Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
Lobectomy for right lower lobe lung cancer with anomalous systemic arterial supply and partial anomalous pulmonary venous connection: a case report.
Hirai Y, Anayama T, Wada H … +5 more , Hirohashi K, Onozato Y, Kamata T, Yoshino I, Yoshida S
J Cardiothorac Surg · 2026 Jun · PMID 42332763 · Full text
BACKGROUND: Anomalous systemic arterial supply to the basal lung (ASASB) and partial anomalous pulmonary venous connection (PAPVC) are rare congenital anomalies; their coexistence in a patient with lung cancer has not be...
BACKGROUND: Anomalous systemic arterial supply to the basal lung (ASASB) and partial anomalous pulmonary venous connection (PAPVC) are rare congenital anomalies; their coexistence in a patient with lung cancer has not been previously reported. CASE PRESENTATION: A 68-year-old woman was referred for a right lower lobe mass detected on screening. Contrast-enhanced computed tomography showed an aberrant artery from the abdominal aorta supplying segments 9-10 and drainage of all right upper pulmonary veins into the superior vena cava. Qp/Qs on echocardiography was 1.3. Three-dimensional reconstruction clarified the vascular anatomy and guided thoracoscopic right lower lobectomy. The aberrant artery was doubly ligated at its intrathoracic origin and divided with a vascular stapler. Postoperative recovery was uneventful. Histology revealed papillary-predominant adenocarcinoma (pT2aN0M0). Twelve-month surveillance showed no recurrence or stump aneurysm; Qp/Qs decreased to 1.1. CONCLUSIONS: Careful cardiopulmonary evaluation and three-dimensional imaging permitted safe minimally invasive resection in this rare condition. However, the mechanisms underlying postoperative changes in Qp/Qs remain unclear and require cautious interpretation.
Successful management of hemolysis after transcatheter mitral valve implantation by valve re-tensioning.
Wang SW, Sun QH, Rao ZM … +2 more , Gao JB, Zhu D
J Cardiothorac Surg · 2026 Jun · PMID 42332722 · Full text
BACKGROUND: Transcatheter mitral valve implantation (TMVI) device featuring an apical fixation design is now the most mature TMVI system and widely applied in routine clinical practice. Nevertheless, severe unique compli...
BACKGROUND: Transcatheter mitral valve implantation (TMVI) device featuring an apical fixation design is now the most mature TMVI system and widely applied in routine clinical practice. Nevertheless, severe unique complications including left ventricular outflow tract (LVOT) obstruction, paravalvular leakage (PVL), and hemolysis can still occur with this device. A 75-year-old frail elderly female with severe mitral regurgitation (MR) and recurrent heart failure was admitted to our institution for treatment. TMVI was successfully completed. The patient was subsequently rehospitalized owing to decompensated heart failure, PVL and severe hemolysis due to late valve dislodgement. We then performed valve re-tensioning via the prior thoracotomy, which resolved PVL and relieved hemolysis. DISCUSSION: Subacute dislodgement of the prosthesis can still occur following TMVI with apical fixation design, leading to severe PVL and hemolysis. Accurate diagnosis using transesophageal echocardiography (TEE) combined with prompt re-tensioning is critical for the management of this complication.
Impact of origin and frequency of premature ventricular complexes on cardiac remodeling: a systematic review and meta-analysis.
Zhang G, Yao J, Gao J … +3 more , Yan J, Xu L, Yang Y
J Cardiothorac Surg · 2026 Jun · PMID 42324553 · Full text
BACKGROUND: Frequent premature ventricular complexes (PVCs) have been associated with adverse cardiac remodeling; however, the relative contributions of PVC frequency and anatomical origin remain unclear. This study eval...
BACKGROUND: Frequent premature ventricular complexes (PVCs) have been associated with adverse cardiac remodeling; however, the relative contributions of PVC frequency and anatomical origin remain unclear. This study evaluated the effects of PVC burden and origin on cardiac structural and functional changes. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, CENTRAL, and the Cochrane Library were searched for English-language observational studies published up to December 2025. Studies assessing the relationship between PVC frequency or origin and echocardiographic parameters were included. Frequent PVCs were defined using study-specific thresholds (e.g., > 10,000 beats/day, > 5% of total beats, or > 5000 occurrences per 10 h). Of 625 records, nine studies involving 1886 patients met the inclusion criteria, including six on PVC frequency and three on PVC origin. Pooled analyses were performed using weighted mean differences (WMD) with 95% confidence intervals. RESULTS: Frequent PVCs were significantly associated with reduced left ventricular ejection fraction (LVEF) (WMD = - 3.66, 95% CI - 6.30 to - 1.02; P = 0.007), increased LVEDD (WMD = 3.17, 95% CI 1.35 to 4.99; P = 0.0006), increased LVESD (WMD = 3.27, 95% CI 0.32 to 6.23; P = 0.03), and increased LAD (WMD = 1.59, 95% CI 0.13 to 3.06; P = 0.03), suggesting adverse ventricular and atrial remodeling. PVC origin was not significantly associated with LVEF or LVEDD. CONCLUSION: A high PVC burden is associated with adverse cardiac remodeling, whereas PVC origin was not significantly associated with structural changes in this analysis and should be interpreted with caution given the limited number of studies and heterogeneity. These findings support the importance of PVC frequency in risk stratification and early intervention.
Association between the TP63 and CIR1 polymorphisms and non-small cell lung cancer in Chinese population.
Shen Y, Zheng P, Zheng J … +1 more , Gu J
J Cardiothorac Surg · 2026 Jun · PMID 42324549 · Full text
OBJECTIVES: Lung cancer is a leading cause of cancer-related death globally, with non-small cell lung cancer (NSCLC) being the predominant form. Genetic factors significantly influence individual susceptibility. This stu...
OBJECTIVES: Lung cancer is a leading cause of cancer-related death globally, with non-small cell lung cancer (NSCLC) being the predominant form. Genetic factors significantly influence individual susceptibility. This study investigated the association of TP63 (rs7631358) and CIR1 (rs13009079) polymorphisms with NSCLC risk in a Chinese population. METHODS: A case-control study was conducted with 500 NSCLC patients and 500 matched controls. Genotyping was performed using the SEQUENOM MassARRAY platform. Associations were evaluated using chi-square tests and logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: In the pre-specified primary analysis with FDR correction, both TP63 rs7631358 (A/G + A/A vs. G/G: adjusted OR = 1.409, FDR P = 0.030) and CIR1 rs13009079 (T/T vs. C/T + C/C: adjusted OR = 1.390, FDR P = 0.030) were significantly associated with an increased risk of lung adenocarcinoma after adjustment for smoking status, gender, and age. Exploratory subgroup analyses suggested that the TP63 association was more pronounced among ever-smokers, although the gene-smoking interaction did not reach statistical significance. CONCLUSIONS: TP63 rs7631358 and CIR1 rs13009079 polymorphisms are significantly associated with the susceptibility to lung adenocarcinoma in the Chinese Han population after correction for multiple testing. These findings support a role for the TP63-mediated DNA damage response pathway and the CIR1-Notch signaling pathway in ADC pathogenesis. Replication in larger, independent cohorts is warranted to confirm these associations and to further evaluate their potential for clinical risk stratification.
The moderating role of sociodemographic characteristics and health behaviours in the relationship between daily living activities and postoperative recovery in CABG patients.
Denler E, Bakir GK
J Cardiothorac Surg · 2026 Jun · PMID 42324548 · Full text
OBJECTIVE: This study examined the moderating role of sociodemographic characteristics and health behaviours in the relationship between daily living activities and postoperative recovery in patients who underwent corona...
OBJECTIVE: This study examined the moderating role of sociodemographic characteristics and health behaviours in the relationship between daily living activities and postoperative recovery in patients who underwent coronary artery bypass graft surgery. METHOD: This descriptive, cross-sectional, and analytical study was conducted with 200 patients who underwent coronary artery bypass graft surgery in two training and research hospitals in Istanbul between December 2024 and April 2025. Data were collected using the Patient Assessment Form, the Barthel Activities of Daily Living Index, and the Postoperative Recovery Index. Pearson correlation analysis and moderation analyses via PROCESS Macro (Model 1) with 5,000 bootstrap resamples were performed. RESULTS: A significant negative relationship was identified between daily living activities and postoperative recovery (r = - .453, p < .01). Physical activities recorded the highest subscale mean (2.52) and the strongest correlation with ADL scores (r = - .834, p < .01). BMI (B = - 0.214, p = .016), educational status (B = 0.036, p = .034), income level (B = - 0.023, p = .042), smoking status (B = - 0.039, p = .018), alcohol consumption (B = - 0.018, p = .009), and previous surgical experience (B = - 0.042, p = .023) each significantly moderated this relationship. CONCLUSION: The relationship between daily living activities and postoperative recovery is significantly shaped by individual sociodemographic and behavioural characteristics. It is recommended that individualised care approaches be strengthened by incorporating patients' sociodemographic profiles and health behaviours into postoperative nursing care planning.
Prognostic value of tertiary lymphoid structures in locally advanced esophageal squamous cell carcinoma treated with neoadjuvant chemoimmunotherapy: a retrospective study.
Xue T, Wu Y, Zi Q … +6 more , Zi T, Gao S, Mao J, Peng Y, Chen J, Wang X
J Cardiothorac Surg · 2026 Jun · PMID 42324542 · Full text
This retrospective study analyzed 73 patients with locally advanced esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemoimmunotherapy, aiming to investigate the impact of the multiple heterogeneity of...
This retrospective study analyzed 73 patients with locally advanced esophageal squamous cell carcinoma (ESCC) who received neoadjuvant chemoimmunotherapy, aiming to investigate the impact of the multiple heterogeneity of tertiary lymphoid structures (TLS) on treatment efficacy and prognosis. The results demonstrated that intratumoral TLS presence correlated with superior radiological and pathological responses, whereas peritumoral TLS expression was associated with poorer outcomes. Regarding spatial heterogeneity, the subgroup characterized by high intratumoral TLS abundance combined with absent peritumoral TLS exhibited the most favorable progression-free survival (PFS) and overall survival (OS). Furthermore, a higher degree of TLS maturation was significantly associated with improved survival benefits. Multivariate analysis confirmed that body mass index (BMI) served as an independent protective factor for both PFS and OS, while pre-treatment TNM stage emerged as an independent risk factor for PFS. These findings suggest that TLS holds promise as a potential predictive biomarker for the efficacy of neoadjuvant chemoimmunotherapy.
Reinforcement mesh repair for persistent pleural leakage following VATS lobectomy: a case report and clinical insights.
Lizwan M, Cynthia Chia ML
J Cardiothorac Surg · 2026 Jun · PMID 42324485 · Full text
Early chest drain removal and discharge are standard in enhanced-recovery protocols after video-assisted thoracoscopic surgery (VATS) lobectomy, but rare wound complications may arise. We report a 71-year-old man who und...
Early chest drain removal and discharge are standard in enhanced-recovery protocols after video-assisted thoracoscopic surgery (VATS) lobectomy, but rare wound complications may arise. We report a 71-year-old man who underwent uneventful 3-port right VATS lower lobectomy. The utility access incision measured approximately 3.5 cm, was protected with a SurgiSleeve wound protector, and was closed in layers. No postoperative drain was placed through this site. The chest drain was removed on postoperative day 1 after absence of air leak and acceptable drainage output, and the patient was discharged on postoperative day 2. Two weeks later, serous pleural fluid leaked through the utility access wound. Conservative management with wound reinforcement, local compression, and empirical antibiotics failed. Re-exploration demonstrated clear pleural effusion without purulence, lung herniation, necrosis, or air leak. Selective reinforcement with polypropylene mesh anchored to the adjacent rib achieved wound stability, and the patient recovered without recurrence. Persistent pleural leakage through a VATS access wound is rare. In selected patients with persistent leakage after conservative management, and where infection has been reasonably excluded, mesh reinforcement may be considered as one feasible surgical option rather than a routine strategy.
Precision neuroprotection in cardiac surgery: a structured narrative review of multimodal, data-driven perioperative care.
Hamza M, Zafarullah M, Mujtaba M … +4 more , Javaid MH, Butt AI, Mahato RK, Chaudhry IUH
J Cardiothorac Surg · 2026 Jun · PMID 42324480 · Full text
Neurological injury remains a major contributor to morbidity, mortality, and long-term cognitive decline in patients undergoing cardiac surgery, despite significant advancements in surgical techniques and cardiopulmonary...
Neurological injury remains a major contributor to morbidity, mortality, and long-term cognitive decline in patients undergoing cardiac surgery, despite significant advancements in surgical techniques and cardiopulmonary bypass (CPB) technology. These injuries arise from a complex interplay of embolic load, hypoperfusion, impaired cerebral autoregulation, inflammatory responses, and patient-specific vulnerabilities, underscoring the need for a precision-based approach rather than generalized neuroprotective strategies. This narrative review synthesizes current evidence across the perioperative continuum to propose an integrated, data-driven framework for precision neuroprotection. This structured narrative review was conducted according to the SANRA framework. Literature was retrieved from PubMed and Scopus databases covering publications from January 2005 to October 2025.Preoperative risk assessment is enhanced by multimodal imaging, frailty evaluation, neurocognitive screening, metabolic and inflammatory biomarkers, and emerging machine learning models capable of predicting postoperative delirium and cognitive dysfunction. Intraoperatively, precision neuroprotection centers on autoregulation-guided blood pressure management, individualized perfusion targets during CPB, optimized temperature and glucose control, and multimodal neuromonitoring, including transcranial Doppler (TCD), near-infrared spectroscopy (NIRS), processed EEG/BIS, and embolic load characterization, to identify and mitigate cerebral insults in real time. Postoperative precision strategies incorporate biomarker-based surveillance, delirium screening, early mobilization, cognitive rehabilitation, and digital monitoring through wearable devices and remote platforms to detect delayed neurological decline. Although these modalities demonstrate clear potential, major research gaps persist, including variability in device accuracy, limited ability to differentiate embolic subtypes, inconsistent biomarker performance and insufficient integration of AI-driven analytics with clinical workflows. Collectively, available evidence supports the transition from fragmented, organ-focused neuroprotection to a unified, multimodal continuum that leverages data integration, personalized thresholds, and predictive analytics. Future large-scale, human-centered clinical trials are essential to validate this approach and operationalize precision neuroprotection across cardiac surgical practice.
Fatal cardiogenic shock following inhalation of aluminum phosphide in a child requiring veno-arterial ECMO support: a rare case and review of extracorporeal strategies.
Guney Sahin E
J Cardiothorac Surg · 2026 Jun · PMID 42324466 · Full text
BACKGROUND: Aluminum phosphide is a pesticide and rodenticide widely used in grain storage and pest management and is associated with high mortality due to refractory shock and multiorgan failure. Although severe cardiog...
BACKGROUND: Aluminum phosphide is a pesticide and rodenticide widely used in grain storage and pest management and is associated with high mortality due to refractory shock and multiorgan failure. Although severe cardiogenic shock requiring mechanical circulatory support has been predominantly reported following oral exposure, profound cardiac involvement after inhalational exposure is exceedingly rare. CASE PRESENTATION: We report the case of a previously healthy 2-year-old girl who developed fulminant cardiogenic shock and malignant ventricular arrhythmias after inhalation of aluminum phosphide. Despite aggressive medical therapy, she experienced recurrent cardiac arrest within the first hours of hospitalization. Transthoracic echocardiography demonstrated severe left ventricular dysfunction, prompting emergent initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) within the first 4 h. Multimodal extracorporeal supportive therapies, including continuous renal replacement therapy, therapeutic plasma exchange, and red blood cell exchange, were used as adjunctive measures to manage multiorgan failure. Cardiac function progressively recovered, and the patient was successfully weaned from VA-ECMO on day 11. However, she subsequently developed acute respiratory distress syndrome and suffered cardiac arrest on day 21 following progressive respiratory deterioration. The exact cause of the terminal cardiac arrest could not be determined. CONCLUSION: While adjunctive extracorporeal therapies may contribute to metabolic stabilization and organ support, this case underscores that early recognition of toxin-induced cardiac failure and timely initiation of veno-arterial extracorporeal membrane oxygenation is essential for initial stabilization in severe aluminum phosphide poisoning.
Safety and feasibility of rotational atherectomy in chronic total occlusion: a systematic review and meta-analysis.
Abdelaziz A, Elsayed H, Hamdaalah A … +18 more , Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Ellabban MH, Mohamed Rzk F, Eid M, AboElfarh HE, Ibrahim RA, Zawaneh EA, Ezzat M, Abdelaziz M, Fadel S, Elnaggar MY, Sena AO, Bahnasy A, Singer E
J Cardiothorac Surg · 2026 Jun · PMID 42323669 · Full text
BACKGROUND: There is a lack of data available on the feasibility of rotational atherectomy (RA) in chronic total occlusion (CTO) lesions compared to RA in non-CTO lesions. So, we aimed to study the safety and feasibility...
BACKGROUND: There is a lack of data available on the feasibility of rotational atherectomy (RA) in chronic total occlusion (CTO) lesions compared to RA in non-CTO lesions. So, we aimed to study the safety and feasibility of RA in patients with CTO lesions compared to non-CTO lesions. METHODS: We searched PubMed, Scopus, Web of Science (WOS), and Ovid until March 2024. We included all relevant studies assessing RA in CTO lesions versus non-CTO lesions. The primary outcome of interest was major adverse cardiovascular events (MACE), while secondary outcomes were all-cause death, cardiac death, myocardial infarction (MI), and target-vessel revascularization (TVR). Other studied angiographic outcomes were vessel perforation, technical success, and procedural success. The pooled data was analyzed using odds ratio (OR) with its 95% CI in using a random-effect model. RESULTS: Four studies comprising 1925 patients were included in the analysis. The pooled analysis showed that RA in CTO lesions was associated with higher rates of vessel perforation (OR = 3.56, 95% CI: 1.59-7.98, p < 0.001) compared to the non-CTO lesions. On the other hand, no significant differences were observed regarding studied clinical outcomes and angiographic outcomes between CTO and non-CTO lesions. CONCLUSION: RA for CTO lesions was associated with comparable clinical and angiographic outcomes. RA is a safe and feasible approach in CTO lesions, despite a higher incidence of vessel perforation. More investigations on the severity of each case should be guided in further studies.
Nonlinear association between the stress hyperglycemia ratio and 180-day mortality in critically ill patients undergoing extracorporeal circulation during open heart surgery: a MIMIC-IV cohort study.
Zhang P, Zhang X, Zhao H … +1 more , Zhang Y
J Cardiothorac Surg · 2026 Jun · PMID 42323628 · Full text
AIMS: The stress hyperglycemia ratio (SHR) has been associated with adverse outcomes in patients with cardiovascular diseases. Recent studies have also linked higher SHR to increased mortality after cardiac surgery, incl...
AIMS: The stress hyperglycemia ratio (SHR) has been associated with adverse outcomes in patients with cardiovascular diseases. Recent studies have also linked higher SHR to increased mortality after cardiac surgery, including analyses using the MIMIC-IV database, and in patients undergoing CABG for acute myocardial infarction. Therefore, the present study should be viewed as an incremental and exploratory analysis rather than as a wholly novel investigation. However, the dose-response pattern and clinically relevant risk thresholds of SHR in an undifferentiated extracorporeal circulation (ECC)-assisted open-heart surgery population remain incompletely characterized. Given the uncertain perioperative timing of glucose measurements in MIMIC-IV, SHR was interpreted as an aggregated prognostic marker rather than a direct measure of intraoperative or immediate postoperative metabolic stress. This study aims to investigate the association between SHR and short-term mortality risk in this patient cohort. METHODS: A retrospective cohort study was conducted by analyzing data from 1,221 patients who underwent extracorporeal circulation during open-heart surgery, obtained from the MIMIC-IV (version 3.1) database. Patients were divided into quartiles based on SHR levels. Cox proportional hazards models, including a segmented variant, were used to evaluate the association between SHR and 180-day mortality. Glucose and HbA1c values were obtained from available laboratory records within the first 24 h of ICU admission; however, precise timing relative to surgery, ECC initiation, or ICU arrival could not be standardized. Important intraoperative parameters, including cardiopulmonary bypass duration and aortic cross-clamp time, were not available as reliable structured variables and therefore could not be adjusted for. In addition, a substantial proportion of potentially eligible patients were excluded because SHR could not be calculated owing to missing glucose or HbA1c measurements, which may have introduced selection bias. RESULTS: Within the study cohort, 63 patients (5.16%) died within 180 days. Following multivariable adjustment, SHR showed a nonlinear, threshold-like association with 180-day mortality, with an estimated inflection point at 0.97. The increase in mortality risk was more clearly observed at SHR levels above this point, whereas the association below this point was not statistically significant. Therefore, the spline-derived point should be interpreted as exploratory rather than as a clinically validated cutoff or treatment target. Compared to participants with SHR levels below the inflection point, those with higher SHR levels exhibited a fourfold increased risk of 180-day mortality (HR 4.62; 95% CI 2.67-7.95). CONCLUSION: Our findings indicate that an elevated SHR, measured by the glucose/HbA1c ratio, is associated with an increased risk of short-term mortality in patients undergoing extracorporeal circulation during open-heart surgery. Because of the retrospective design, lack of precise perioperative glucose timing, substantial exclusion of patients with missing glycemic data, uncertain completeness of post-discharge mortality ascertainment, and inability to adjust for key intraoperative variables, these findings should be interpreted as prognostic and hypothesis-generating rather than causal. The observed nonlinear pattern may help refine risk stratification, but the proposed inflection point requires validation in prospective studies with standardized perioperative glucose monitoring.
Predictors of target lesion restenosis after endovascular therapy for lower-extremity atherosclerotic peripheral artery disease: a real-world single center cohort.
Xu H, Li X, Liu Y … +1 more , Sun X
J Cardiothorac Surg · 2026 Jun · PMID 42323621 · Full text
BACKGROUND: Lower-extremity peripheral artery disease often requires endovascular therapy. Target-lesion restenosis (TLRS) remains frequent, but current risk stratification is limited. METHODS: We retrospectively analyze...
BACKGROUND: Lower-extremity peripheral artery disease often requires endovascular therapy. Target-lesion restenosis (TLRS) remains frequent, but current risk stratification is limited. METHODS: We retrospectively analyzed 1,005 lesions from 917 patients undergoing endovascular therapy for lower-extremity atherosclerotic disease at a single center (2019-2024) with scheduled surveillance (approximately 6, 12, and 24 months) and administrative censoring at 36 months. The primary endpoint was time to first TLRS ≥ 50%, adjudicated by duplex ultrasound (peak systolic velocity ratio criteria) or CTA/DSA when available. Lesion‑level Fine-Gray competing‑risk models (death as a competing event) with patient‑level clustering were used. A prespecified Core model (clinical, anatomic, procedural/device covariates and C‑reactive protein) was compared with an Extended model additionally including the Atherogenic Index of Plasma (AIP) and log‑transformed Systemic Immune-Inflammation Index (SII). Models were internally validated by 1,000 bootstrap resamples and assessed at the 24‑month horizon using the C‑index, calibration, Brier score, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision‑curve analysis. RESULTS: Among 917 patients (1,005 lesions), mean age was 75.2 ± 11.7 years and 68.6% were male. At 24 months, cumulative incidences were 31.4% for TLRS, 14.9% for clinically driven target‑lesion revascularization, and 12.3% for death. In multivariable analyses, GLASS stage III, lesion length ≥ 150 mm, residual stenosis > 20%, chronic kidney disease, and Rutherford class 4-6 predicted higher TLRS risk, whereas good distal runoff was protective. In the Extended model, AIP and SII remained independent predictors and improved the optimism‑corrected 24‑month C‑index from 0.68 to 0.73 (Δ0.05, p = 0.002), reduced the Brier score (0.19 to 0.17), yielded positive IDI and NRI, and preserved good calibration. Exploratory analyses suggested lower TLRS risk with cilostazol and low‑dose rivaroxaban plus aspirin. CONCLUSIONS: AIP and SII improved lesion-level prediction of TLRS beyond conventional covariates. The Extended model may support risk-tiered surveillance after endovascular therapy; external validation is warranted.
Dumbbell-shaped thoracic epidural capillary hemangioma mimicking schwannoma: a case report.
Thiyagarajan S, Rahul S, Naleer M … +2 more , Senthilkumar J, Rathore M
J Cardiothorac Surg · 2026 Jun · PMID 42323601 · Full text
BACKGROUND: Spinal epidural hemangiomas are rare benign vascular lesions. A dumbbell configuration defined by extension through the neural foramen with both intraspinal and extraspinal components is most commonly associa...
BACKGROUND: Spinal epidural hemangiomas are rare benign vascular lesions. A dumbbell configuration defined by extension through the neural foramen with both intraspinal and extraspinal components is most commonly associated with schwannomas. Dumbbell-shaped capillary hemangiomas are exceptionally rare and can pose significant diagnostic challenges. CASE PRESENTATION: A 66-year-old woman presented with a one-year history of back pain and progressive bilateral lower-limb weakness that progressed to a bedridden state. Imaging revealed a dumbbell-shaped lesion extending from D3 to D5 with a large paravertebral component measuring 4.3 × 3.6 × 5.7 cm. A combined D3-D5 laminectomy and right posterolateral thoracotomy was performed. The tumor was markedly hypervascular intraoperatively, and gross total resection was achieved. Recent coronary artery bypass grafting and dual antiplatelet therapy increased the operative hemorrhagic risk. Postoperatively, the patient demonstrated neurological improvement with restoration of bladder control and regained ambulation with a walker. CONCLUSIONS: Dumbbell capillary hemangiomas can mimic schwannomas radiologically yet carry substantial hemorrhagic risk. Multidisciplinary surgical planning is essential for safe management.
Protein losing enteropathy and hypoalbuminemia after cardiac surgery.
Redelmeier DA, Cheung CM, Patel AM
J Cardiothorac Surg · 2026 Jun · PMID 42323595 · Full text
RATIONALE: Postoperative hypoalbuminemia is a common, persistent, and ominous abnormality following major surgery and has uncertain etiology. The purpose of this study was to investigate the incidence of protein-losing e...
RATIONALE: Postoperative hypoalbuminemia is a common, persistent, and ominous abnormality following major surgery and has uncertain etiology. The purpose of this study was to investigate the incidence of protein-losing enteropathy as measured by alpha-1-antitrypsin clearance after major surgery. METHODS: We conducted a prospective cohort study of consecutive patients undergoing cardiac surgery at one hospital (n = 38, mean age = 65 years, male = 79%). Alpha-1-antitrypsin was measured in both blood and stool samples using standard techniques for diagnosing protein-losing enteropathy. Sensitivity, specificity, and predictive indices were calculated taking into account the measured serum albumin concentration. FINDINGS: Postoperative hypoalbuminemia was a common finding and occurred in 82% of patients (95% confidence interval: 66 to 91). Paired analyses of blood and stool for alpha-1-antitrypsin clearance showed protein-losing enteropathy in 39% of patients (95% confidence interval: 26 to 55). Stool alpha-1-antitrypsin clearance for detecting postoperative hypoalbuminemia had a sensitivity of 48% (95% confidence interval: 30 to 67) and a specificity of 100% (95% confidence interval: 59 to 100). The positive predictive value was about 100% (95% confidence interval: 59 to 100). CONCLUSIONS: We suggest protein-losing enteropathy may partially explain some cases of postoperative hypoalbuminemia after cardiac surgery.
Intracardiac bone cement embolism and cardiac injury: a systematic review of 116 reported cases.
Shim H, Jeon C, Lee SS … +4 more , Cho Y, Kim SW, Chung JW, Baek J
J Cardiothorac Surg · 2026 Jun · PMID 42323586 · Full text
BACKGROUND: Intracardiac bone cement embolism (BCE) is a rare but potentially serious complication of spinal augmentation. Clinical awareness remains limited because these events occur at the interface of spine and cardi...
BACKGROUND: Intracardiac bone cement embolism (BCE) is a rare but potentially serious complication of spinal augmentation. Clinical awareness remains limited because these events occur at the interface of spine and cardiothoracic specialties. This study synthesizes a collection of strictly intracardiac BCE cases to describe reported clinical features, injury patterns, and management strategies. METHODS: A systematic search of PubMed, Embase, and Cochrane (from inception through 2025) identified 116 unique cases after a two-tier adjudication process to eliminate duplicates. Reporting quality was assessed using a modified Joanna Briggs Institute checklist. RESULTS: The median patient age was 69 years, and 75.9% were female. Most embolic events followed vertebroplasty (67.2%) or kyphoplasty (26.7%). Chest pain (59.5%) and dyspnea (54.3%) were the most common symptoms. Diagnostic yield was high for echocardiography (96.0%) and computed tomography (CT) (93.8%) but lower for chest X-ray (63.4%). Linear cement fragments were frequently associated with perforation (46.6%), most often involving the right ventricle (70.9%). Surgical retrieval was reported in 65.5% of cases, with concomitant structural repair in 19.2%. No deaths were attributable to surgical retrieval, whereas delayed diagnosis or treatment refusal led to fatal outcomes. CONCLUSIONS: Published reports suggest that intracardiac BCE may behave as a mechanically hazardous condition with a substantial risk of perforation. The recurring patterns observed across studies highlight the importance of timely recognition and careful management. These descriptive findings may help inform clinical awareness and generate hypotheses for future investigation.
Ballistic fragment embolism to superior mesenteric artery after the shrapnel injury to the chest: a case report of casualty from Russia-Ukraine war.
Lurin I, Khoroshun E, Panasenko S … +5 more , Nehoduiko V, Shypilov S, Gorobeiko M, Maliuga A, Dinets A
J Cardiothorac Surg · 2026 Jun · PMID 42321869 · Full text
BACKGROUND: The Russia-Ukraine war has produced widespread lethal ballistic trauma with unusual injury patterns, including rare cases of projectile migration and arterial embolism. Prompt differential management near fro...
BACKGROUND: The Russia-Ukraine war has produced widespread lethal ballistic trauma with unusual injury patterns, including rare cases of projectile migration and arterial embolism. Prompt differential management near frontlines is crucial to improve outcomes and reduce evacuation risk. The aim of the study was to present clinical features, diagnostic workup, and management of a combat patient with a penetrating chest wound, cardiac involvement, and subsequent migration of a ballistic fragment into the superior mesenteric artery (SMA), and to contextualize this case within existing literature on ballistic emboli. CASE PRESENTATION: A 41-year-old serviceman sustained a chest injury from FPV-drone munitions. Initial delayed evacuation and staged imaging (X-ray, FAST, whole-body CT) identified a ballistic channel from chest to abdomen and a metallic intraluminal fragment in the SMA. Clinical decision-making weighed endovascular versus open approaches amid tactical constraints and patient consent dynamics. Contrast-enhanced CT suggested transcardiac migration of the fragment into the SMA. With absent critical mesenteric ischemia and delayed consent, laparotomy on day 14 revealed an intraluminal metallic fragment that was removed via arteriotomy with primary repair. The patient recovered and was discharged after 21 days. CONCLUSIONS: The arterial ballistic emboli must be suspected in patients with isolated chest- or thoracoabdominal injuries. The whole-body contrast-enhanced CT scan is an important diagnostic tool for patients with gunshot injuries. In the absence of evidence of bowel necrosis, surgery can be postponed in patients with SMA emboli. An important role in visualization is played by contrast-enhanced MSCT. We recommend removing projectile fragments from the major blood vessels.
Comparative perioperative outcomes of robot-assisted versus video-assisted thoracoscopic mediastinal tumor resection: a propensity score-matched analysis.
Yu J, Pan K, Chen Z … +3 more , Jiang L, Shen S, Xia H
J Cardiothorac Surg · 2026 Jun · PMID 42321845 · Full text
OBJECTIVES: To compare perioperative outcomes of robotic-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection in a propensity score-matched cohort. METHODS:...
OBJECTIVES: To compare perioperative outcomes of robotic-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection in a propensity score-matched cohort. METHODS: This retrospective study analyzed patients undergoing minimally invasive mediastinal tumor resection between January 2022 and November 2025. Patients were categorized into RATS and VATS groups. Propensity score matching balanced baseline characteristics including age, gender, body mass index, ASA score, Charlson Comorbidity Index, tumor size, tumor location, pathology, and prior thoracic surgery history. The primary outcome was postoperative complications of Clavien-Dindo grade ≥ II. Secondary outcomes included operative time, blood loss, chest tube duration, hospital stay, costs, and pain scores. RESULTS: After matching, 102 patients (51 per group) were included. RATS was associated with significantly less intraoperative blood loss [median difference - 15 mL (95% CI: - 20 to - 10), P < 0.001], shorter chest tube duration [median difference - 1 day (95% CI: - 1.7 to - 0.3), P = 0.003], and shorter hospital stay [median difference - 1 day (95% CI: - 1.7 to - 0.1), P = 0.009]. Total costs were higher in the RATS group [median difference +$4,400 (95% CI: $3,800-$5,000), P < 0.001]. Operative time, postoperative pain scores, and complication rates (grade ≥ II: 9.8% vs. 13.7%, P = 0.55) were comparable between groups. Using an alternative definition (grade ≥ III), complications occurred in 3.9% (RATS) vs. 5.9% (VATS), P = 0.65. CONCLUSIONS: For mediastinal tumor resection, RATS offers modest perioperative benefits including reduced blood loss and shorter recovery times compared to VATS, but at substantially higher cost and without a reduction in major complications. RATS is a feasible and safe minimally invasive alternative, but its advantages over VATS are small and must be weighed against economic considerations. Routine adoption is not supported by the current evidence; selection should be individualized.
Changes in thoracic spinal curvature after nuss procedure in adult pectus excavatum.
Htut N, Keong DE, Tzeng IS … +1 more , Cheng YL
J Cardiothorac Surg · 2026 Jun · PMID 42321835 · Full text
BACKGROUND: Pectus excavatum (PE) is commonly associated with spinal abnormalities. However, the effect of the Nuss procedure on thoracic scoliosis remains unclear. This study therefore aimed to characterize the dynamic...
BACKGROUND: Pectus excavatum (PE) is commonly associated with spinal abnormalities. However, the effect of the Nuss procedure on thoracic scoliosis remains unclear. This study therefore aimed to characterize the dynamic changes in the thoracic Cobb angle (tCA) among adult PE patients undergoing Nuss procedure. METHODS: A total of 186 Patients with PE who underwent the Nuss procedure and subsequent bar removal (BR) were retrospectively analyzed. Clinical data were collected, including serial tCA measurements from posteroanterior chest radiographs taken preoperatively, at 1 month, 3-6 months, and 1 year postoperatively, as well as 1 day before and 1 week after BR for analysis. Subgroups were stratified by sex, Haller index (≥ 4 vs. <4), bar number (1-3), bar orientation (oblique vs. horizontal), bar flipping within 3 months, and preoperative tCA (≥ 10° vs. <10°). RESULTS: Compared to the preoperative mean tCA, the tCA increased significantly at 1 month postoperatively (5.4 ± 4.2° vs. 5.9 ± 4.4°, p < 0.001). It then decreased significantly by 1 day before BR (5.4 ± 4.2° vs. 4.9 ± 3.9°, p < 0.001) and further at 1 week after BR (5.4 ± 4.2° vs. 4.4 ± 4.0°, p < 0.001). All subgroup analyses demonstrated a significant reduction in the tCA following BR. CONCLUSIONS: The Nuss procedure induced a temporary increase in tCA at 1 month postoperatively, followed by gradual improvement during the bar maintenance period and a net reduction below the preoperative level after bar removal. Notably, patients with mild thoracic scoliosis also experienced a reduction in tCA after complete PE correction. While this reduction was not clinically meaningful, it still indicates that the procedure does not worsen thoracic spinal alignment and may offer some improvement.
Residual apical space (RAS) correlation with recurrence in primary spontaneous pneumothorax after surgery: multicenter analysis stratified by type of surgery.
Napolitano AG, Sanguigni M, Nachira D … +15 more , Coviello E, Congedo MT, Petracca Ciavarella L, Pourmolkara D, Nocera A, Leoni C, Vita ML, Santoro G, Chiappetta M, Mucilli F, Meacci E, Vannucci J, Puma F, Margaritora S, Lococo F
J Cardiothorac Surg · 2026 Jun · PMID 42321834 · Full text
BACKGROUND: This study aims to evaluate residual apical space (RAS) as a predictor of pneumothorax recurrence in patients undergoing video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP)...
BACKGROUND: This study aims to evaluate residual apical space (RAS) as a predictor of pneumothorax recurrence in patients undergoing video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) and to assess its impact by surgical treatment type. METHODS: Data of 463 patients undergoing VATS for PSP at three Italian high-volume thoracic surgery centers (January 2012-March 2023) were retrospectively reviewed. Exclusions included secondary pneumothorax, patients < 18 years, and those undergoing thoracotomy. Four surgical approaches were analyzed, with RAS measured using the Collins method (4.2% equivalent to 0 cm RAS) on chest X-ray before discharge. The primary outcome of interest was the recurrence rate stratified by surgical procedure. Statistical analyses were performed to correlate RAS, clinical and surgical variables with pneumothorax recurrence. RESULTS: The overall recurrence rate was 6.9% (32 patients). The mean hospitalization was 6.5 ± 3.5 days, with an average RAS before discharge of 9.7 ± 5.4%=1.15 cm. Mechanical pleurodesis alone had an higher recurrence risk (*p* = 0.0027), while apicectomy with chemical pleurodesis significantly reduced recurrence risk (*p* < 0.0001). Increased RAS (> 9.7%) was associated with a higher recurrence rate (*p* = 0.063). Multivariate analysis confirmed that increased RAS significantly predicts recurrence (*p* = 0.002), particularly in patients aged > 34 years. Stratifying by type of surgery, an increased RAS value was associated to higher rate of recurrence (*p* = 0.001) in patients who underwent apicectomy combined to mechanical pleurodesis. CONCLUSIONS: Apicectomy combined with chemical pleurodesis is still the most protective approach for recurrence. However, despite its proven efficacy, this strategy is being progressively used less. Residual apical space may represent a procedure-dependent radiological marker associated with recurrence, particularly in patients undergoing apicectomy and mechanical pleurodesis and may be considered to reduce recurrence rates.
Inverse association between body mass index and abdominal aortic calcification based on NHANES.
Wang Y, Meng J, Wang L … +1 more , Zhang J
J Cardiothorac Surg · 2026 Jun · PMID 42321831 · Full text
BACKGROUND: The increasing prevalence of obesity worldwide has led to conflicting research on its cardiovascular effects. Although obesity is an established risk factor for cardiovascular disease (CVD), certain evidence...
BACKGROUND: The increasing prevalence of obesity worldwide has led to conflicting research on its cardiovascular effects. Although obesity is an established risk factor for cardiovascular disease (CVD), certain evidence indicates that a higher body mass index (BMI) might unexpectedly reduce the risk of vascular calcification. This study was designed to examine the association between BMI and the presence of abdominal aortic calcification (AAC) within a general population. METHODS: We analyzed data from 3,116 adults participating in the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Severe AAC was diagnosed using the Kauppila score based on dual-energy X-ray absorptiometry (DXA) scans. The relationships between BMI (treated both continuously and categorically) and severe AAC were evaluated using logistic regression. To investigate potential variations and non-linear patterns, subgroup analyses and restricted cubic spline regression were performed. RESULTS: After comprehensive adjustment. higher BMI was significantly associated with lower odds of severe AAC (OR = 0.89, 95% CI: 0.81-0.98, p = 0.013). When compared to individuals with normal weight, obese participants had 62% lower odds of severe AAC (OR = 0.38, 95% CI: 0.16-0.94, p = 0.037). This inverse relationship remained significant in subgroups including males, elderly individuals, and those without hypertension or diabetes. Restricted cubic spline analysis indicated a significant non-linear trend (p for nonlinearity = 0.0023). CONCLUSIONS: An inverse association was observed between BMI and AAC prevalence, implying that overweight and obesity may paradoxically confer a protective effect against vascular calcification. These results contribute evidence supporting the existence of an "obesity paradox" in the context of vascular health.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe