rap1 caused by GGTI298 partly reversed the effects of Trem1 knockdown both in vivo and in vitro. In conclusion, Trem1 promotes myocardial remodeling in post-MI HF by suppressing the Rap1 pathway, suggesting Trem1 is a potential therapeutic target.
Large aneurysm of the right atrial and the tetralogy of fallot: a rare case report and literature review.
Moghadam EA, Mirzaaghayan M, Mohsen SS
J Cardiothorac Surg · 2026 Jun · PMID 42381076 · Full text
INTRODUCTION: Congenital right atrial (RA) aneurysm is a rare cardiac anomaly, and its association with complex cyanotic heart disease, such as tetralogy of Fallot (TOF), is exceptionally uncommon. This combination poses...
INTRODUCTION: Congenital right atrial (RA) aneurysm is a rare cardiac anomaly, and its association with complex cyanotic heart disease, such as tetralogy of Fallot (TOF), is exceptionally uncommon. This combination poses significant diagnostic and therapeutic challenges. CASE PRESENTATION: We report the case of a 22-month-old boy with uncorrected TOF who was found to have a giant RA aneurysm (approximately 3 × 5 cm) causing significant compression of the left ventricle. The diagnosis was confirmed by transthoracic echocardiography and computed tomography angiography. The patient underwent complete single-stage surgical repair, including TOF correction (ventricular septal defect closure and right ventricular outflow tract reconstruction) and RA aneurysmectomy with patch closure of a large communication between the RA and the aneurysmal sac. OUTCOME: Despite a technically successful operation, the patient developed catastrophic hemodynamic collapse several hours postoperatively and could not be resuscitated. Post-mortem examination revealed re-expansion of the aneurysm with thrombus within the pericardial space, adjacent to the left ventricle. While the exact mechanism of hemodynamic collapse remains uncertain, the post-mortem findings suggest that the distended aneurysmal sac may have contributed to impaired cardiac filling or reduced ventricular preload. We hypothesize that residual vascular communications to the aneurymal cavity may have contributed to this fatal complication. CONCLUSION: This case highlights a rare and fatal association between a giant RA aneurysm and TOF. It underscores the critical importance of meticulous intraoperative evaluation for potential coronary-cameral fistulae or additional venous drainage into the aneurysmal sac. We recommend direct intraoperative testing, such as cardioplegic injection, to identify and ligate these vessels, which may be crucial for preventing fatal postoperative re-expansion in similar cases.
C-reactive protein-albumin-lymphocyte (CALLY) index and all-cause and cardiovascular mortality in the general population: a national health and nutrition examination survey analysis.
Xu XY, Li DH, Li YC … +6 more , Ou Q, Wei HY, Shi XY, Xie JY, Yan DD, Zhao ZW
J Cardiothorac Surg · 2026 Jun · PMID 42381074 · Full text
BACKGROUND: The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker integrating systemic inflammation (elevated C-reactive protein), nutritional status (decreased albumin), and immune function (r...
BACKGROUND: The C-reactive protein-albumin-lymphocyte (CALLY) index is a composite biomarker integrating systemic inflammation (elevated C-reactive protein), nutritional status (decreased albumin), and immune function (reduced lymphocyte count). Its prognostic significance for mortality in the general population remains insufficiently characterized. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 1999-2010), comprising 11,797 adults (5,671 men [weighted 48.4%] and 6,126 women [weighted 51.6%]; median age, 45 years). The CALLY index was calculated for each participant. Associations between the CALLY index and all-cause and cardiovascular mortality were evaluated using Kaplan-Meier analysis (for descriptive visualization), weighted multivariable Cox proportional hazards regression, Fine-Gray competing risk models, and restricted cubic spline (RCS) regression. Predictive performance was assessed using time-dependent receiver operating characteristic (ROC) analysis. The incremental predictive value beyond established risk factors was quantified using the integrated discrimination improvement (IDI) and category-free net reclassification improvement (NRI). RESULTS: Compared with the lowest quartile, the highest CALLY quartile was associated with lower risks of all-cause mortality (multivariable-adjusted hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.51-0.74; P < 0.001) and cardiovascular mortality (HR, 0.51; 95% CI, 0.39-0.68; P < 0.001). In Fine-Gray competing risk models, the subdistribution hazard ratio for cardiovascular mortality was 0.55 (95% CI, 0.39-0.76; P < 0.001), with a lower cumulative incidence of cardiovascular death in quartile 4 versus quartile 1 (Gray's test, P < 0.001). RCS analyses revealed significant non-linear associations: an approximately L-shaped relationship for all-cause mortality and a monotonically decreasing non-linear pattern for cardiovascular mortality (both P for non-linearity < 0.001). The CALLY index provided modest incremental predictive value beyond established risk factors for all-cause mortality (IDI, 0.4%; P = 0.007), but individual-level risk reclassification was limited (continuous NRI, 2.7%; P = 0.272). Significant effect modification for all-cause mortality was observed only for alcohol use (P for interaction = 0.005). CONCLUSION: Higher CALLY index values were significantly associated with lower mortality risk. The CALLY index demonstrated a significant, independent, and non-linear inverse association with all-cause and cardiovascular mortality in US adults. Its standalone predictive discrimination was modest (time-dependent AUC < 0.70), but its integration into multivariable risk models provided modest yet statistically significant incremental prognostic information (IDI, 0.4%; P = 0.007). Individual-level risk reclassification was limited (continuous NRI, 2.7%; P = 0.272). These findings suggest that CALLY may serve as a complementary biomarker for risk stratification when integrated with conventional risk factors rather than as a standalone prediction tool.
Minimally invasive mitral valve repair revisited: Respect or Resect? Amidst competing risks.
Brooks RW, Biaggi P, Gaemperli O … +5 more , Emmert MY, Jacobs S, Gruenenfelder J, Holubec T, Reser D
J Cardiothorac Surg · 2026 Jun · PMID 42374593 · Full text
BACKGROUND: Mitral valve repair (MVr) remains the preferred surgical treatment for degenerative mitral regurgitation (DMR), offering superior long-term outcomes compared with mitral valve replacement (MVR). However, the...
BACKGROUND: Mitral valve repair (MVr) remains the preferred surgical treatment for degenerative mitral regurgitation (DMR), offering superior long-term outcomes compared with mitral valve replacement (MVR). However, the optimal surgical strategy-leaflet preservation with or without neochordal implantation ('Respect') versus leaflet resection ('Resect'), or a combination thereof ('Both')-remains a matter of debate. Our aim was to compare the longer-term outcomes of these techniques in minimally invasive mitral valve surgery, in a real-world cohort encompassing anatomically complex valve pathology. METHODS: In this single-center, retrospective cohort study, 447 consecutive patients who underwent isolated MVr via right lateral mini-thoracotomy between 2006 and 2014 were included and analyzed. Patients were stratified according to the surgical repair technique ('Respect', 'Resect', or 'Both'). Primary endpoints were valve performance measures: freedom from mitral valve-related reoperation and mitral regurgitation severity during follow-up. Secondary endpoints were all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). Competing risk regression (Fine-Gray) was applied to account for death as a competing event. RESULTS: Of the total cohort, 293 patients (65.5%) underwent MVr using the 'Respect' technique, 109 (24.4%) underwent leaflet resection ('Resect'), and 45 (10.1%) received a combined approach ('Both'). In-hospital mortality was 0.7%, and cerebrovascular events occurred in 0.9% of patients. At a mean follow-up of 5 years, durable mitral valve competence was present in 88.4% of patients (MR grade ≤ I). Five-year freedom from mitral valve-related reoperation was 93.3%, with no significant differences between techniques (P = 0.647). Five-year survival was 94.0%, and 5-year freedom from MACCE was 96.8%, with no statistically significant differences between techniques. Competing risk analysis (death as competing event) confirmed the absence of significant intergroup differences. CONCLUSION: This study demonstrates that all three techniques yield equally favorable longer-term outcomes in a minimally invasive setting, extending even to anatomically complex degenerative pathologies such as Barlow's disease, bileaflet involvement, and anterior leaflet prolapse. A morphology-guided, individualized surgical approach emerges as a reliable and durable standard for the management of DMR.
Endovascular management of iliac vessel injury complicating lumbar disc surgery: a case report and review of literature.
Murshid M, Jamjoom R, Bokhari R … +3 more , Khoja S, Aljilani L, Toonsi F
J Cardiothorac Surg · 2026 Jun · PMID 42374523 · Full text
BACKGROUND: Lumbar disc surgery is one of the most commonly performed spinal procedures and is generally considered safe. However, rare complications such as major vascular injury can be life-threatening and are often di...
BACKGROUND: Lumbar disc surgery is one of the most commonly performed spinal procedures and is generally considered safe. However, rare complications such as major vascular injury can be life-threatening and are often difficult to recognize intraoperatively. These injuries most commonly involve the iliac vessels because of their close anatomical relationship to the L4-L5 disc space. Early diagnosis is challenging, and delayed recognition is associated with significant morbidity and mortality. With advances in endovascular techniques, minimally invasive management has emerged as an effective alternative to open surgical repair. Reporting such cases remains important to improve awareness, highlight diagnostic pitfalls, and illustrate evolving management strategies. CASE PRESENTATION: A 32-year-old previously healthy female presented with right lower limb radiculopathy due to an L4-L5 disc prolapse. She underwent elective minimally invasive tubular L4-L5 discectomy. During surgery, unexpected bleeding from the disc space was noted but appeared controlled with local measures. In the immediate postoperative period, the patient developed hypotension, tachycardia, and altered consciousness, along with a significant drop in hemoglobin and rising serum lactate levels. Computed tomography angiography demonstrated a large left retroperitoneal hematoma with active contrast extravasation and non-opacification of the left common iliac artery, consistent with major arterial injury. Emergency angiography confirmed the diagnosis, and endovascular covered stent placement was performed, achieving immediate hemostasis. The postoperative course was complicated by hemorrhagic shock, coagulopathy, and transient neurological deficits related to mass effect from the retroperitoneal hematoma. With intensive care support, blood product transfusion, and multidisciplinary management, the patient gradually stabilized and recovered. She was discharged in stable condition with improving neurological function and ongoing outpatient follow-up. CONCLUSIONS: Major vascular injury during lumbar disc surgery is rare but potentially fatal and may not be immediately evident during the procedure. Sudden postoperative hemodynamic instability should raise suspicion for vascular injury and prompt urgent imaging. Early computed tomography angiography and rapid endovascular intervention can be life-saving and may avoid the morbidity associated with open surgical repair. This case emphasizes the importance of early recognition, multidisciplinary collaboration, and the growing role of endovascular techniques in managing vascular complications of lumbar disc surgery.
Secondary prevention of recurrent ischemic stroke: from guidelines to precision medicine.
Liu S, Fong SY, Liu H … +1 more , Sun P
J Cardiothorac Surg · 2026 Jun · PMID 42374519 · Full text
Recurrent ischemic stroke remains a major global health challenge, accounting for substantial disability and mortality despite advances in acute management. Secondary prevention has undergone a fundamental paradigm shift...
Recurrent ischemic stroke remains a major global health challenge, accounting for substantial disability and mortality despite advances in acute management. Secondary prevention has undergone a fundamental paradigm shift-from standardized, population-based regimens toward individualized, mechanism-targeted precision medicine. This review integrates evidence from recent AHA/ASA and ESO guidelines and landmark clinical trials including NAVIGATE ESUS, RE-SPECT ESUS, CHANCE-2, INSPIRES, and COMPASS, highlighting how etiological diagnosis and multimodal risk stratification have reshaped secondary prevention strategies. In Embolic Stroke of Undetermined Source (ESUS), empirical anticoagulation has given way to systematic etiological investigation guided by advanced imaging and biomarkers. For non-cardioembolic stroke, dual antiplatelet therapy (DAPT) exemplifies precision in patient selection, timing, and pharmacogenomic-guided drug choice. Direct oral anticoagulants (DOACs) have become the standard for atrial fibrillation-related stroke and are being explored for broader vascular protection, while lipid management now pursues earlier, lower, and more intensive LDL-C targets through combination therapy. Finally, emerging fields-including metabolomics, genomics, and artificial intelligence-are driving the next generation of risk prediction and individualized therapeutic optimization; yet a substantial translational gap persists between these research advances and their routine clinical operationalization, a theme this review addresses explicitly throughout. Together, these developments define the future landscape of precision secondary prevention, bridging evidence-based guidelines with personalized vascular medicine.
Global research trends of cell death in diabetic cardiomyopathy from 2000 to 2024: a bibliometric analysis and integrative overview.
Yan M, Liang P, Huang H … +5 more , Zhang S, Kang J, Li Y, Li G, Wu H
J Cardiothorac Surg · 2026 Jun · PMID 42374512 · Full text
OBJECTIVE: Over recent years, the exploration of cell death mechanisms has become a central focus in the investigation of the pathogenesis and therapeutic prospects of diabetic cardiomyopathy. The purpose of this study w...
OBJECTIVE: Over recent years, the exploration of cell death mechanisms has become a central focus in the investigation of the pathogenesis and therapeutic prospects of diabetic cardiomyopathy. The purpose of this study was to delineate the current landscape of cell death research in diabetic cardiomyopathy using a bibliometric approach, and to provide an integrative overview of the major cell death pathways implicated in this condition, thereby offering valuable insights and academic resources, aiming to promote further research and advancements in associated disciplines. METHODS: A bibliometric analysis was conducted on diabetic cardiomyopathy-associated cell death. Publications derived from the Web of Science Core Collection were exported in full-text format and examined using CiteSpace 6.2 R4 and VOSviewer v.1.6.18. RESULTS: A total of 1,535 records satisfying the specified criteria were identified. During the first nine years, publication output was relatively low; however, there was a significant increase in the number of publications in both 2021 and 2024. China and Wenzhou Medical University led the research on cell death within diabetic cardiomyopathy, which encompassed 72 countries and 1,487 institutions. The author with the most published works was Cai Lu while the most cited author was Jia GH. Circulation Research was the journal with the highest number of co-citations. The most frequently appearing keywords included oxidative stress, apoptosis, activation, mechanisms, and heart failure. The extracted keywords were mainly associated with diabetic cardiomyopathy, cardiovascular disease, NLRP3, heart failure, and diabetes mellitus. CONCLUSION: The growing recognition of cell death as a potential therapeutic target in diabetic cardiomyopathy is reflected in a notable surge in pertinent research articles. This increase has established cell death as an important and evolving domain of study in the field. Beyond the bibliometric trends, the integrative discussion presented herein synthesizes the roles of multiple cell death mechanisms-including apoptosis, pyroptosis, necroptosis, ferroptosis, and others-in the pathogenesis of diabetic cardiomyopathy, offering a conceptual framework for future mechanistic and therapeutic investigations.
Immediate extubation post-surgery in cardiac patients: a retrospective single-center case series and literature review.
Cai X, Gao M, Chen J … +9 more , Liu R, Tang X, Li D, Li R, Yang G, Zhou H, Li D, Zhao X, Zeng Q
J Cardiothorac Surg · 2026 Jun · PMID 42374490 · Full text
BACKGROUND: Immediate extubation following cardiac surgery is rarely performed, largely due to concerns over hemodynamic instability, respiratory compromise, and potential postoperative complications. Most centers limit...
BACKGROUND: Immediate extubation following cardiac surgery is rarely performed, largely due to concerns over hemodynamic instability, respiratory compromise, and potential postoperative complications. Most centers limit immediate extubation to low-risk patients, leaving its broader applicability less understood. This study utilized a standardized anesthetic procedure to implement immediate extubation in a diverse cardiac surgical population with varying risk profiles based on a single-center case series. METHODS: We retrospectively reviewed the medical records of 34 cardiac surgery patients (congenital, valve, aortic, and coronary artery bypass grafting) from May 2024 to January 2025. A standardized, 10-step perioperative procedure was employed to facilitate immediate extubation. The effects of immediate extubation were assessed by extubation time, intensive care unit (ICU) length of stay, hospital length of stay, and postoperative complications. RESULTS: This study included 34 patients (73.5% male, mean age 55.9 ± 16.1 years), predominantly New York Heart Association class II (55.9%) and American Society of Anesthesiologists class IV (52.9%). Most completed preoperative pulmonary training with nebulization, and 88.2% maintained negative fluid balance pre-surgery. Valve replacements comprised 67.6% of cases, followed by coronary artery bypass grafting (17.6%) and congenital cardiac defect repairs (11.8%). Immediate extubation was achieved in 97.1% of patients (33/34), with mean extubation time of 5 ± 4.7 min post-operation. Mean ICU stay was 4 ± 4.1 days and postoperative hospitalization 14 ± 5.9 days. Acute kidney injury represented the most common complication (33.3%), followed by delirium (18.2%) and 24-hour reintubation (9.1%). Most perioperative complications remained manageable within standard protocols. CONCLUSION: Immediate extubation appears feasible in a carefully selected cohort of predominantly minimally invasive cardiac surgery patients managed under a standardised perioperative protocol, with an immediate extubation success rate of 97.1%. Larger, prospective, risk-stratified studies are needed before immediate extubation can be recommended as a broadly safe strategy across all cardiac surgical subgroups.
Recurrent lung cancer with multi-organ metastases showing remarkable regression after two weeks of targeted therapy: a case report.
Tang Y, Fu M, Wang J … +6 more , Guo N, Zhu H, Duan L, Li F, Zhou C, Han C
J Cardiothorac Surg · 2026 Jun · PMID 42374440 · Full text
BACKGROUND: Recurrent pulmonary malignancy with multi-organ metastasis remains one of the most refractory scenarios in thoracic oncology. Despite advances in systemic therapy, the prognosis for such cases remains poor. W...
BACKGROUND: Recurrent pulmonary malignancy with multi-organ metastasis remains one of the most refractory scenarios in thoracic oncology. Despite advances in systemic therapy, the prognosis for such cases remains poor. We report a case of disease recurrence with multiple metastatic lesions detected 34 months following initial surgical resection. After repeat surgical intervention, targeted therapy was initiated, resulting in complete resolution of brain and pericardial metastatic foci within two weeks-a response rarely observed in clinical practice. This case underscores the critical role of surgical intervention combined with precision targeted therapy in managing advanced lung cancer. It also highlights the potential of individualized treatment strategies to achieve favorable outcomes in refractory cases; it underscores the imperative for dynamic molecular monitoring and reaffirms the transformative potential of precision therapy in managing refractory metastatic non-small-cell lung cancer (NSCLC). CASE PRESENTATION: A 53-year-old woman was referred to our institution after a computed tomography (CT) scan identified a 1.2 cm × 0.9 cm solid nodule in the anterior segment of the left upper lobe. Preoperative assessments-including complete blood count, liver and renal function, coagulation profile, pulmonary function, electrocardiography, echocardiography, and tumor markers (alpha-fetoprotein and carcinoembryonic antigen)-were within normal limits. The patient underwent uncomplicated resection of the anterior segment. Histopathology confirmed a moderately differentiated invasive lung adenocarcinoma, and next-generation sequencing (NGS) detected an epidermal growth factor receptor (EGFR) exon 21 p.L858R mutation with a variant allele frequency (VAF) of 23.59%. Thirty-four months later, she developed intermittent chest tightness and exertional dyspnea. Chest CT showed a 9 mm × 8 mm part-solid nodule adjacent to the left mediastinal pleura and significant pericardial effusion. Brain imaging revealed metastatic lesions in the brainstem and left cerebellum, confirmed by magnetic resonance imaging (MRI). Thoracoscopic wedge resection confirmed recurrent lung adenocarcinoma. Repeat NGS identified the same EGFR p.L858R mutation with a markedly elevated VAF of 85.15%. Oral almonertinib was initiated, leading to complete resolution of brain metastases and near-complete resolution of pericardial effusion within two weeks. At eight-month follow-up, the patient remained asymptomatic with no evidence of disease progression. CLINICAL DISCUSSION: This case illustrates key aspects of recurrent lung adenocarcinoma management. Initial resection of a small nodule achieved local control, but recurrence with brain metastases and pericardial effusion later occurred, emphasizing the need for vigilant follow-up and multimodal imaging. Critical to the outcome was genotype-guided therapy: post-biopsy genetic testing guided almonertinib administration, leading to complete resolution of brain metastases and improved pericardial effusion within 2 weeks, which was defined according to response evaluation criteria in solid tumors (RECIST) 1.1 criteria. In NSCLC, activating mutations in the EGFR gene are detected, and these mutations render tumor cells highly sensitive to tyrosine kinase inhibitors (TKIs). The rapid response of the central nervous system (CNS) to targeted drugs highlights the value of personalized therapy in advanced-stage diseases. CONCLUSION: This case demonstrates the efficacy of genotype-guided targeted therapy in the management of recurrent lung adenocarcinoma presenting with brain metastases and pericardial effusion. The rapid and complete resolution of brain metastases and marked improvement in pericardial effusion within two weeks of initiating almonertinib therapy underscore the pivotal role of molecular profiling in guiding personalized treatment for advanced EGFR-mutated NSCLC. It also emphasizes the importance of rigorous postoperative surveillance for early detection of recurrence, thereby facilitating timely intervention and optimizing clinical outcomes in patients with advanced NSCLC.
Factors associated with air leak prolongation observed after lung cancer surgery.
Kamata S, Ishida I, Suzuki Y … +2 more , Suzuki H, Oura H
J Cardiothorac Surg · 2026 Jun · PMID 42366421 · Full text
PURPOSE: Risk factors that classify patients with postoperative air leaks into prolonged-air-leak (PAL, ≥ 5 days) and non-PAL populations remain unknown. Our objectives were to identify these risk factors and devise a sc...
PURPOSE: Risk factors that classify patients with postoperative air leaks into prolonged-air-leak (PAL, ≥ 5 days) and non-PAL populations remain unknown. Our objectives were to identify these risk factors and devise a scoring system to predict whether air leaks observed on postoperative day 1 will progress to PAL. METHODS: We conducted a retrospective examination of 329 patients after lung surgery. RESULTS: Significant factors associated with air leaks included male sex (p = 0.0097), low body mass index (BMI) (p = 0.0016), smoking (p = 0.0076), pack-years (0.0017), predicted vital capacity (p = 0.0053), predicted forced expiratory volume in one second (p = 0.0352), and operative duration (p = 0.0118). Furthermore, in patients with air leaks on the day after surgery, significant factors associated with PAL included low BMI (p = 0.0248), current smoking (p = 0.0054), pack-years (p = 0.005), and significant blood loss (p = 0.0147). Upon classifying the patients on day 1, one point each was allotted for BMI < 23.7, pack-years ≥ 28.5, current smoker, and blood loss ≥ 38 ml. Depending upon the risk factors present, the rates of PAL observed were 0%, 7.69%, 33.33%, 70.59%, and 83.33% associated with 0, 1, 2, 3, and 4 points, respectively (p < 0.001). CONCLUSIONS: For the first time, we identified risk factors for the onset of postoperative air leakage and PAL.
From metabolic to pathologic complete response: case report of Neoadjuvant Lorlatinib in Stage IIIB ALK-positive NSCLC combined with uniportal VATS.
Li R, Wang C, Li Y … +4 more , Zhao J, Wang X, Zhang M, Li S
J Cardiothorac Surg · 2026 Jun · PMID 42366402 · Full text
While stage IIIB non-small cell lung cancer (NSCLC) is generally considered unresectable, a subset of patients may benefit from neoadjuvant therapy following comprehensive evaluation. We report a 35-year-old non-smoking...
While stage IIIB non-small cell lung cancer (NSCLC) is generally considered unresectable, a subset of patients may benefit from neoadjuvant therapy following comprehensive evaluation. We report a 35-year-old non-smoking female diagnosed with stage IIIB (cT1bN2bM0) adenocarcinoma of the left lower lobe with multiple-station mediastinal lymph node metastasis. Based on multidisciplinary evaluation of multimodality imaging and ALK-positive status, the patient with high tumor burden yet no significant comorbidities received neoadjuvant lorlatinib. The patient achieved a complete metabolic response (CMR) on restaging PET-CT after 10 weeks of lorlatinib, which led to a multidisciplinary decision to undergo uniportal VATS lobectomy. Pathological examination confirmed a pathological complete response (pCR). After an uneventful 5-day hospitalization without complications, the patient remains disease-free at the 12-month follow-up. This is the first report of neoadjuvant lorlatinib followed by uniportal VATS achieving pCR predicted by CMR in stage IIIB ALK-positive NSCLC, given the limitations of short-term follow-up and a single-case design.
Cardiac performance and left ventricular dimensions in neonates with left-sided congenital diaphragmatic hernia before and after surgical repair.
Shalaby MM, Taha FA
J Cardiothorac Surg · 2026 Jun · PMID 42366400 · Full text
BACKGROUND: Congenital Diaphragmatic Hernia (CDH) is associated with significant cardiopulmonary morbidity. Pulmonary Hypertension (PH) and left ventricular (LV) dysfunction are major determinants of outcome. While the i...
BACKGROUND: Congenital Diaphragmatic Hernia (CDH) is associated with significant cardiopulmonary morbidity. Pulmonary Hypertension (PH) and left ventricular (LV) dysfunction are major determinants of outcome. While the impact of CDH repair on pulmonary hemodynamics is recognized, comprehensive serial assessment of cardiac performance, specifically LV dimensions and function, surrounding surgical repair is limited. OBJECTIVES: To characterize changes in LV dimensions, systolic/diastolic function, and global cardiac performance in neonates with CDH immediately before and within 48-72 h after surgical repair. METHODS: A prospective observational cohort study conducted between January 2022 and January 2025 in our tertiary center. Term neonates with isolated, left-sided Bochdalek CDH requiring surgical repair were included. Comprehensive transthoracic echocardiography (TTE) was performed at three time points: (1) Pre-Operative (Pre-Op): Within 24 h before repair (after initial stabilization), (2) Early Post-Operative (E-Post-Op): 48-72 h after completion of surgical repair. (3) One-month Post-Operative (M-Post-Op): One month after completion of surgical repair. Parameters measured from the LV and from the right ventricle (RV), Ventilator settings, inotrope score, and vasoactive-inotrope score (VIS) were recorded concurrently. Data were recorded and analyzed. RESULTS: Thirty neonates met the inclusion criteria (Median gestational age: 38 weeks [IQR 37-39], Birth weight: 3.0kg [IQR 2.7-3.3]). Significant PH was present pre-operatively in 70% (n = 21). Parameters of LV dimensions and function revealed: Left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) (absolute and z-score) increased significantly early and one-month post-repair (p < 0.05*). Left ventricular fractional shortening (LVFS), left ventricular ejection fraction (LVEF), and left ventricular global longitudinal strain (LVGLS) decreased significantly in the early post-operative period, then increased again to their normal levels one-month post-repair (p < 0.05*). The decrease in LV systolic function correlated with higher peak Post-Op VIS (r = -0.45, p = 0.01). Improvement in LVEDD correlated with lower oxygen requirements at 7 days post-op (r = -0.38, p = 0.03). The mitral inflow E/A ratio decreased significantly early post-repair and then improved for one month (p = 0.004*), while the average E/e' ratio did not change significantly. Parameters reflecting RV systolic function improved immediately post-repair: Tricuspid annular plane systolic excursion (TAPSE) and Right Ventricular global longitudinal strain (RVGLS) increased significantly (p < 0.05*). Estimated systolic pulmonary artery pressure (ESPAP) decreased significantly (p = 0.002*) and ventricular septal flattening was significantly less common post-repair. CONCLUSIONS: Surgical repair of CDH induces significant acute changes in cardiac performance. While reduction of herniated viscera rapidly improves LV dimensions (indicating relief of compression) and RV function/PAP, it is also associated with a transient impairment in LV systolic function and altered diastolic relaxation pattern in the immediate post-operative period.
Potential role of the C-reactive protein-albumin-lymphocyte (CALLY) index in predicting MIDCAB outcomes.
Ciftci H, Sahin M
J Cardiothorac Surg · 2026 Jun · PMID 42365370 · Full text
BACKGROUND: To determine the potential role of C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index in predicting minimally-invasive direct coronary artery bypass (MIDCAB) outcomes. METHODS: This study included 124...
BACKGROUND: To determine the potential role of C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index in predicting minimally-invasive direct coronary artery bypass (MIDCAB) outcomes. METHODS: This study included 124 consecutive patients who underwent MIDCAB surgery. Demographic properties of patients, CALLY index, operative parameters and post operative outcomes were recorded. Patients were stratified into quartiles based on their CALLY index values. For comparative analyses, the lower half (Q1-Q2) was designated as the low-CALLY group, and the upper half (Q3-Q4) as the high-CALLY group. RESULTS: Blood analyses revealed that patients in the higher CALLY group had significantly elevated albumin and lymphocyte levels and lower CRP concentrations (p < 0.01 for all). CALLY index was significantly higher in the Q3-Q4 group (median: 2.7 vs. 0.5, p < 0.001). Operative time was longer in the low CALLY index group (198.7 min vs. 162.2 min, p = 0.001). Among the operation time divisions, the time to reach the pericardium was similar between the groups, while preparation of vessels and anastomosis times were longer in the low CALLY group (p = 0.190, p = 0.001 and p = 0.009). Hospital length of stay was longer in the low CALLY group (p = 0.001). The complication rate was 27.4% in the low CALLY group and 9.6% in the high CALLY group (p = 0.011). CONCLUSION: For the first time the present study found a significant relationship between higher CALLY index and shorter operation time, shorter hospitalisation time. Additionally, patients with lower CALLY index were significantly more vulnerable to postoperative complications following MIDCAB. TRIAL REGISTRATION: Not applicable.
miR-2116-5p functions as a tumor suppressor in lung adenocarcinoma by targeting ADAM12 and serves as a prognostic biomarker.
Huang H, Xiao L, Xiao M … +3 more , Chen K, Chen S, Wu N
J Cardiothorac Surg · 2026 Jun · PMID 42363282 · Full text
BACKGROUND: MicroRNAs play key roles in tumor progression. miR-2116-5p is downregulated in lung adenocarcinoma (LUAD), and this study investigated its prognostic value and functional role in the disease. MATERIALS AND ME...
BACKGROUND: MicroRNAs play key roles in tumor progression. miR-2116-5p is downregulated in lung adenocarcinoma (LUAD), and this study investigated its prognostic value and functional role in the disease. MATERIALS AND METHODS: A total of 125 LUAD patients contributed tissue samples. miR-2116-5p and ADAM12 expression in tissues and cell lines were detected by RT‑qPCR. Clinicopathological correlations of miR-2116-5p were analyzed using the chi-square test. Kaplan‑Meier and Cox regression were employed to assess prognostic significance. CCK‑8, Transwell, and dual‑luciferase reporter assays were performed to investigate miR‑2116-5p function and its targeting of ADAM12. Rescue experiments validated the functional involvement of ADAM12. RESULTS: Significant downregulation of miR-2116-5p was observed in LUAD tissues and cell lines. Low expression was markedly linked to lymph node metastasis (P = 0.013) and advanced TNM stage (P = 0.002). Patients exhibiting reduced miR-2116-5p levels showed worse overall survival, and it was identified as an independent prognostic factor (HR = 2.521, 95% CI: 1.129-5.628, P = 0.020). Functional experiments showed that increasing miR-2116-5p expression suppressed LUAD cell proliferation, migration, and invasion, whereas its knockdown promoted these processes. ADAM12 was confirmed as a direct target, with expression inversely correlated in LUAD tissues (r = -0.749, P < 0.001). ADAM12 overexpression effectively counteracted the ability of miR-2116-5p to suppress proliferation, migration, and invasion. CONCLUSION: miR‑2116-5p suppresses LUAD progression by targeting ADAM12, suggesting it may serve as a prognostic biomarker and therapeutic target.
Attenuation of sepsis-associated acute lung injury by lncRNA LINC00052 via sponging miR-106b-5p.
Wang K, Guo Y, Yu X
J Cardiothorac Surg · 2026 Jun · PMID 42363260 · Full text
BACKGROUND: Sepsis-associated acute lung injury (SA-ALI) is a prevalent sequela of sepsis, which imposes a substantial public health burden. Due to the incomplete understanding of its underlying pathogenesis, no fundamen...
BACKGROUND: Sepsis-associated acute lung injury (SA-ALI) is a prevalent sequela of sepsis, which imposes a substantial public health burden. Due to the incomplete understanding of its underlying pathogenesis, no fundamental breakthroughs in its treatment have been achieved. To explore the predictive value of LINC00052 and miR-106b-5p in SA-ALI and clarify its mechanism. METHODS: LINC00052 and miR-106b-5p levels were quantified using real-time quantitative polymerase chain reaction (RT-qPCR). The predictive capacity for SA-ALI was assessed using receiver operating characteristic (ROC) curve analysis. Risk factors associated with ALI development were evaluated by Logistic regression. Pearson analysis was conducted to examine the correlation between LINC00052 and clinical indicators. Cellular viability was determined via cell counting kit-8 (CCK-8) assay and flow cytometry, while the concentrations of inflammatory and apoptotic factors were measured using enzyme-linked immunosorbent assay (ELISA) and Western blotting (WB). RESULTS: LINC00052 levels in serum from sepsis patients were lower than in the healthy group and further decreased with the development of SA-ALI, whereas miR-106b-5p expression showed the opposite trend. LINC00052 and miR-106b-5p demonstrated high diagnostic value in distinguishing ALI patients, with enhanced predictive efficacy when combined. LINC00052 expression was inversely correlated with clinical indicators in SA-ALI patients. Mechanistically, upregulation of LINC00052 modulated proliferation, apoptosis, inflammation, and apoptosis markers in A549 cells, an effect cancelled by miR-106b-5p mimic. CONCLUSIONS: LINC00052 functions by sponging miR-106b-5p to suppress apoptosis and mitigate inflammation, with the LINC00052/miR-106b-5p axis exhibits excellent predictive value for SA-ALI, underscoring their clinical relevance as both therapeutic targets and diagnostic biomarkers.
MicroRNA-425-5p as a diagnostic biomarker and ox-LDL-induced VSMC regulator in atherosclerosis.
Chen J, Lin B, Zhan Z
J Cardiothorac Surg · 2026 Jun · PMID 42363251 · Full text
BACKGROUND: MicroRNAs (miRNAs) are key regulators of atherosclerotic (AS) development. This study aimed to evaluate miR-425-5p expression patterns and their clinical relevance in patients with AS. METHODS: 131 patients w...
BACKGROUND: MicroRNAs (miRNAs) are key regulators of atherosclerotic (AS) development. This study aimed to evaluate miR-425-5p expression patterns and their clinical relevance in patients with AS. METHODS: 131 patients with AS and 112 controls were enrolled. Serum miR-425-5p and Krüppel-like factor 7 (KLF7) levels were quantified using RT-qPCR. ROC analysis assessed the diagnostic value of miR-425-5p for AS, and logistic regression identified risk factors. An in vitro AS model was established using ox-LDL-stimulated HVSMC cells. Cell viability, apoptosis, inflammatory cytokine secretion, and migration were assessed by CCK-8, flow cytometry, ELISA, and Transwell assays, respectively. Bioinformatics was used to predict the downstream target genes of miR-425-5p, and their targeting bindings were verified by DLR and RIP assays. RESULTS: miR-425-5p was significantly upregulated, while KLF7 was downregulated, in serum of AS patients and in ox-LDL-stimulated HVSMCs. Serum miR-425-5p was positively correlated with CIMT, TG, and LDL-C, and negatively correlated with HDL-C. It showed favorable diagnostic performance for AS (85.50% sensitivity, 85.71% specificity) and was identified as an independent risk factor for AS. Moreover, ox-LDL-induced HVSMC dysfunction, including reduced viability, increased apoptosis, elevated migration, and excessive inflammation, was attenuated by miR-425-5p inhibition and further attenuated by KLF7 knockdown. CONCLUSIONS: Serum miR-425-5p demonstrates diagnostic potential for AS and correlates with HVSMC proliferation, apoptosis, migration, and inflammatory responses.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe