Journal Of Cardiothoracic Surgery[JOURNAL]
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200 papers
Emergency donor pericardial conduit for ruptured pulmonary artery in lung transplantation for severe PH: a case report.
Chen J, Liu D, Zhang J … +1 more , Han W
J Cardiothorac Surg · 2026 Jun · PMID 42243862 · Full text
BACKGROUND: Intraoperative pulmonary artery (PA) rupture is a rare but catastrophic complication during lung transplantation, particularly in patients with severe pulmonary hypertension (PH). Effective salvage strategies...
BACKGROUND: Intraoperative pulmonary artery (PA) rupture is a rare but catastrophic complication during lung transplantation, particularly in patients with severe pulmonary hypertension (PH). Effective salvage strategies in this setting are not well described. This case report details the successful emergency application of a readily available donor pericardial conduit to manage an uncontrollable PA rupture during lung transplantation for end-stage idiopathic pulmonary fibrosis (IPF) with severe PH. CASE PRESENTATION: A 58-year-old woman with end-stage IPF and severe PH (preoperative pulmonary artery systolic pressure 105 mmHg) underwent bilateral lung transplantation. Immediately upon reperfusion of the left lung, an acute longitudinal dissection and rupture of the recipient's left main PA occurred, causing massive hemorrhage unresponsive to re-clamping due to extreme vessel friability. After emergent conversion from peripheral veno-arterial extracorporeal membrane oxygenation to full cardiopulmonary bypass, the damaged PA segment was resected. A 24-mm tubular conduit was fashioned intraoperatively from donor pericardium and anastomosed end-to-end to restore vascular continuity. The patient survived the procedure. Her postoperative course was complicated by a resistant Burkholderia cepacia infection, requiring prolonged treatment and tracheostomy. She was discharged on postoperative day 86. The follow-up CTA two months later showed that the catheter was widely patent and that the anastomosis had mild stenosis, which did not affect blood flow. CONCLUSION: Emergency reconstruction of a ruptured PA using an on-site fabricated donor pericardial conduit is a feasible and life-saving salvage technique in the setting of severe PH. Although the technique itself is not novel, its application in this extreme scenario-where the native PA is exceptionally friable and direct repair is impossible-offers a practical, biocompatible, and infection-resistant solution. We highlight the critical decision-making, technical execution, and lessons learned for perioperative preparedness in high-risk transplant recipients.
A rare case of relapsed primary pulmonary synovial sarcoma (PPSS) following surgery with multidisciplinary team management: case report and systematic review of literature.
Haj Khalaf MA, Higaze M, Kikoyan H … +5 more , Hartmann A, Agaimy A, Stöhr R, Rieker R, Sirbu H
J Cardiothorac Surg · 2026 Jun · PMID 42243856 · Full text
BACKGROUND: Primary pulmonary synovial sarcoma (PPSS) is a rare and invasive subtype of soft tissue sarcoma that originates in the lung. Because of its rare incidence, nonspecific presentation, and radiographic overlap w...
BACKGROUND: Primary pulmonary synovial sarcoma (PPSS) is a rare and invasive subtype of soft tissue sarcoma that originates in the lung. Because of its rare incidence, nonspecific presentation, and radiographic overlap with other thoracic malignancies, diagnosis is often delayed. This systematic review aims to synthesize evidence to improve clinical management of such case presentations. METHODS: This systematic review was conducted and reported in accordance with the PRISMA statement, which guided the literature search strategy, data extraction, and data management. To ensure structured and consistent data collection, the PICO framework was applied to define the population, intervention, comparison, and relevant outcomes for each individual reported case of primary pulmonary synovial sarcoma (PPSS). Methodological quality of the included reports was assessed using the Murad tool for case reports and case series. The search targeted single-case reports and case series published through April 2025. In addition, we report a 58-year-old male patient with a confirmed primary pulmonary synovial sarcoma (PPSS). Treatment was provided by a multidisciplinary team (MDT) at the Department of Thoracic Surgery, University Hospital Erlangen. RESULTS: The result of our systematic review revealed a total of 146 PPSS cases. Geographical distribution: Asia (56.6%, 82 cases), the Americas (21.4%, 31), Europe (20%, 29), and Africa (2%, 4). The majority of reported patients were male (61.6%, 90), and (29.5%, 43) reported smoking. The surgical resection was performed in (91.1%, 133), chemotherapy in (51.4%, 75), and radiotherapy in (24.0%, 35). Most patients underwent open surgical resection (72.6%), predominantly lobectomy (65.1%), reflecting advanced tumor size at diagnosis, with 80.1% of tumors measuring ≥ 3 cm. The monophasic subtype was the most common (62.3%, 91), followed by the biphasic subtype (22.0%, 32) and the poorly differentiated subtype (15.8%, 23). At the time of publication, the reported patient shows no evidence of disease (NED). CONCLUSION: PPSS requires early diagnosis and multidisciplinary management. Surgical resection is still the most important measure, supplemented by chemotherapy and/or radiotherapy. However, recurrence remains a major challenge. Further research is needed to standardize treatment and improve outcomes.
A case of phlegmonous esophagitis complicated by pharyngeal infection: so-called descending necrotizing esophagitis.
Azuma Y, Sakai T, Koezuka S … +4 more , Kusano M, Kato S, Toba T, Iyoda A
J Cardiothorac Surg · 2026 Jun · PMID 42243852 · Full text
BACKGROUND: Descending necrotizing mediastinitis (DNM) is a fatal disease caused by odontogenic or pharyngeal infection extending into the mediastinum along the deep fascial surface, retropharyngeal space, or peritrachea...
BACKGROUND: Descending necrotizing mediastinitis (DNM) is a fatal disease caused by odontogenic or pharyngeal infection extending into the mediastinum along the deep fascial surface, retropharyngeal space, or peritracheal space. Although the esophagus is generally excluded from the infectious spillover route, in extremely rare cases deep neck infections can cause phlegmonous esophagitis. Herein, we report a case of phlegmonous esophagitis that was difficult to differentiate from DNM. CASE PRESENTATION: A 61-year-old man was diagnosed with deep neck infection and DNM based on radiological findings and underwent emergency cervical drainage with a tracheostomy and right thoracotomy with mediastinal drainage. Intraoperative findings showed swelling of the entire esophagus, and esophageal esophagitis was diagnosed by esophagogastroduodenoscopy following surgery. The patient made favorable progress on treatment with antibiotics and fasting. CONCLUSIONS: To accurately diagnose this severe condition (so-called descending necrotizing esophagitis) radiologic and intraoperative intrapleural findings are important.
Research progress on coronary heart disease and cytokines: mechanisms, clinical implications, and future directions.
Zhang L, Xu J, Sun G
J Cardiothorac Surg · 2026 Jun · PMID 42243844 · Full text
Coronary heart disease (CHD) is a prevalent cardiovascular condition with increasing prevalence and mortality, where inflammation plays a key pathogenic role. Cytokines, critical mediators of immune and inflammatory resp...
Coronary heart disease (CHD) is a prevalent cardiovascular condition with increasing prevalence and mortality, where inflammation plays a key pathogenic role. Cytokines, critical mediators of immune and inflammatory responses, are closely involved in CHD progression by regulating inflammation, myocardial apoptosis, endothelial dysfunction, and vascular smooth muscle cell proliferation. It introduces cytokines' basic properties, elaborates on pro-inflammatory (TNF-α, IL-1, IL-6) and anti-inflammatory (IL-10, TGF-β) cytokines' specific effects on atherosclerosis and cardiomyocyte function, and discusses their clinical value in risk assessment, prognosis, and targeted therapy. Existing research gaps and future directions (e.g., advanced technologies, personalized therapies) are highlighted. This review provides a comprehensive overview to inform CHD basic research and clinical management.
Recurrent cardiac hydatid cyst: a rare case of initial misdiagnosis and successful surgical management.
Afshar S, Moeinipour Y, Poorzand H … +4 more , Ghods K, Amadeh Taheri A, Afkhami Teimouri G, Moeinipour A
J Cardiothorac Surg · 2026 Jun · PMID 42243834 · Full text
BACKGROUND: Cardiac hydatid cyst (CHC), caused by Echinococcus granulosus, is a rare condition, comprising approximately 0.5-2% of hydatid cases. Despite its rarity, CHC presents significant clinical challenges, includin...
BACKGROUND: Cardiac hydatid cyst (CHC), caused by Echinococcus granulosus, is a rare condition, comprising approximately 0.5-2% of hydatid cases. Despite its rarity, CHC presents significant clinical challenges, including mechanical obstruction, valvular dysfunction, arrhythmias, and the risk of anaphylactic shock due to cyst rupture. Surgical resection remains the standard treatment, but non-adherence to post-operative albendazole therapy is a major cause of recurrence. CASE PRESENTATION: We report a 43-year-old man from an endemic rural region with a history of pulmonary hydatid cyst surgery five years earlier, who had prematurely discontinued albendazole and was lost to follow-up. He presented with progressive exertional dyspnea and signs of right-sided heart failure, including peripheral edema and ascites. Transthoracic and transesophageal echocardiography demonstrated a mass-like structure in the right ventricle causing outflow obstruction, and the working preoperative diagnosis was double-chambered right ventricle (DCRV) due to prominent hypertrophied muscle bundles. No dedicated hydatid serology or advanced cross-sectional cardiac imaging (CT or MRI) was obtained before surgery, and the patient was referred for correction of presumed structural heart disease. Intraoperatively, a large, partially perforated cystic lesion arising from the interventricular septum and infundibulum of right ventricle extending toward the tricuspid annulus was unexpectedly encountered and identified as a hydatid cyst; the diagnosis was subsequently confirmed by histopathological examination of the excised specimen. The cyst was completely removed, tricuspid valve competence was restored, and the patient experienced marked clinical improvement, with re-initiation of albendazole therapy at discharge. DISCUSSION: This case demonstrates how intracardiac hydatid cysts can masquerade as structural heart diseases such as DCRV, leading to initial diagnostic misinterpretation. In endemic areas, clinicians should maintain a high index of suspicion for parasitic etiology, particularly in patients with previous hydatid disease. Integration of clinical, laboratory, and multimodal imaging data is essential for accurate diagnosis and timely surgical management. CONCLUSION: Our case emphasizes the need for strict adherence to anti-parasitic therapy to prevent recurrence and highlights the complexities of diagnosing and managing CHCs. The challenges of echocardiographic diagnosis further reinforce the necessity of comprehensive imaging approaches and multidisciplinary management for optimal patient outcomes.
Preoperative pulmonary valve annulus diameter z score as a predictor of pulmonary regurgitation after tetralogy of Fallot repair: a retrospective cohort study.
Busro PW, Adityawarman A, Wardoyo S … +5 more , Wibawanti R, Aulia Sakti DD, Lelya O, Kurniawati Y, Lilyasari O
J Cardiothorac Surg · 2026 Jun · PMID 42243828 · Full text
BACKGROUND: Tetralogy of Fallot (ToF) is the most common cause of cyanotic congenital heart disease and pulmonary regurgitation (PR) remains its most frequent postoperative complication. The preoperative z score of the p...
BACKGROUND: Tetralogy of Fallot (ToF) is the most common cause of cyanotic congenital heart disease and pulmonary regurgitation (PR) remains its most frequent postoperative complication. The preoperative z score of the pulmonary valve annulus (PVA) has been associated with an increased risk of PR after ToF repair; however, the optimal cut-off value varies among studies and has not been investigated in the Indonesian population. This study aimed to determine the predictive value of the preoperative MSCT-derived PVA diameter z score for early PR after ToF repair. METHODS: This retrospective cohort study was conducted using secondary data from pediatric patients who underwent ToF repair at the National Cardiac Center Harapan Kita between January 2023 and December 2024. The preoperative PVA diameter was measured using cardiac multislice computed tomography (MSCT). Early PR was assessed via echocardiography within 45 days post-operatively. Multivariable logistic regression was performed and receiver operating characteristic (ROC) curve analyses were performed. RESULTS: A total of 101 subjects were analysed. Both maximal and minimal diameters of the PVA z scores were associated with moderate or greater PR in the univariate analysis (p = 0.001 and p < 0.001, respectively). However, in multivariate analysis, only transannular patch (TAP) remained an independent predictor (p < 0.001), while PVA z scores were no longer statistically significant. ROC analysis revealed that the minimal diameter of the PVA z score (area under the curve [AUC] 0.701; cut-off - 2.5) demonstrated moderate discriminatory ability, with high specificity (90.6%) but limited sensitivity (42%). CONCLUSION: Preoperative PVA z score is associated with early PR but does not independently predict the outcome after adjustment, as its effect is largely mediated by surgical strategy, particularly the use of TAP. While the proposed cut-off of - 2.5 demonstrates high specificity, its low sensitivity limits its utility as a screening tool. PVA z score should therefore be interpreted alongside intraoperative factors rather than used as a standalone predictor of postoperative PR, as it reflects a preoperative anatomical parameter that influences surgical decision-making.
Rosuvastatin calcium administration and its impact on myocardial microcirculation and postoperative recovery in patients undergoing coronary artery bypass grafting.
Wang X, Qi H, Zhao J … +2 more , Chen N, Yuan B
J Cardiothorac Surg · 2026 Jun · PMID 42237405 · Full text
BACKGROUND: Coronary artery bypass grafting (CABG) is a common intervention for coronary artery disease, but postoperative myocardial microcirculation and recovery remain challenging. This study aimed to evaluate the eff...
BACKGROUND: Coronary artery bypass grafting (CABG) is a common intervention for coronary artery disease, but postoperative myocardial microcirculation and recovery remain challenging. This study aimed to evaluate the effects of rosuvastatin calcium on myocardial microcirculation and postoperative outcomes in CABG patients. METHODS: This retrospective cohort study included 216 patients who underwent CABG between February 2020 and February 2024. Participants were divided into a conventional treatment group (n = 111) and a rosuvastatin group (n = 105) receiving additional rosuvastatin calcium (10 mg/day) from 7 days pre-surgery to 28 days post-surgery. Cardiac echocardiography, blood tests (inflammatory markers, lipids, and cardiac enzymes), and New York Heart Association (NYHA) functional classification were assessed preoperatively and 8 weeks postoperatively. Postoperative complications and mortality were monitored during a one-year follow-up. RESULTS: The rosuvastatin group showed significantly improved left ventricular remodeling, with reduced left ventricular end-diastolic diameter (LVEDD, P = 0.022), Left Ventricular Septal Thickness (LVST, P = 0.048), and Left Ventricular Posterior Wall Thickness (LVPWT, P = 0.019). Enhanced systolic function was evidenced by higher LVEF (P < 0.001) and Left Ventricular Fractional Shortening (LVFS, P < 0.001). Myocardial microcirculation parameters including Left Acceleration Time (AT), Pulsatility Index (PI), and Aortic Pre-Ejection Period (APT) also improved (all P < 0.05). Additionally, the rosuvastatin group had lower postoperative creatine kinase MB isoenzyme (CK-MB, P = 0.012), higher High-Density Lipoprotein Cholesterol (HDL-C, P = 0.003), and reduced incidence of atrial fibrillation (P = 0.007) and all-cause mortality (P = 0.026). CONCLUSION: Rosuvastatin calcium administration significantly improves myocardial microcirculation, cardiac function, and postoperative recovery in CABG patients.
Neurological injury in patients with acute myocardial infarction undergoing operative myocardial revascularization within 48 h.
Heumüller F, Huenges K, Trigui N … +10 more , Tulun A, Markscheffel B, Panholzer B, Attmann T, Thiem A, Gravert H, Langguth P, Sommer W, Warnecke G, Grothusen C
J Cardiothorac Surg · 2026 Jun · PMID 42237367 · Full text
BACKGROUND: Acute myocardial infarction (AMI) is associated with an increased rate of neurological events (NE). AMI patients, who undergo coronary artery bypass graft (CABG) surgery may be at an even greater risk for per...
BACKGROUND: Acute myocardial infarction (AMI) is associated with an increased rate of neurological events (NE). AMI patients, who undergo coronary artery bypass graft (CABG) surgery may be at an even greater risk for peri-operative NE, but detailed data is missing. METHODS: We conducted a retrospective, single-center data analysis of 1628 patients that underwent CABG within 48 h after being diagnosed with AMI. Between 01/2001 and 03/2023, 77 patients (4.7%) suffered from a peri-operative NE. This included 66 (4.0%) thromb-embolic strokes and 11 (0.7%) hypoxic brain damages. We compared the outcome between NE patients and those without (w/o) NE. Primary outcome parameters were 30-day mortality and long-term survival. Secondary outcome parameters included post-operative ICU length of stay, transfusion rates and need for renal replacement therapy (RRT). RESULTS: Median time from AMI diagnosis to CABG was 7.6 h (4.4-16.4 h). Significantly more NE patients were smokers (n = 36(46.8%) vs. n = 532(34.5%);p = 0.04) and presented with a severely reduced left ventricular function pre-operatively (n = 15(20.3%) vs. n = 161(11.1%);p = 0.02). NE patients had undergone CPR pre-operatively more often than patients w/o NE (n = 23(29.9%)vs n = 168(10.8%);p < 0.001). Accordingly, EuroScore II was significantly higher in NE patients compared to patients w/o NE (7.8 (4.2-14.3) vs. 4.9 (2.8-10.2); p < 0.001). Intra-operatively, bypass-time proved to be longer in NE patients (117 (94-149) vs. 107 (88-130)minutes; p = 0.02). Post-operatively, significantly more NE patients had to stay longer than 48 h in the ICU (n = 72 (94.7%) vs. n = 866 (55.8%); p < 0.001). Neither transfusion rates nor need for RRT differed between the groups. Thirty day mortality was higher in NE patients (n = 16 (20.8%) vs. n = 165 (10.7%); p < 0.01). Pre-operative diagnosis of peripheral artery disease (pad) and need for CPR were identified as independent predictors of 30-day mortality in NE patients. Ten-year survival of NE patients remained impaired compared to patients w/o NE (39% vs. 69%; p < 0.001). CONCLUSION: AMI Patients undergoing CABG within 48 h are at an increased risk for neurological injuries. In particular, patients with generalized atherosclerosis and those that underwent CPR pre-operatively, seem to represent a vulnerable subgroup. Further studies have to clarify whether individualized peri-operative actions may reduce the stroke rates in this setting.
Air embolism resulting from contrast agent injection during coronary computed tomography: a case report.
Fan Y, Han H, Chai Z … +5 more , Zhang Y, Du Y, Jing L, Jing F, Xu F
J Cardiothorac Surg · 2026 Jun · PMID 42237342 · Full text
BACKGROUND: Air embolism is a rare but potentially lethal iatrogenic complication. Clinicians must recognize its warning signs and implement timely standardized interventions, as early detection is crucial to reduce morb...
BACKGROUND: Air embolism is a rare but potentially lethal iatrogenic complication. Clinicians must recognize its warning signs and implement timely standardized interventions, as early detection is crucial to reduce morbidity and mortality. This report presents a case of venous air embolism following coronary computed tomography angiography (CCTA). CASE PRESENTATION: A 60-year-old female developed air embolism due to contrast agent administration during a coronary CT study, presenting with new-onset dyspnea and dizziness approximately 1 min after the end of contrast injection, immediately after completing the CT scan. Following treatment including high-flow oxygen therapy (10 L/min), fluid resuscitation, and left lateral decubitus position with head down, her vital signs stabilized and arterial blood gas parameters returned to normal. A follow-up CT scan 7 days later showed complete absorption of the air emboli, and the patient was discharged uneventfully. DISCUSSION: The patient was diagnosed with grade 1 venous air embolism (VAE) according to the Tubingen VAE grading scale, with an estimated air volume of 5-10mL. The mild clinical manifestations were consistent with the small air volume and slow entry rate, and the patient achieved a favorable prognosis with timely standardized interventions. This case highlights the importance of vigilance for VAE during contrast-enhanced CT, even in patients with mild and non-specific symptoms. CONCLUSION: While rare, air embolism can cause mild symptoms with small volumes, but larger volumes may be life-threatening. Air embolism should be suspected in patients with sudden neurological, respiratory or cardiovascular symptoms, especially in the presence of iatrogenic risk factors. Prompt cessation of the embolism source, appropriate patient positioning, high-flow oxygen therapy, and hyperbaric oxygen treatment when indicated should be initiated immediately to minimize air entry into the right ventricular outflow tract. These timely interventions can prevent disease progression, improve patient outcomes and reduce mortality. TRIAL REGISTRATION: This case report does not involve a clinical trial.
Thoracoscopic diagnosis of tuberculous pleuritis mimicking pleural malignancy with chest wall involvement: a challenging case report.
Rshrash MNT, Saleh A, Abdulrazzak A
J Cardiothorac Surg · 2026 Jun · PMID 42237338 · Full text
BACKGROUND: Tuberculous pleuritis is a common form of extrapulmonary tuberculosis that may closely mimic pleural malignancy, particularly when associated with loculated effusion, pleural thickening, or chest wall involve...
BACKGROUND: Tuberculous pleuritis is a common form of extrapulmonary tuberculosis that may closely mimic pleural malignancy, particularly when associated with loculated effusion, pleural thickening, or chest wall involvement. This diagnostic challenge is amplified in resource-limited settings. CASE PRESENTATION: We report a 41-year-old male with a 30 pack-year smoking history who presented with a two-month history of pleuritic chest pain, dyspnea, night sweats, and significant weight loss. Imaging revealed a large loculated right-sided pleural effusion with diffuse pleural thickening and associated rib destruction, raising strong suspicion for pleural malignancy. Thoracentesis demonstrated a lymphocyte-predominant exudative effusion. Due to limited diagnostic resources, advanced microbiological investigations were unavailable. The patient underwent video-assisted thoracoscopic surgery (VATS), which revealed diffusely thickened pleura with multiple whitish plaques. Histopathological examination revealed caseating granulomatous inflammation consistent with tuberculous pleuritis. The patient responded well to anti-tuberculous therapy. CONCLUSIONS: Tuberculous pleuritis can mimic pleural malignancy, particularly in the presence of chest wall involvement. Thoracoscopic pleural biopsy remains a highly valuable diagnostic tool in cases where non-invasive investigations are inconclusive or unavailable.
Pulmonary valve and supravalvular membrane fusion: a case report.
Chen X, Huang A, Zhu X … +1 more , Li R
J Cardiothorac Surg · 2026 Jun · PMID 42237331 · Full text
BACKGROUND: Isolated congenital supravalvular pulmonary stenosis is an exceedingly rare cardiac anomaly, typically characterized by a discrete membrane above the valve obstructing the main pulmonary artery. We present a...
BACKGROUND: Isolated congenital supravalvular pulmonary stenosis is an exceedingly rare cardiac anomaly, typically characterized by a discrete membrane above the valve obstructing the main pulmonary artery. We present a previously unreported anatomical variation in which this membrane fused with one of the pulmonary valve leaflets, forming a distinct pouch-like configuration. CASE PRESENTATION: A 44-year-old male presented with progressive exertional dyspnea. Preoperative echocardiography identified severe pulmonary stenosis and an obstructing supravalvular membrane, with a peak transvalvular gradient of 170 mmHg. Intraoperative exploration revealed that the pulmonary valve is trileaflet, with visibly thickened and fused commissures, causing severe pulmonary valve stenosis. Uniquely, the supravalvular pulmonary membrane fused with one leaflet forming a pouch-like configuration. Surgical separation of the fused commissures was performed, which successfully relieved the obstruction. The patient recovered well and reported complete symptom resolution at one-month follow-up. CONCLUSION: This case presents a unique anatomical variant of isolated congenital supravalvular pulmonary stenosis, characterized by fusion between the abnormal supravalvular membrane and one valve leaflet. The surgical approach adopted achieved acceptable results and substantially improved the patient's clinical condition.
Zone 1 total arch replacement with frozen elephant trunk for type A dissection: early-to-mid-term outcomes.
Takei Y, Shibasaki I, Tezuka M … +7 more , Kato T, Ogasawara T, Hori T, Kuwata T, Tsuchiya G, Kawamura M, Fukuda H
J Cardiothorac Surg · 2026 Jun · PMID 42237324 · Full text
BACKGROUND: Total arch replacement with frozen elephant trunk is widely used to treat acute Stanford type A aortic dissection. Zone 1 proximalization, which requires concomitant extra-anatomical left subclavian artery by...
BACKGROUND: Total arch replacement with frozen elephant trunk is widely used to treat acute Stanford type A aortic dissection. Zone 1 proximalization, which requires concomitant extra-anatomical left subclavian artery bypass, may provide a practical balance between safety and technical complexity. Although the early outcomes of this procedure have previously been reported, comprehensive mid-term data, particularly regarding left subclavian artery bypass durability, remain limited. This study aimed to evaluate the early and mid-term outcomes of zone 1 proximalization in total arch replacement with frozen elephant trunk for acute Stanford type A aortic dissection. METHODS: This retrospective observational study included 80 patients with acute type A aortic dissection who underwent zone 1 total arch replacement with frozen elephant trunk, which requires concomitant extra-anatomical left subclavian artery bypass, between 2014 and 2025 at two institutions. Primary outcomes were postoperative mortality and freedom from aorta- and left subclavian artery bypass-related events. Secondary outcomes included perioperative complications and reinterventions. Event-free survival was assessed using Kaplan-Meier analysis. RESULTS: Thirty-day and in-hospital mortality rates were 8.8% and 10.0%, respectively. Stroke occurred in 12.5% of patients and spinal cord injury in 5.0%. Freedom from aorta-related events was 88.4%, 84.0%, and 81.5% at one, three, and five years, respectively; corresponding rates for left subclavian artery bypass-related events were 95.6%, 91.5%, and 86.4%, respectively. Of the 21 aorta-related events, 62% involved the downstream aorta and were managed with endovascular repair. The eight left subclavian artery bypass-related events were mostly asymptomatic occlusions caused by technical issues. Distal stent graft-induced new entry, a major late complication, was associated with a larger zone 4 diameter. CONCLUSIONS: This descriptive study provided early and mid-term outcome data for zone 1 total arch replacement with frozen elephant trunk in patients with acute type A aortic dissection. The long-term durability of the left subclavian artery bypass remains a concern. Considering the anatomical features of the patient and ensuring vigilant follow-up may reduce downstream events, making this procedure a viable option for selected patients.
Surgical management of recurrent MRSA empyema with eloesser flap in a complex thoracic patient: lessons from endobronchial valve failure.
Parvathaneni A, Enriquez J
J Cardiothorac Surg · 2026 Jun · PMID 42237321 · Full text
BACKGROUND: Endobronchial valves (EBVs) have emerged as a minimally invasive option for managing bronchopleural fistula (BPF), with reported efficacy rates of approximately 70-75%. However, their long-term performance in...
BACKGROUND: Endobronchial valves (EBVs) have emerged as a minimally invasive option for managing bronchopleural fistula (BPF), with reported efficacy rates of approximately 70-75%. However, their long-term performance in the setting of chronic infection remains poorly characterized, and documentation of specific failure mechanisms is limited. CASE PRESENTATION: A 74-year-old man with recurrent methicillin-resistant Staphylococcus aureus (MRSA) empyema following right lower lobectomy presented with treatment failure 14 months after Zephyr EBV placement. During Eloesser flap creation, both valves were found displaced from the bronchial stump, with one completely dislodged into the pleural space. The bronchial stump showed evidence of erosion from chronic infection. The patient demonstrated clinical improvement following the Eloesser procedure, with negative cultures at three-month follow-up. CONCLUSIONS: This case provides direct intraoperative visualization of EBV displacement in chronic empyema, suggesting that ongoing infection, tissue destruction, and mechanical forces may compromise valve stability over time. The finding supports consideration of patient selection criteria for EBV therapy and demonstrates the continued role of open drainage procedures when minimally invasive approaches fail.
Management strategies for non-A non-B aortic dissection: a comprehensive review.
Liu T, Hou Y, Lian W
J Cardiothorac Surg · 2026 Jun · PMID 42231455 · Full text
Aortic dissection (AD) represents a life-threatening cardiovascular emergency. The condition is traditionally classified according to the Stanford system: type A involves the ascending aorta, while type B is confined to...
Aortic dissection (AD) represents a life-threatening cardiovascular emergency. The condition is traditionally classified according to the Stanford system: type A involves the ascending aorta, while type B is confined to the descending aorta. However, a small subset of cases defies this binary classification and is categorized as non-A non-B aortic dissection. These atypical presentations frequently involve the aortic arch or exhibit complex morphological features, such as retrograde extension or multi-territorial involvement, distinguishing them from classical type A or B dissections. The optimal management strategy for non-A non-B aortic dissection remains controversial. Current therapeutic approaches encompass open surgical repair, thoracic endovascular aortic repair (TEVAR), hybrid procedures, and conservative medical management. This review synthesizes the contemporary evidence regarding the epidemiology, pathophysiology, diagnostic challenges, and treatment modalities for non-A non-B aortic dissection, underscoring the critical importance of individualized management in therapeutic decision-making.
A case of new onset of atrial fibrillation during thoracoscopic lobectomy and review of the literature.
Zuo Y, Yang Y, Liang G … +2 more , Wei Z, Wu X
J Cardiothorac Surg · 2026 Jun · PMID 42231454 · Full text
BACKGROUND: Atrial fibrillation (AF) is a prevalent perioperative complication associated with lung surgery, contributing to an elevated risk of adverse postoperative outcomes. However, instances of new-onset intraoperat...
BACKGROUND: Atrial fibrillation (AF) is a prevalent perioperative complication associated with lung surgery, contributing to an elevated risk of adverse postoperative outcomes. However, instances of new-onset intraoperative Atrial fibrillation (IOAF) remain infrequently documented. In this report, we present a case of intraoperative new-onset atrial fibrillation occurring during thoracoscopic partial lung resection. Additionally, we examine the risk factors, preventive strategies, and therapeutic interventions for atrial fibrillation, with the objective of enhancing prevention and management of this condition in the perioperative setting. CASE PRESENTATION: A 71-year-old female patient was scheduled to undergo a thoracoscopic left upper lobectomy due to a 'left upper lung mass.' Preoperative electrocardiogram showed occasional atrial premature beats, and cardiac ultrasound indicated left ventricular diastolic dysfunction. During the intraoperative dissection of the hilar lymph nodes, the patient suddenly developed rapid atrial fibrillation with a heart rate of 113 beats per minute, accompanied by pulse deficit. Immediately suspend the surgical operation, but after intravenous administration of dexmedetomidine, the patient's rhythm did not convert to sinus rhythm, and hemodynamic instability occurred. After stabilizing blood pressure with vasoactive drugs, intravenous amiodarone was given to control the ventricular rate. The patient was transferred to the ICU postoperatively and successfully restored sinus rhythm after subsequent amiodarone treatment. CONCLUSIONS: New-onset atrial fibrillation during surgery is a complication that requires attention in thoracic surgery. The novelty of this report lies in: (1)providing a detailed description of the negative clinical experience in which dexmedetomidine was ineffective in this scenario and led to hemodynamic instability, contrasting with previous case reports; (2) proposing a pragmatic strategy of controlling heart rate during surgery and delaying cardioversion until after surgery; (3)emphasizing that elderly women, left lung lobe resection (involving hilar lymph node dissection), and preoperative diastolic dysfunction should also be considered as potential risk factors.
The CRP-albumin-lymphocyte (CALLY) index is an independent prognostic factor for patients undergoing transcatheter aortic valve implantation.
Çelik A, Kiris T, Ege B … +3 more , Erdem H, Babacan S, Karaca M
J Cardiothorac Surg · 2026 Jun · PMID 42231448 · Full text
BACKGROUND/OBJECTIVES: The C-reactive protein-albumin-lymphocyte (CALLY) index is an emerging composite biomarker that integrates inflammatory, nutritional, and immune parameters. Although its prognostic utility has been...
BACKGROUND/OBJECTIVES: The C-reactive protein-albumin-lymphocyte (CALLY) index is an emerging composite biomarker that integrates inflammatory, nutritional, and immune parameters. Although its prognostic utility has been established in oncological and certain cardiovascular contexts, its role in predicting outcomes following transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to investigate the prognostic value of the CALLY index in patients with severe aortic stenosis undergoing TAVI, with a focus on its association with all-cause mortality. METHODS: A single-center, retrospective cohort study was conducted including 330 patients who underwent TAVI for severe aortic stenosis between December 2016 and January 2025. The CALLY index was calculated using preprocedural C-reactive protein, serum albumin, and lymphocyte count. Primary outcome was the incidence of all-cause mortality. RESULTS: The CALLY index was lower in deceased patients than in survivors (1.0 [0.4-2.0] vs. 3.0 [1.0-10.6], p < 0.001). In multivariable analysis, a lower CALLY index was independently associated with higher all-cause mortality (HR: 0.965, 95% CI: 0.933-0.997, p = 0.034). The optimal cut-off value of the CALLY index for predicting all-cause mortality was 2.21, with an AUC of 0.730 (95% CI: 0.674-0.787), sensitivity of 76.7%, and specificity of 61.3% (p < 0.001). CONCLUSIONS: The CALLY index was independently associated with all-cause mortality in patients with severe aortic stenosis undergoing TAVI. As a simple and readily available biomarker, it may help support early risk stratification in this population.
Sex impacts outcome in minimally invasive surgery of the ascending aorta: a propensity score matched analysis.
Helms F, Krüger H, Deniz E … +7 more , Martens A, Popov AF, Schmack B, Schmitto JD, Weymann A, Ruhparwar A, Arar M
J Cardiothorac Surg · 2026 Jun · PMID 42231440 · Full text
BACKGROUND: Minimally invasive approaches have gained immense importance in surgery of the aortic valve, aortic root, and ascending aorta over the last decades. Despite this, data concerning impact factors of the postope...
BACKGROUND: Minimally invasive approaches have gained immense importance in surgery of the aortic valve, aortic root, and ascending aorta over the last decades. Despite this, data concerning impact factors of the postoperative outcome and especially investigations regarding sex-specific outcome parameters for minimally invasive aortic surgery are still lacking to date. METHODS: We present a single-center analysis of 387 patients undergoing supracoronary ascending aorta replacement, Wheat procedure, David procedure, or Bentall procedure through a minimally invasive access. A multivariate linear model was developed to identify predicting factors for a prolonged intensive care unit stay. Subsequently, the impact of the patients sex on perioperative complications and outcome as well as short- and long-term survival was investigated using a propensity score matched analysis of each 118 women and men undergoing minimally invasive ascending aortic procedures. RESULTS: Female sex, patients age at operation, and operation times were identified as independent patient-specific predictors for ICU length of stay after minimally invasive ascending aortic surgery. The perioperative stroke-rate was significantly higher in women compared to men (7.6% vs. 1.7%, p = 0.031). Erythrocyte concentrate transfusion requirement was significantly higher in females (4 (IQR 2-5) vs. 2 (QR 0-4), p < 0.001). No significant differences were found between male and female patients with respect to short- and long-term survival. CONCLUSIONS: Sex impacts outcome after minimally invasive ascending aortic surgery. In particular, female patients had worse short-term outcome compared to men with respect to perioperative stroke, ICU length-of-stay, and transfusion requirements.
Perioperative transfusion rates and efficiency in thoracic surgery: toward rational transfusion strategies.
Gülhan SŞE, Yaylacı Aİ, Acar LN … +6 more , Hazer S, Türk İ, Alagöz A, İncekara F, Demir ÖF, Bıçakçıoğlu P
J Cardiothorac Surg · 2026 Jun · PMID 42231437 · Full text
OBJECTIVE: To evaluate perioperative blood transfusion requirements, transfusion-related risk factors, and blood utilization efficiency in thoracic surgery, and to establish procedure-specific recommendations for the Max...
OBJECTIVE: To evaluate perioperative blood transfusion requirements, transfusion-related risk factors, and blood utilization efficiency in thoracic surgery, and to establish procedure-specific recommendations for the Maximum Surgical Blood Ordering Schedule (MSBOS). MATERIALS AND METHODS: A retrospective analysis was conducted on 2,062 patients who underwent thoracic surgery at a single center between January 2022 and June 2024. Demographic characteristics, comorbidities, surgical techniques, perioperative transfusion requirements, and clinical outcomes were analyzed. Transfusion efficiency was assessed using the Transfusion Index (TI), Transfusion Percentage (%T), and Crossmatch-to-Transfusion Ratio (C/T). MSBOS recommendations were derived based on these metrics. RESULTS: Perioperative transfusion was required in 15.1% of patients, while 8.0% received intraoperative transfusions. Transfusion need was significantly associated with advanced age, lower preoperative hemoglobin levels, longer anesthesia duration, thoracotomy, decortication, and pneumonectomy. Patients who received intraoperative transfusions had significantly higher complication and mortality rates. Overall transfusion efficiency was low (TI: 0.27; %T: 15%), indicating substantial over-preparation of blood products. CONCLUSION: Routine preoperative blood preparation is unnecessary for many thoracic surgery procedures. A procedure-specific MSBOS or a "type-and-screen" strategy appears sufficient for most interventions, except for decortication and pneumonectomy. Tailored patient blood management strategies, including procedure-specific MSBOS implementation, may substantially improve resource utilization and patient outcomes.
Combined ascending aortic and hemi-arch replacement with coronary bypass in a young woman with systemic lupus erythematosus and prior inferior STEMI.
Hattab M, Abufara M, Abualhommos F … +1 more , Awwad N
J Cardiothorac Surg · 2026 Jun · PMID 42231426 · Full text
INTRODUCTION: Systemic lupus erythematosus (SLE) confers markedly increased cardiovascular risk, including premature coronary artery disease and rare but high-risk aortic aneurysms. Surgical decision-making becomes chall...
INTRODUCTION: Systemic lupus erythematosus (SLE) confers markedly increased cardiovascular risk, including premature coronary artery disease and rare but high-risk aortic aneurysms. Surgical decision-making becomes challenging when significant aortic pathology coexists with advanced coronary disease. CASE PRESENTATION: A 47-year-old woman with longstanding SLE and prior inferior STEMI presented with recurrent chest pain and exertional dyspnea. Workup revealed tight in-stent restenosis of the right coronary artery and a 5.3-cm ascending/proximal arch aneurysm. A multidisciplinary heart team recommended single-stage repair. She underwent supracoronary ascending aortic and hemi-arch replacement under hypothermic circulatory arrest, along with saphenous vein bypass to the posterior descending artery. Postoperative imaging confirmed excellent aortic reconstruction and a patent graft, and recovery was uneventful. CONCLUSION: This case illustrates the accelerated vascular complications of SLE and highlights the feasibility and benefit of combined aortic replacement and coronary bypass in selected young patients with complex, coexisting pathology.
Beating-heart mitral valve replacement assisted by rapid ventricular pacing after Bentall procedure: a case report.
Yao LT, Yang MJ, Husanova F … +3 more , Tao TT, Ni YM, Yao YX
J Cardiothorac Surg · 2026 Jun · PMID 42231378 · Full text
BACKGROUND: Beating-heart open mitral valve replacement (MVR) precludes aorta clamping, cardioplegic arrest, and reperfusion injury in cardiac surgery. However, beating-heart MVR still poses the risk of air embolism. The...
BACKGROUND: Beating-heart open mitral valve replacement (MVR) precludes aorta clamping, cardioplegic arrest, and reperfusion injury in cardiac surgery. However, beating-heart MVR still poses the risk of air embolism. The main cause of air embolisms is effective ventricular contraction and stroke. Rapid ventricular pacing (RVP) is commonly used in transcatheter valve implantation to temporarily halt cardiac output. However, its application in open beating-heart surgery has not explored in depth. Recently, we successfully employed RVP to perform MVR on an on-pump beating heart, without cross-clamping, in a patient with mitral valve prolapse developed 5 years after Bentall procedure. CASE PRESENTATION: A 63-year-old female, who underwent simultaneous Bentall and Sun's procedures five years back, was admitted for dyspnea, orthopnea, and palpitations since 20 days. Echocardiography revealed severe mitral valve regurgitation and prolapse. She had a European System for Cardiac Operative Risk Evaluation II of 6.8%. After multidisciplinary consultations, open-heart MVR on beating heart was scheduled. Following induction of anesthesia, a balloon-tipped flotation pacemaker catheter was introduced into the right ventricle. RVP was activated at 180 beats/min during valve resection and de-airing. The mitral valve was replaced by a pericardial bioprosthesis under cardiopulmonary bypass (CPB). Transesophageal echocardiography confirmed the absence of intracardiac air bubbles. The patient was then successfully weaned off CPB and recovered without complications, regaining consciousness 45 min following the operation. She was discharged on the 8th postoperative day, with a New York Heart Association class I. At the 6-month postoperative follow-up visit, the patient showed satisfactory recovery with no complications. CONCLUSIONS: This case demonstrates that beating-heart MVR with RVP, without aortic cross-clamping, can be used as a viable and feasible option in selected patients who are at a high risk of complications secondary to routine CPB and cardioplegia.
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