Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
Comparative analysis of postoperative outcomes and utilization trends for valve-in-valve transcatheter aortic valve implantation versus reoperative surgical aortic valve replacement.
Zhao L, Wang X, Yang F … +2 more , Su C, Zhou J
J Cardiothorac Surg · 2026 Jun · PMID 42363204 · Full text
OBJECTIVE: To evaluate clinical outcomes, temporal trends, and age-related heterogeneity of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus redo surgical aortic valve replacement (re-SAVR) in pat...
OBJECTIVE: To evaluate clinical outcomes, temporal trends, and age-related heterogeneity of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus redo surgical aortic valve replacement (re-SAVR) in patients with failed aortic bioprosthetic valves. METHODS: Patients undergoing ViV-TAVI or re-SAVR between 2011 and 2021 were identified from the Nationwide Readmission Database (NRD). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Temporal trends in procedure utilization and patient age were assessed across calendar years. The primary outcome was all-cause mortality, including in-hospital, 30-day, and 6-month mortality. Secondary outcomes included in-hospital complications, all-cause readmission, and days alive and out of hospital (DAOH). Age-stratified and interaction analyses were performed. RESULTS: ViV-TAVI utilization increased significantly over time (p < 0.001), accompanied by a modest decline in patient age. Compared with re-SAVR, ViV-TAVI was associated with lower in-hospital mortality (OR 0.50, 95% CI 0.35-0.71; p < 0.001) and 30-day mortality (HR 0.60, 95% CI 0.43-0.83; p = 0.002), as well as lower risks of in-hospital stroke or transient ischemic attack, renal failure, and major bleeding (all p < 0.001). However, ViV-TAVI was associated with higher 30-day (HR 1.23, 95% CI 1.02-1.48; p = 0.031) and 6-month readmission (HR 1.25, 95% CI 1.07-1.46; p = 0.006). ViV-TAVI was also associated with higher DAOH at 30 days and 6 months (both p < 0.001). Interaction analyses suggested age-related heterogeneity for selected outcomes. CONCLUSIONS: ViV-TAVI use increased substantially and was associated with lower short-term mortality and fewer in-hospital complications, but higher readmission risk. Improved DAOH and potential age-related heterogeneity warrant further evaluation.
Tricuspid valve infective endocarditis due to ESBL producing E.coli associated with AV block requiring epicardial pacing: A case report.
Ohev Shalom R, Avedikian S, Watkins V … +2 more , Johal MJ, Togay VS
J Cardiothorac Surg · 2026 Jun · PMID 42363188 · Full text
BACKGROUND: Infective endocarditis (IE) caused by non-HACEK gram-negative organisms accounts for fewer than 2% of cases, and endocarditis due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is rare. Ri...
BACKGROUND: Infective endocarditis (IE) caused by non-HACEK gram-negative organisms accounts for fewer than 2% of cases, and endocarditis due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is rare. Right-sided involvement, particularly isolated tricuspid valve infective endocarditis (TVIE), and associated atrioventricular (AV) conduction abnormalities are rarely reported, creating diagnostic and management challenges, especially when pacing is required. CASE PRESENTATION: A 75-year-old Caucasian man with pre-existing right bundle branch block presented with syncope one week after hospitalization for ESBL E. coli bacteremia treated with intravenous ertapenem. Electrocardiography now revealed progressive AV conduction delay with intermittent high-degree AV block. Transthoracic echocardiography was nondiagnostic, while transesophageal echocardiography identified a tricuspid valve vegetation without abscess despite antimicrobial therapy. Progressive high-grade AV block developed despite appropriate antimicrobial therapy, necessitated urgent epicardial pacing due to contraindication of transvenous systems in active infection. He completed a six-week course of ertapenem with subsequent resolution of the tricuspid valve vegetation on follow-up imaging. After infection clearance, a transvenous dual-chamber pacemaker was successfully implanted. CONCLUSIONS: This case highlights an uncommon presentation of ESBL-producing E. coli TVIE complicated by advanced AV block. It underscores the importance of early transesophageal imaging in suspected right-sided endocarditis, awareness of conduction disturbances as a marker of disease severity, and the role of epicardial pacing as a safe bridging strategy when permanent transvenous systems are contraindicated during active infection.
Risk factors and prognosis of postoperative hepatic dysfunction after Stanford type A aortic dissection repair: a systematic review and meta-analysis.
Liu H, Arjune R, Xie A
J Cardiothorac Surg · 2026 Jun · PMID 42363187 · Full text
BACKGROUND: Evidence on postoperative hepatic dysfunction after Stanford type A aortic dissection repair remains limited. Existing studies have used heterogeneous definitions and have reported inconsistent perioperative...
BACKGROUND: Evidence on postoperative hepatic dysfunction after Stanford type A aortic dissection repair remains limited. Existing studies have used heterogeneous definitions and have reported inconsistent perioperative factors and clinical outcomes. This systematic review and meta-analysis aimed to estimate the incidence of postoperative hepatic dysfunction, summarize associated perioperative variables, and evaluate its association with short-term postoperative outcomes. METHODS: PubMed, Embase (Ovid), Web of Science, and the Cochrane Library were systematically searched for clinical studies investigating postoperative hepatic dysfunction in patients undergoing surgical repair for Stanford type A aortic dissection. Pooled analyses were performed to estimate the incidence of postoperative hepatic dysfunction and its associations with perioperative variables and postoperative outcomes. RESULTS: A total of 960 records were identified, and nine single-center retrospective cohort studies involving 3,234 patients were included. The pooled incidence of postoperative hepatic dysfunction was 37%. Male sex was associated with postoperative hepatic dysfunction (OR 1.35, 95% CI 1.10-1.64, I = 0%). Compared with patients without postoperative hepatic dysfunction, those who developed postoperative hepatic dysfunction had higher preoperative white blood cell counts (MD 0.94 × 10⁹/L, 95% CI 0.21-1.67, I = 67%), longer cardiopulmonary bypass time (MD 21.29 min, 95% CI 11.25-31.34, I = 85%), longer aortic cross-clamp time (MD 11.57 min, 95% CI 7.88-15.26, I = 52%), and greater perioperative red blood cell transfusion volume (MD 1.90 units, 95% CI 0.92-2.88, I = 90%). Postoperative hepatic dysfunction was also associated with higher odds of short-term mortality (OR 5.59, 95% CI 3.96-7.88, I = 0%) and acute kidney injury (OR 5.62, 95% CI 4.16-7.59, I = 30%), as well as longer intensive care unit stay (MD 60.18 h, 95% CI 54.83-65.53, I = 23%). CONCLUSIONS: Postoperative hepatic dysfunction was common after Stanford type A aortic dissection repair and was associated with worse short-term postoperative outcomes. Several preoperative and intraoperative variables were associated with postoperative hepatic dysfunction; however, the available evidence was limited by retrospective study designs, heterogeneous definitions, and residual confounding. Future multicenter studies using standardized definitions and systematically collected malperfusion-related, operative, and perfusion-related variables are needed to clarify its clinical significance and support risk-stratification research. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251234391.
Surgical management of a giant left atrial appendage aneurysm and chronic atrial fibrillation.
Zengin A, Yılmaz C, Adademir T
J Cardiothorac Surg · 2026 Jun · PMID 42363181 · Full text
Left atrial appendage aneurysm (LAAA) is a rare congenital cardiac anomaly that is associated with potentially life-threatening complications, including thromboembolism and arrhythmias. We report a 36-year-old male patie...
Left atrial appendage aneurysm (LAAA) is a rare congenital cardiac anomaly that is associated with potentially life-threatening complications, including thromboembolism and arrhythmias. We report a 36-year-old male patient with giant LAAA (66 × 46 mm) and chronic atrial fibrillation (CAF) presenting with palpitations. Surgical resection of LAAA and Cox-Maze IV procedure were performed under cardiopulmonary bypass. The patient was discharged in sinus rhythm, remained asymptomatic, and had normal echocardiographic findings at follow-up.
HIF-1α-mediated mitochondrial autophagy in the post-treatment protective effect of thyroxine against myocardial ischemia-reperfusion injury.
Yu H, Feng J, Wang K … +1 more , Zhang X
J Cardiothorac Surg · 2026 Jun · PMID 42363171 · Full text
BACKGROUND: This study aimed to investigate the role of HIF-1α-regulated mitochondrial autophagy in the protective effect of Thyroxine against myocardial ischemia-reperfusion injury. METHODS: Male Sprague-Dawley rats wer...
BACKGROUND: This study aimed to investigate the role of HIF-1α-regulated mitochondrial autophagy in the protective effect of Thyroxine against myocardial ischemia-reperfusion injury. METHODS: Male Sprague-Dawley rats were randomly divided into five groups (n = 10 each): Sham, I/R, L-Thyroxine (T4) post-treatment (20 µg/kg i.p. immediately after reperfusion), 2ME2 + I/R (15 mg/kg 2ME2 i.p. 30 min before ischemia), and 2ME2 + Thyroxine groups. The I/R model was established by ligating the left anterior descending coronary artery for 40 min followed by 120 min of reperfusion. RESULTS: Compared with the I/R group, Thyroxine treatment significantly up-regulated HIF-1α (2.<0.01) and BNIP3 (1.8 < 0.01) protein expressions, reduced the LC3-II/LC3-I ratio (0.6-fold, P < 0.01), Beclin-1 (0.<0.01) and P62 (0.40.01) accumulation, while increasing LAMP2 expression (1.6-fold, P < 0.01). Thyroxine treatment reduced ROS production from 80% to 40% DHE-positive nuclei (P < 0.01), increased ATP content from 45% to 75% of sham levels (P < 0.05), restored mitochondrial membrane potential (JC-1 red/green ratio increased from 0.4 to 0.8, P < 0.01), and decreased myocardial infarct size from 45% to 20% of the area at risk (P < 0.01). These protective effects were abolished by the HIF-1α inhibitor 2ME2 pre-treatment. CONCLUSION: Thyroxine reduced the area of myocardial infarction and promoted mitochondrial autophagy by activating the HIF-1α/BNIP3 signaling pathway.
T2-sparing vs T2-including sympathectomy for hyperhidrosis: a meta-analysis on compensatory sweating.
Delgado LM, D'Ambrosio PD, da Nobrega Oliveira REN … +9 more , Mortman K, Caldonazo T, Passos FS, Martins MAB, Sreepathi D, Pimienta-Ibarra AS, Fernandes PM, Wolosker N, Campos JRM
J Cardiothorac Surg · 2026 Jun · PMID 42351253 · Full text
BACKGROUND: Sympathectomy is the definitive treatment for primary hyperhidrosis, offering high success rates. However, compensatory sweating (CS) remains a frequent and distressing complication. The level of ganglionic r...
BACKGROUND: Sympathectomy is the definitive treatment for primary hyperhidrosis, offering high success rates. However, compensatory sweating (CS) remains a frequent and distressing complication. The level of ganglionic resection, particularly the inclusion of T2, may influence CS incidence, but evidence remains inconsistent. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted up to July 2025, to identify studies comparing T2-sparing versus T2-including sympathectomy for primary hyperhidrosis. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic. For outcomes with significant heterogeneity, leave-one-out sensitivity analyses were performed. RESULTS: Eleven studies involving 3,090 patients were included. Of these, 47.2% underwent T2-sparing sympathectomy and 52.8% underwent T2-including procedures. T2-sparing sympathectomy was associated with a significantly lower incidence of overall CS (OR 0.38; 95% CI 0.21-0.67; p = 0.0009; I2 = 65%) and severe CS (OR 0.43; 95% CI 0.28-0.64; p < 0.0001; I2 = 19%). Subgroup analyses confirmed consistent results across both randomized and non-randomized studies, as well as across short-term (≤ 12 months) and long-term (> 12 months) follow-up periods. Sensitivity analyses confirmed the robustness of the findings. No publication bias was detected. CONCLUSIONS: T2-sparing sympathectomy was associated with a significantly lower incidence of CS. These findings support avoiding T2 when feasible to minimize postoperative morbidity. Further prospective studies are needed to confirm these results.
Identification of T-cell exhaustion-related biomarkers in aortic dissection via integrated multi-omics analysis and mendelian randomization.
Zhang Y, Zhao Y, Long X … +1 more , Xu J
J Cardiothorac Surg · 2026 Jun · PMID 42351206 · Full text
BACKGROUND: Aortic dissection (AD) is a life-threatening cardiovascular emergency characterized by high acute mortality. While immune dysregulation is known to drive AD pathogenesis, the specific involvement of T-cell ex...
BACKGROUND: Aortic dissection (AD) is a life-threatening cardiovascular emergency characterized by high acute mortality. While immune dysregulation is known to drive AD pathogenesis, the specific involvement of T-cell exhaustion-related genes (TEXRGs) remains largely elusive. METHODS: Differentially expressed TEXRGs (DETEXRGs) between AD and control samples were identified using transcriptomic datasets. Functional enrichment and Mendelian randomization (MR) analyses were performed to investigate potential causal associations with AD risk. Key diagnostic biomarkers were selected through integrated machine learning algorithms. Immune infiltration landscapes were characterized via gene set enrichment analysis (GSEA), while single-cell RNA sequencing (scRNA-seq) was employed to elucidate cell-type-specific expression profiles. Furthermore, the transcription factor (TF)-regulatory network and drug-gene interaction map were constructed. Finally, the expression levels of candidate genes were validated using quantitative real-time PCR (qRT-PCR). RESULTS: A total of 270 DETEXRGs were identified, which were predominantly enriched in cytokine-mediated signaling pathways and viral infection-related processes. MR analysis identified six genes significant causal associations with AD susceptibility. Among these, CASP4 and FPR1 were prioritized as core biomarkers through integrated machine learning algorithms. Immune infiltration analysis revealed a significantly altered immune landscape in AD tissues, characterized by the enrichment of eight immune cell subtypes that positively correlated with the expression of the identified biomarkers. Furthermore, scRNA-seq analysis localized FPR1 expression primarily to macrophages and monocytes. Finally, qRT-PCR validation confirmed significantly elevated expression levels of FPR1, PLSCR1, and other candidate genes in AD samples. CONCLUSION: This study underscores the critical involvement of T-cell exhaustion-related mechanisms in the pathogenesis of AD and robust diagnostic biomarkers. These findings offer novel insights for early risk stratification and provide a theoretical foundation for the development of targeted immunotherapeutic strategies in aortic dissection.
Postoperative rupture of bronchial stump inducing severe hemorrhage from pulmonary artery trunk: a case report.
Wei X, Yang H, Wang X … +7 more , YujieLei, Tang X, Zi Q, Zhang J, Mao J, Peng Y, Huang Y
J Cardiothorac Surg · 2026 Jun · PMID 42351187 · Full text
Surgical resection constitutes the cornerstone of treatment for lung cancer, a disease with high global incidence. Among postoperative complications, delayed fatal hemorrhage occurring beyond 30 days postoperatively has...
Surgical resection constitutes the cornerstone of treatment for lung cancer, a disease with high global incidence. Among postoperative complications, delayed fatal hemorrhage occurring beyond 30 days postoperatively has garnered scant attention in clinical and research settings. Notably, there are no documented cases of vascular rupture and bleeding induced by chronic mechanical friction between the bronchial stump and pulmonary artery trunk to date. Following pulmonary lobectomy, the anatomical proximity between the bronchial stump and pulmonary artery trunk creates a potential risk of delayed pulmonary artery hemorrhage secondary to bronchial stump-related pathology. Herein, we report a case of a 53-year-old male patient who presented with sudden massive hemoptysis on the 40th day after right upper lobectomy. Bronchial artery embolization was initially performed but failed to control the bleeding. Emergency thoracotomy revealed a 3-mm rupture with active bleeding in the right pulmonary artery trunk, accompanied by a 2-mm fistula at the right upper lobe bronchial stump. Intraoperatively, the vascular rupture was repaired using a pericardial patch, and both the repaired vessel and the bronchial stump were wrapped with an intercostal muscle flap, achieving successful hemostasis. The patient experienced an uneventful postoperative recovery and remained alive and well at the 3-month follow-up. Written informed consent was obtained from the patient for the publication of this case report and the accompanying clinical images.
Safety and feasibility of a single-surgeon cardiac surgery program during workforce shortage: a propensity-matched cohort study.
Park GT, Park KT, Son YJ … +3 more , Kim SW, Lee J, Hong J
J Cardiothorac Surg · 2026 Jun · PMID 42351185 · Full text
OBJECTIVES: This study compared clinical outcomes of cardiac surgeries performed by a single surgeon (operating alone [OA]) versus those performed by multiple surgeons (operating together [OT]) to evaluate the feasibilit...
OBJECTIVES: This study compared clinical outcomes of cardiac surgeries performed by a single surgeon (operating alone [OA]) versus those performed by multiple surgeons (operating together [OT]) to evaluate the feasibility and safety of different surgical staffing models. METHODS: We retrospectively reviewed adult patients who underwent cardiac surgery at Chung-Ang University Hospital from September 2016 to August 2021. Between September 2016 and August 2018, two or three surgeons assisted each other (OT), while from September 2018 to August 2021, a single surgeon operated alone (OA). After propensity score matching, 79 patients were selected in each group for analysis. RESULTS: Major postoperative adverse events, including mortality, stroke, new-onset atrial fibrillation, and low cardiac output, did not statistically significant differ between groups. Other postoperative outcomes such as, acute kidney injury, ICU stay length, hospital days, CPB time, ACC time was not statistically different, whereas operation time was shorter in the OT group than in the OA group (median 300 vs. 379 min, P < 0.001). CONCLUSIONS: Except for differences in operation time, there were not significantly different short-term postoperative outcomes in OT and OA groups. Given the various limitations of the present study, the result should be interpreted cautiously.
Long-term outcomes of one-stop unilateral thoracoscopic hybrid ablation for persistent atrial fibrillation after failed catheter ablation.
Wang L, Liu X, Mei J … +7 more , Liu H, Lu C, Wang F, Wang B, Lei J, Tan C, Lee C
J Cardiothorac Surg · 2026 Jun · PMID 42351179 · Full text
BACKGROUND: Hybrid ablation is a treatment option for persistent (PsAF) or long-standing persistent atrial fibrillation (LS-PsAF) after failed catheter ablation (CA), but long-term outcomes (> 5 years) and predictors of...
BACKGROUND: Hybrid ablation is a treatment option for persistent (PsAF) or long-standing persistent atrial fibrillation (LS-PsAF) after failed catheter ablation (CA), but long-term outcomes (> 5 years) and predictors of recurrence after hybrid ablation in this population have not been well characterized in prior studies. METHODS: We retrospectively analyzed 44 consecutive patients with symptomatic PsAF or LS-PsAF who underwent one-stop unilateral thoracoscopic hybrid ablation with left atrial appendage (LAA) management between May 2015 and April 2021. The procedure consisted of same-day epicardial and endocardial ablation. Primary endpoint was defined as recurrence of atrial arrhythmias ≥ 30 s after the 3-month blanking period, regardless of antiarrhythmic drug (AAD) use. Given the limited sample size and number of events, multivariable Cox regression was performed as an exploratory analysis. RESULTS: Patients (77.3% male; mean age 59.6 ± 8.3 years) had median AF duration of 8.0 years; 97.7% had prior failed CA (mean 1.4 ± 0.7 procedures). At discharge, 93.2% were in sinus rhythm, with no in-hospital mortality or stroke. Over median 5.2-year follow-up, freedom from arrhythmias at 1, 3, and 5 years was 68.2%, 52.3%, and 50.0%, respectively. Recurrence occurred in 22 patients (50.0%), with 63.6% of recurrences within the first year. On exploratory multivariable Cox regression analysis, left atrial (LA) diameter (HR 1.073, 95% CI: 1.001-1.151, P = 0.047) showed a potential association with recurrence. LAA pathology revealed myocardial hypertrophy (84.1%), inflammation (65.9%), and occult thrombus was identified in 10.0% of LAA specimens (4/40). No thromboembolic events occurred during follow-up. CONCLUSIONS: One-stop hybrid ablation with routine LAA management was associated with acceptable safety and rhythm control in half of patients with PsAF/LS-PsAF at 5 years within this exploratory cohort. These long-term data suggest hybrid ablation is a viable strategy in this challenging population. Although routine LAA resection/clipping yielded promising histological findings, definitive clinical benefits could not be confirmed within this single-arm cohort. Given the exploratory nature of the analysis and limited sample size, these findings require validation in larger prospective multicenter studies.
Impact of a comprehensive healthy lifestyle score on a broad spectrum of cardiometabolic and related diseases and its incremental value for risk prediction based on the UK biobank database.
Chen X, Han S, Chen Y … +5 more , Yuan S, He J, Ye Z, Song Y, Dou K
J Cardiothorac Surg · 2026 Jun · PMID 42343405 · Full text
BACKGROUND: Cardiometabolic and related diseases (CMDs) represent a major global disease burden. While traditional risk factors are well-established, the role of lifestyle factors in primary prevention has not been suffi...
BACKGROUND: Cardiometabolic and related diseases (CMDs) represent a major global disease burden. While traditional risk factors are well-established, the role of lifestyle factors in primary prevention has not been sufficiently studied. METHODS: This study analyzed data from 148,155 participants in the UK Biobank without baseline CMDs. Cox proportional hazards models were used to assess the impact of healthy lifestyle factors (non-current smoking, non-excessive drinking, regular physical activity, healthy diet, and healthy sleep) on 11 types of CMDs (coronary heart disease, type 2 diabetes, atrial fibrillation, hypertension, stroke, heart failure, Alzheimer's disease, non-alcoholic fatty liver disease, valvular heart disease, cardiomyopathy, and pulmonary hypertension). Participants were categorized into four groups based on weighted lifestyle scores. Improvements in predictive models after incorporating lifestyle factors were evaluated. RESULTS: Most individual healthy lifestyle factors were associated with a lower risk of CMDs, while regular physical activity was not independently associated with composite CMD risk in the fully adjusted model; healthy sleep contributed the largest weight to the composite lifestyle score (β = 0.342). Adhering to a healthier lifestyle demonstrated a significant and dose-response association with a reduced risk of composite CMDs. In the fully adjusted model, compared to the "very unhealthy" group, the "very healthy" group exhibited a significantly lower risk of developing CMDs (HR: 0.70, 95% CI: 0.67-0.74). Similar inverse associations were observed across several individual CMDs, with the strongest association observed for pulmonary hypertension (HR: 0.34, 95% CI: 0.24-0.50). Incorporating the lifestyle score into traditional risk models was associated with modest improvement in predictive performance. The findings were generally consistent across subgroups and sensitivity analyses. CONCLUSIONS: These findings suggest that adherence to a comprehensive healthy lifestyle, including adequate sleep, is associated with reduced risk of various CMDs and may improve risk stratification. The particularly strong association observed for pulmonary hypertension also supports further investigation of lifestyle patterns across a broader range of cardiometabolic and related conditions. TRIAL REGISTRATION: Not applicable.
Single-cell transcriptomics unveils pyroptosis-related immune microenvironment dynamics and prognostic modeling in esophageal squamous cell carcinoma.
Zou H, Ren Q, Wu J … +1 more , He J
J Cardiothorac Surg · 2026 Jun · PMID 42337781 · Full text
BACKGROUND: Esophageal cancer remains a leading cause of global cancer mortality with limited therapeutic efficacy. This study aims to characterize pyroptosis-related immune mechanisms in esophageal cancer and develop a...
BACKGROUND: Esophageal cancer remains a leading cause of global cancer mortality with limited therapeutic efficacy. This study aims to characterize pyroptosis-related immune mechanisms in esophageal cancer and develop a clinical prediction model to improve prognostic evaluation. METHODS: Single-cell RNA sequencing data from seven esophageal cancer tissues and one normal control were integrated to construct a cellular atlas. Immune subpopulations were isolated, and pyroptosis-associated differentially expressed genes were identified. We intersected these genes with pyroptosis-related genes(PRG), identifying 13 key pyroptosis genes. Computational analyses included pyroptosis scoring, subcluster re-analysis, pathway enrichment, and intercellular communication mapping. Pseudotime trajectory analysis was applied to high-pyroptosis immune subsets. A clinical prognostic model incorporating PRG was validated using bulk sequencing data, followed by immune infiltration quantification and chemotherapy response assessment. RESULTS: By integrating single-cell and bulk transcriptomic datasets, we found that pyroptosis-related genes were enriched in immune-inflammatory pathways in ESCC immune cells. B cells showed extensive interactions within the ESCC immune microenvironment. The identified pyroptosis-related genes appeared to be involved in immune-cell state transitions and intercellular communication. A two-gene pyroptosis-related prognostic model based on GSDMB and CYCS showed moderate predictive performance in the TCGA training cohort. However, its performance in the external GSE53625 validation cohort was limited, indicating that the model should be interpreted as an exploratory prognostic signature rather than a clinically established prediction tool. A nomogram integrating the risk score with pathological stage was further constructed to explore its potential clinical applicability.
An exploratory radiologic index for evaluating diaphragmatic injury risk in left thoracoabdominal penetrating stab wounds: the diaphragmatic penetration index.
Cakar E, Karagulle OO, Komek YS … +4 more , Cicek ME, Ayvazoglu M, Rakici IT, Sevinc MM
J Cardiothorac Surg · 2026 Jun · PMID 42337757 · Full text
OBJECTIVES: Penetrating injuries to the left thoracoabdominal (LTA) region pose significant diagnostic challenges due to the diaphragm's anatomical location. Early diaphragmatic injuries may be clinically silent and radi...
OBJECTIVES: Penetrating injuries to the left thoracoabdominal (LTA) region pose significant diagnostic challenges due to the diaphragm's anatomical location. Early diaphragmatic injuries may be clinically silent and radiologically occult, whereas delayed diagnosis can result in visceral herniation and life-threatening complications. No studies have investigated the role of individualized anatomical parameters, specifically the distance from the entry wound to the diaphragm and diaphragm area, in predicting injury risk. Recognizing this gap, we aimed to introduce and assess a novel parameter, the Diaphragmatic Penetration Index (DPI), that incorporates both factors. METHODS: This retrospective study included 67 adult patients with single-entry LTA penetrating trauma who underwent laparoscopic or open surgical exploration between 2010 and 2025. Patients with multiple wounds, blunt trauma, cardiopulmonary resuscitation, missing CT scans, or loss to follow-up were excluded. DPI was defined as the ratio of diaphragm area (DA) (mm²) to entry wound-to-diaphragm distance (EHD) (mm), both measured from preoperative CT using 3D Slicer and Medseg.ai. Receiver operating characteristic (ROC) curve analysis was applied to evaluate DPI's diagnostic performance. RESULTS: The mean patient age was 29.37 ± 11.80 years; 94.0% were male. Diaphragmatic injury was intraoperatively confirmed in 37.3% (n = 25) of patients. Median EHD was 82.48 mm, median DA was 32,450 mm², and median DPI was 394.9. ROC analysis demonstrated that EHD alone did not reach statistical significance (AUC 0.567, 95% CI: 0.415-0.716; p = 0.184), while DA (AUC 0.664, 95% CI: 0.530-0.791; p = 0.013) and DPI (AUC 0.654, 95% CI: 0.516-0.787; p = 0.018) achieved statistical significance but only modest discriminatory ability. Pairwise comparison revealed no significant difference between DA and DPI (p = 0.900), indicating that DA is the principal contributor to DPI performance. At the optimal DPI cut-off of 266.96 (Youden's index), sensitivity was 48.0% and specificity was 83.3%; retrospective simulation showed that applying this threshold prospectively would have spared 35 patients (83.3% of non-injured patients) unnecessary surgical exploration, while 13 diaphragmatic injuries (52.0%) would have remained undetected. CONCLUSION: Neither DA, EHD, nor DPI demonstrated sufficient individual discriminatory performance to reliably predict diaphragmatic injury in penetrating left thoracoabdominal trauma. EHD was not independently associated with injury likelihood, and DPI offered no significant discriminatory advantage over DA alone. These findings suggest that anatomical parameters derived from CT-based measurements are inadequate as standalone triage tools, and that the high false negative rate at any clinically applicable threshold precludes their use as rule-out criteria. The quantification of this limitation is itself a clinically meaningful contribution, establishing a benchmark for future research. Prospective studies incorporating multiparametric models that combine anatomical, clinical, and radiological variables are required before any of these parameters can be considered for clinical adoption.
The critical role of the RUNX1/NF-κB transcriptional complex-mediated PVAT-VSMC axis in aortic dissection.
Guo X, Liu B, Han Y … +3 more , Si X, Zhou Y, Wang Y
J Cardiothorac Surg · 2026 Jun · PMID 42337688 · Full text
Aortic dissection (AD) is a devastating vascular disorder pathologically characterized by pathological phenotypic switching of medial vascular smooth muscle cells (VSMCs) and progressive breakdown of extracellular matrix...
Aortic dissection (AD) is a devastating vascular disorder pathologically characterized by pathological phenotypic switching of medial vascular smooth muscle cells (VSMCs) and progressive breakdown of extracellular matrix (ECM) architecture. Conventional paradigms have primarily emphasized unidirectional injury originating within the vessel wall. Nevertheless, accumulating evidence indicates that perivascular adipose tissue (PVAT), which directly envelops the adventitia and is increasingly regarded as the "fourth layer" of the vascular wall, exerts a critical outside-in influence on vascular homeostasis and microenvironmental imbalance. This review systematically delineates how perivascular adipose tissue (PVAT) shifts from a vasoprotective component to a pathogenic source under conditions of local inflammation or metabolic stress. We particularly focus on the pathological state in which PVAT releases a broad array of pro-inflammatory mediators through paracrine signaling, most notably transforming growth factor-β1 (TGF-β1), which crosses tissue boundaries to orchestrate microenvironmental crosstalk between the adventitia and the media.Under persistent TGF-β1 stimulation, vascular smooth muscle cells (VSMCs) may develop a cooperative transcriptional regulatory network centered on Runt-related transcription factor 1 (RUNX1) and nuclear factor-κB (NF-κB). This review explores the hypothesis that PVAT-derived inflammatory stimuli may induce post-receptor TGF-β1 signal shunting, thereby favoring the formation of a RUNX1/NF-κB regulatory axis in VSMCs. Such a network may contribute to aortic wall destabilization by suppressing contractile phenotype-associated genes while promoting inflammatory and extracellular matrix remodeling programs. From an "outside-in" perspective, we discuss the potential role of PVAT-VSMC microenvironmental crosstalk in AD pathogenesis and critically evaluate the current evidence supporting this model, as well as its limitations. Furthermore, we propose that future therapeutic strategies targeting this transcriptional axis may require localized delivery approaches to minimize systemic adverse effects, including bleeding and immunosuppression, thereby offering a potential avenue for precision treatment of AD.
The lived experiences of patients with left ventricular assist devices in China: a qualitative study.
Li J, Li C, Dong R … +3 more , Yang X, Zhang J, Wang J
J Cardiothorac Surg · 2026 Jun · PMID 42337684 · Full text
BACKGROUND: Patients with left ventricular assist devices (LVAD) experience unique challenges shaped by both device characteristics and cultural context. Their psychosocial and cultural implications remain underexplored,...
BACKGROUND: Patients with left ventricular assist devices (LVAD) experience unique challenges shaped by both device characteristics and cultural context. Their psychosocial and cultural implications remain underexplored, especially in non-Western contexts. This study explored the lived experiences of LVAD implantation patients in the context of Chinese culture. METHODS: A hermeneutic phenomenological approach was employed, involving five Chinese patients who had undergone LVAD implantation. Data were collected through semi-structured interviews, audio-recorded, and transcribed verbatim. And data analysis based on the methodology of Interpretive phenomenological analysis (IPA). RESULTS: Two themes that emerged from the analysis: (1) Perceived loss of mastery, (2) Coping Strategies. The former includes five subthemes: contrast-induced disparity, restrictions imposed by the device, insufficient external support, loss of control over self-management, and emotional dysregulation, which represent the core adaptive challenge following implantation. The latter encompasses two subthemes: reconstruction of self-care ability and emotional adjustment. CONCLUSION: This study reveals that Chinese LVAD patients experience a pervasive loss of mastery after implantation and adopt adaptive coping strategies through self-care reconstruction and emotional adjustment. Family support has a unique yet paradoxical influence on patients' adaptation in the Chinese cultural context. Targeted interventions that combine functional and psychological support with culturally appropriate family-based strategies are essential for restoring patients' sense of mastery and improving long-term clinical outcomes.
Combined effect of the triglyceride-glucose index and frailty index on advanced stages among cardiovascular-kidney-metabolic syndrome patients.
Tu D, Li J, Li Y … +1 more , Wang J
J Cardiothorac Surg · 2026 Jun · PMID 42337669 · Full text
BACKGROUND: Advanced cardiovascular-kidney-metabolic (CKM) syndrome (stages 3-4) signifies high-risk multi-organ dysfunction. The triglyceride-glucose-frailty index (TyG-FI), combining the TyG index with a frailty index,...
BACKGROUND: Advanced cardiovascular-kidney-metabolic (CKM) syndrome (stages 3-4) signifies high-risk multi-organ dysfunction. The triglyceride-glucose-frailty index (TyG-FI), combining the TyG index with a frailty index, may better reflect both metabolic dysregulation and physiological decline than TyG-related indices alone. This study aimed to examine the association between TyG-FI and advanced CKM syndrome. METHODS: This cross-sectional analysis used 2011-March 2020 National Health and Nutrition Examination Survey data from 6,960 adults with CKM syndrome. CKM syndrome stages 3 or 4 were considered advanced. Survey-weighted logistic regression and restricted cubic splines models were used to evaluate the relationship between TyG-FI and advanced CKM syndrome. The discriminatory power of TyG-FI was assessed using receiver operating characteristic (ROC) curves and compared to other TyG-related indices and FI. RESULTS: The highest TyG-FI quartile had significantly increased odds of advanced CKM syndrome (odds ratio: 10.32, 95% confidence intervals: 6.51-16.34) versus the lowest. A unit increase in TyG-FI corresponded to an odds ratio of 2.78 (95% confidence intervals: 2.39-3.22). Restricted cubic splines indicated a nonlinear dose-response association between TyG-FI and advanced CKM syndrome. Furthermore, ROC analysis demonstrated that TyG-FI had superior discriminatory ability (AUC = 0.796) compared to FI and all other TyG-related indices. CONCLUSIONS: TyG-FI shows a strong, dose-response association with advanced CKM syndrome and superior predictive performance, suggesting that a higher TyG-FI may increase the risk of advanced CKM syndrome.
Screening of atherosclerosis diagnostic markers based on lymphangiogenesis-related genes and analysis of immunological characteristics.
Zhu N, Bi J, Tong G
J Cardiothorac Surg · 2026 Jun · PMID 42337638 · Full text
BACKGROUND: Atherosclerosis (AS) was a major cause of cardiovascular disease, and traditional diagnostic methods often fail to detect AS promptly and accurately. Formation of new lymphatic vessels, or lymphangiogenesis,...
BACKGROUND: Atherosclerosis (AS) was a major cause of cardiovascular disease, and traditional diagnostic methods often fail to detect AS promptly and accurately. Formation of new lymphatic vessels, or lymphangiogenesis, is a crucial process in the development of many diseases. However, the value of lymphangiogenesis-related genes (LRGs) as potential diagnostic markers for AS remained incompletely elucidated. METHODS: This study analyzed AS transcriptome data from comprehensive gene expression omnibus databases. A systematic screening for potential AS biomarkers was performed using the integration of three machine learning techniques. Single-gene enrichment analysis explored the potential biological processes of diagnostic genes in AS. Diagnostic gene features served as the basis for constructing a nomogram, whose predictive efficacy was then assessed and confirmed. Immune infiltration analysis was employed to investigate the immune microenvironment characteristics of AS. To screen for potential drugs targeting diagnostic genes, drug prediction was performed using the DSigDB database. Separately, consensus clustering analysis of AS samples revealed molecular subtypes that differ in biological features. RESULTS: This study identified three key LRGs as diagnostic biomarkers for AS and constructed a diagnostic model. The model demonstrated robust diagnostic performance in both training and validation sets. Further enrichment analysis indicated that all three diagnostic genes participate in immune-related biological processes. Immune cell infiltration analysis revealed higher infiltration levels of CD8 + T cells, NK cells, and neutrophils in the AS group. Butein and pimaric acid emerged as potential therapeutic agents targeting these diagnostic genes. Additionally, AS was successfully classified into three molecular subtypes, each exhibiting distinct molecular mechanisms and immune characteristics. CONCLUSION: This study established a diagnostic model centered on lymphangiogenesis to elucidate the complex immune response characteristics in AS and their associated molecular mechanisms.
Bibliometric analysis of research hotspots in coronary artery CT fractional flow reserve for diagnosing myocardial ischemia in coronary artery disease.
Abudoueryimu A, Xirefu A, Maihemuti Z … +5 more , Mahemuti M, Qiaohui C, Keremu G, Xiaomei W, Haihong MA
J Cardiothorac Surg · 2026 Jun · PMID 42337637 · Full text
OBJECTIVE: This study aimed to conduct a comprehensive bibliometric analysis to map the global research landscape, identify evolving hotspots, and forecast future trends in the application of coronary computed tomography...
OBJECTIVE: This study aimed to conduct a comprehensive bibliometric analysis to map the global research landscape, identify evolving hotspots, and forecast future trends in the application of coronary computed tomography-derived fractional flow reserve (CT-FFR) for diagnosing myocardial ischemia in coronary artery disease (CAD). METHODS: A systematic literature search was performed in the Web of Science Core Collection for publications from 2015 to 2025, using an expanded strategy combining CT-FFR terms with synonyms for myocardial ischemia and CAD. Bibliometric data visualization and analysis were conducted using CiteSpace and VOSviewer to examine publication trends, national/institutional contributions, collaborative networks, core journals, keyword co-occurrence, and citation bursts. RESULTS: From an initial retrieval of 730 records, 582 eligible publications (405 articles, 117 reviews) were included. Annual publication output showed sustained growth with a compound annual growth rate (CAGR) of 6.4%. The United States led in publication volume (n = 231) and total citations, followed by China in output (n = 143), though with lower average citation impact. International collaboration was prominent, with the US, China, and Italy forming central hubs. JACC: Cardiovascular Imaging was the leading journal in both output and influence. Keyword analysis confirmed "Fractional Flow Reserve," "Coronary Artery Disease," and "Diagnostic Performance" as core themes. Burst detection revealed a clear evolution: early research (2015-2018) focused on technical validation (e.g., "dual source ct"), while recent trends (2022-2025) shifted towards clinical integration, with strong bursts for "stable chest pain," "diagnosis," and "coronary computed tomography angiography." CONCLUSION: This bibliometric analysis delineates a dynamic and growing CT-FFR research field, marked by a transition from technological exploration to clinical guideline-directed application. The findings highlight distinct geographic patterns of productivity and influence, and clarify the evolution of research priorities towards personalized, ischemia-guided patient management. Future research is anticipated to focus on multimodal integration with plaque and perfusion imaging, artificial intelligence-driven workflow solutions, and evidence generation in complex patient cohorts to solidify clinical adoption.
The effect of remote ischemic preconditioning on cardiac injury in adults undergoing cardiac surgery: a systematic review with quantitative synthesis.
Chen Z, Dong W, Zhang Q … +1 more , Wang Y
J Cardiothorac Surg · 2026 Jun · PMID 42337618 · Full text
BACKGROUND: To evaluate the association between remote ischemic preconditioning and postoperative hs-TnT levels in patients undergoing cardiac surgery. METHODS: We systematically searched PubMed, Cochrane Central, Scopus...
BACKGROUND: To evaluate the association between remote ischemic preconditioning and postoperative hs-TnT levels in patients undergoing cardiac surgery. METHODS: We systematically searched PubMed, Cochrane Central, Scopus, Embase, and Web of Science library databases for original RCTs (randomized controlled trials) articles that looked at the effect of RIPC on cardioprotection undergoing Cardiovascular Surgery. The outcome assessed was high-sensitivity troponin T (hs-TnT). Random-effects-analyses were conducted using standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals, applying the Hartung-Knapp-Sidik-Jonkman (HKSJ) method with restricted maximum likelihood estimation (REML). Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, certainty of evidence was graded using GRADE. RESULTS: Four randomized controlled trials were included in the quantitative synthesis. Using a random-effects model with restricted maximum likelihood estimation (REML) and HKSJ, the pooled analysis showed no significant difference in hs-TnT levels between the RIPC and control groups (Hedges' g = - 0.13, 95% CI - 0.83 to 0.56; p = 0.59). Substantial heterogeneity was observed among studies (I² = 84.6%, τ² = 0.16). Leave-one-out sensitivity analyses demonstrated that the pooled estimate was highly sensitive to the inclusion of individual studies, indicating limited robustness of the available evidence. Exploratory subgroup analyses suggested that effect estimates varied according to postoperative hs-TnT measurement timing; however, these findings were based on very small numbers of studies and should be interpreted cautiously. CONCLUSION: Remote ischemic preconditioning was not associated with a significant overall reduction in postoperative hs-TnT levels in adult cardiac surgery. The available evidence is limited by the small number of trials, substantial heterogeneity, and reliance on a surrogate biomarker outcome. Consequently, current evidence is insufficient to support or refute a clinically meaningful cardioprotective effect of RIPC in this setting.
Sleep-duration abnormality, depressive symptoms, and cardiometabolic indicators: evidence from NHANES 2013-2023.
Chen L, Deng H, Meng L
J Cardiothorac Surg · 2026 Jun · PMID 42337605 · Full text
BACKGROUND: Sleep-duration abnormality and depressive symptoms are both associated with cardiometabolic health, and they often co-exist. Current research has largely focused on the separate associations of abnormal sleep...
BACKGROUND: Sleep-duration abnormality and depressive symptoms are both associated with cardiometabolic health, and they often co-exist. Current research has largely focused on the separate associations of abnormal sleep duration or depressive symptoms with cardiometabolic indicators, whereas fewer studies have examined their joint association and potential interaction across population subgroups. This study aimed to evaluate the co-occurrence of sleep-duration abnormality and depressive symptoms in relation to cardiometabolic indicators and to explore whether these associations differed by gender and age using NHANES 2013-2023 data. METHODS: This study utilized publicly available data from the National Health and Nutrition Examination Survey (NHANES) 2013-2023. Adult participants with complete data on sleep-duration variables, depression assessment, and cardiometabolic indicators were included. Sleep exposure was operationalized using NHANES Sleep Questionnaire variables for usual weekday/workday sleep duration (SLD012) and weekend/non-workday sleep duration (SLD013). Sleep-duration abnormality was defined as short sleep duration (< 7 h) or long sleep duration (> 9 h) on either weekday/workday or weekend/non-workday measures. Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Cardiometabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, and high-sensitivity C-reactive protein (hs-CRP). Survey-weighted multivariable logistic regression was used to examine the associations between sleep-duration abnormality, depressive symptoms, and cardiometabolic indicators. The adjusted models included demographic, socioeconomic, lifestyle, and clinical covariates, including age, gender, race/ethnicity, education level, household income, smoking status, alcohol consumption, diabetes history, and BMI where appropriate. Multiplicative interaction was assessed by including a product term between sleep-duration abnormality and depressive symptoms in the regression models. For hypertension, additive interaction was further evaluated using the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). Gender- and age-stratified analyses were also conducted. RESULTS: Participants with both sleep-duration abnormality and depressive symptoms had higher levels or prevalence of several adverse cardiometabolic indicators, including hypertension, obesity, and elevated hs-CRP, than those without either condition. For hypertension, the odds ratio associated with the co-occurrence of sleep-duration abnormality and depressive symptoms was 3.02 (95% CI: 2.56-3.56), compared with 1.48 (95% CI: 1.26-1.74) for sleep-duration abnormality alone and 1.62 (95% CI: 1.38-1.91) for depressive symptoms alone. Evidence of interaction for hypertension was observed on both the multiplicative scale (interaction P < 0.001) and additive scale (RERI = 1.21, 95% CI: 0.93-1.49; AP = 40.1%, 95% CI: 31.5-48.7%). Stratified analyses suggested that the additive interaction for hypertension was more apparent among women and older adults. CONCLUSIONS: The co-occurrence of sleep-duration abnormality and depressive symptoms was associated with less favorable cardiometabolic indicators in this cross-sectional NHANES analysis. Evidence of additive interaction was observed for hypertension, particularly among women and older adults. These findings support the need to consider abnormal sleep duration and depressive symptoms jointly when evaluating cardiometabolic health, while causal and mechanistic interpretations require confirmation in longitudinal studies.
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