Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
Radial access for peripheral intervention: differences in comfort and care.
Sugimoto T, Miki T, Wada N … +5 more , Takai S, Wakana N, Yamada H, Zen K, Matoba S
J Cardiothorac Surg · 2026 Jun · PMID 42321808 · Full text
Peripheral vascular interventions (PVIs) are less invasive alternatives to surgical bypass. However, the impact of PVIs on the post-procedural quality of life of patients and workload of nurses remains unclear. Therefore...
Peripheral vascular interventions (PVIs) are less invasive alternatives to surgical bypass. However, the impact of PVIs on the post-procedural quality of life of patients and workload of nurses remains unclear. Therefore, we conducted a questionnaire-based survey including patients and nurses. The patient questionnaire consisted of eight items, including intra-procedure access site pain, post-procedure access site pain, discomfort during rest time, difficulty eating, bathroom difficulties, difficulty sleeping, difficulty walking the following day, and overall procedure satisfaction. The nurses' workload questionnaire comprised seven items, including bathroom care, eating care, pain care, access-site care, post-procedure nurse call support, handling postoperative complications, and overall workload. Patients who underwent PVIs using the transradial approach expressed significantly less discomfort during the post-procedure rest time, difficulty eating, bathroom difficulties, difficulty sleeping, and difficulty walking the following day than those who underwent the transfemoral approach. Nurses found the post-procedural management of the transradial approach easier than that of the transfemoral approach, with significant differences in bathroom care, eating care, access-site care, and handling postoperative complications. Notably, the overall workload was significantly lower for the transradial approach than that for the transfemoral approach. Thus, the transradial arterial approach for PVI had advantages over the transfemoral approach in this study, including improved patient comfort and decreased nursing workload.
Serum uric acid is associated with advanced stages in patients with cardiovascular-kidney-metabolic syndrome.
Tu D, Li Y, Wang Y … +1 more , Wang J
J Cardiothorac Surg · 2026 Jun · PMID 42321795 · Full text
BACKGROUND: In 2023, the American Heart Association introduced the cardiovascular-kidney-metabolic (CKM) syndrome to comprehensively assess multimorbidity involving obesity, diabetes, chronic kidney disease, and cardiova...
BACKGROUND: In 2023, the American Heart Association introduced the cardiovascular-kidney-metabolic (CKM) syndrome to comprehensively assess multimorbidity involving obesity, diabetes, chronic kidney disease, and cardiovascular disease. This study aimed to explore the potential association between serum uric acid (SUA) level and advanced CKM syndrome. METHODS: This cross-sectional study analyzed data from U.S. adults collected in the National Health and Nutrition Examination Survey between 2011 and 2020. Participants were categorized into five CKM syndrome stages based on clinical severity. CKM syndrome stages 3 or 4 were considered advanced. Multivariable weighted Poisson regression with robust error variance were used. RESULTS: The final analysis included 15,839 patients diagnosed with CKM syndrome. Out of the total, 12,975 cases were classified as non-advanced CKM syndrome, and 2,864 cases were classified as advanced CKM syndrome. In the fully adjusted model, patients in the highest SUA quintile had a prevalence ratio of 1.32 (95% confidence interval: 1.14-1.53) for advanced stages compared to those in the lowest quintile, with a 7% increased risk per 1 mg/dL SUA elevation. Moreover, the restricted cubic spline curve indicated a significant increase in the likelihood of advanced stages when SUA level was ≥ 5.5 mg/dL. CONCLUSIONS: In patients with CKM syndrome, elevated SUA levels correlated with a higher prevalence of advanced stages, demonstrating a dose-response relationship. Our data underscore the importance of SUA screening among CKM syndrome patients for identifying individuals at higher risk.
Management of multiple sequential complications following coronary artery bypass grafting: a case report from Tanzania.
Hassanali HM, Bhat N, Lunawadawala MA … +4 more , Dibaba AD, Ntungi AM, Kiwia J, Gebrewahd SH
J Cardiothorac Surg · 2026 Jun · PMID 42321769 · Full text
BACKGROUND: Coronary artery bypass grafting (CABG) is the gold standard treatment for advanced coronary artery disease (CAD). Postoperative complications can be life-threatening, particularly in patients with comorbiditi...
BACKGROUND: Coronary artery bypass grafting (CABG) is the gold standard treatment for advanced coronary artery disease (CAD). Postoperative complications can be life-threatening, particularly in patients with comorbidities. A 63-year-old male with triple-vessel CAD, diabetes mellitus, hypertension, obesity, and asthma underwent on-pump CABG using bilateral internal mammary artery grafts. The early postoperative course was complicated by traumatic sternal wound dehiscence following a fall on postoperative day 6, resulting in anterior chest wall dehiscence, rib fractures, and displaced sternal wires. Emergency re-exploration and modified Robicsek sternal closure were performed. The patient subsequently developed critical illness polyneuropathy and myopathy overlap syndrome (CIPNM), which gradually improved with supportive management and rehabilitation. He later developed deep sternal wound infection caused by Pseudomonas aeruginosa requiring prolonged targeted antibiotic therapy, repeated debridement, negative pressure wound therapy, removal of sternal wires, and pectoralis major flap reconstruction. Additional complications included arrhythmia, difficult airway management, acute kidney injury, pleural effusion, and electrolyte disturbances, all of which were managed successfully. OUTCOME: Following eight months of coordinated multidisciplinary care and rehabilitation, the patient achieved complete wound healing and restored functional capacity. DISCUSSION/CONCLUSION: This case illustrates the complexity of sequential post-CABG complications and emphasizes the importance of early recognition, multidisciplinary intervention, and structured rehabilitation in achieving favorable outcomes.
Recent perioperative challenges in anesthesia during expansion of heart transplantation.
Wang A, Hussain N, Mudhar A … +8 more , Robbins J, Friessen J, Hicks A, Satyapriya S, Whitson B, Bhandary S, Khorsandi M, Awad H
J Cardiothorac Surg · 2026 Jun · PMID 42316311 · Full text
The evolving landscape of heart transplantation requires cardiac anesthesiologists to adapt to new paradigms aimed at expanding donor and recipient pools such as utilizing more donor hearts from older donors, those with...
The evolving landscape of heart transplantation requires cardiac anesthesiologists to adapt to new paradigms aimed at expanding donor and recipient pools such as utilizing more donor hearts from older donors, those with higher BMI, left ventricular hypertrophy (LVH), or coronary artery disease, as well as grafts obtained through long-distance procurement and from donors with infectious conditions such as hepatitis C, COVID-19, and HIV. The promising use of devices such as Organ Care System (OCS), Paragonix SherpaPak (SCTS), and Hypothermic Oxygenated Machine Perfusion (HOPE) for preservation of donor hearts, as well as recent increases in donation after circulatory death (DCD) transplants, exemplifies these advancements. In particular, the introduction of beating heart DCD transplants offers the opportunity to minimize ischemic times. However, perioperative complications such as catecholamine-sensitive and resistant vasoplegia, acute right-sided heart dysfunction, primary graft dysfunction (PGD), surgical bleeding, and coagulopathy complicate the picture. The expansion of donor and recipient pools increases the risk of ischemia and reperfusion injury. Despite these challenges, cardiac anesthesiologists must be vigilant in recognizing and managing these complications to ensure the best short and long-term outcomes. For example, novel prediction tools for PGD such as RADIAL and PREDICTA may assist in facilitating earlier intervention in high-risk patients. Finally, the interplay between surgical bleeding, vasoplegia, acute RV dysfunction/failure, and PGD immediately post-transplant provides a significant challenge to cardiac anesthesiologists. By addressing these challenges, they can improve outcomes and play a pivotal role in advancing heart transplantation. Their efforts will make the expansion worthwhile, increasing the availability of donor hearts and enhancing patient care.
Inhaled nitric oxide after lung transplantation: a systematic review and meta-analysis of prospective studies.
Alzahrani A, Belal MM, Alfaifi M … +8 more , Sedeek A, Albalawi MZ, Alamoudi F, Alkeraidees AS, Alaboud M, Alshehri A, AlShuraim RA, Al Sulaiman K
J Cardiothorac Surg · 2026 Jun · PMID 42316262 · Full text
BACKGROUND: Lung transplantation (LT) improves survival and quality of life for patients with end-stage lung disease, but ischemia-reperfusion injury (IRI) poses significant challenges. IRI leads to prolonged ICU stays a...
BACKGROUND: Lung transplantation (LT) improves survival and quality of life for patients with end-stage lung disease, but ischemia-reperfusion injury (IRI) poses significant challenges. IRI leads to prolonged ICU stays and increased mortality, primarily due to primary graft dysfunction (PGD), especially grade 3 PGD. Inhaled nitric oxide (iNO), a known vasodilator and antioxidant, has been explored for the management of IRI and for mitigating PGD3 severity. Some studies recommend its preventive use; however, insufficient evidence has delayed regulatory approval. METHODS: A systematic review and meta-analysis was conducted across four databases (PubMed, Scopus, Cochrane Library, and Web of Science) from inception through September 2024. Prospective studies evaluating adult lung transplant recipients who received inhaled nitric oxide (iNO) compared to a placebo or control group were included. The primary outcome was the risk of grade 3 primary graft dysfunction (PGD3). Secondary outcomes included intensive care unit length of stay (ICU-LOS), duration of mechanical ventilation (MV), and 30-day mortality. Pooled estimates for the primary analysis were calculated using a random-effects model. RESULTS: Out of 2,503 studies screened, six met the eligibility criteria, encompassing 420 patients. iNO was administered 12 to 48 hours post-transplant at doses of 10 to 20 ppm. There was a trend toward a lower risk of PGD3 in patients who received iNO; however, this trend failed to reach statistical significance (RR = 0.73, 95% CI = 0.45-1.19, I² = 30%). In addition, no significant differences in ICU LOS (MD = -0.21 days, 95%CI = -3.78 to 3.36, I² = 65%), mechanical ventilation duration (MD = -0.20 days, 95% CI = -0.69 to 0.28, I² = 9%), or 30-day mortality (RR =0.94, 95% CI = 0.35-2.55, I² = 0%) were observed in the random-effects analysis. CONCLUSION: Inhaled nitric oxide is well tolerated, and there is a non-significant trend toward reducing the risk of PGD3 and shortening mechanical ventilation duration. Larger, high-quality RCTs are needed to confirm these therapeutic benefits and establish definitive clinical usage guidelines.
A hybrid approach via video-assisted thoracoscopic surgery and limited sternal incision for resection of invasive thymoma with superior vena cava prosthetic replacement: a case report.
Mo H, Li Y, Yao S … +3 more , Zheng Y, Wang K, Zhu W
J Cardiothorac Surg · 2026 Jun · PMID 42316259 · Full text
OBJECTIVE: When an invasive thymoma involves major vessels such as the superior vena cava (SVC), conventional management requires median sternotomy with en bloc resection and vascular reconstruction, which carries substa...
OBJECTIVE: When an invasive thymoma involves major vessels such as the superior vena cava (SVC), conventional management requires median sternotomy with en bloc resection and vascular reconstruction, which carries substantial surgical trauma and delayed recovery. This report presents a case of invasive thymoma invading the SVC and left innominate vein treated using a hybrid approach combining video-assisted thoracoscopic surgery (VATS) with a limited sternal incision, in which the technical highlight was a Y-shaped reconstruction of the SVC and left innominate vein. METHODS: A 39-year-old woman presented with an incidentally discovered anterior mediastinal mass. Contrast-enhanced CT showed an invasive thymoma(3.7 cm×3.0 cm×5.6 cm) invading the SVC and left innominate vein confluence. After multidisciplinary evaluation, preoperative biopsy was deemed too hazardous owing to the tumor's intimate proximity to the great vessels, and upfront surgery was recommended. Thoracoscopic exploration via a 3 cm subxiphoid incision confirmed resectability, followed by partial upper sternotomy (≈ 12 cm). Under temporary venous shunting and clamping of the SVC and left innominate vein, the tumor and invaded vessels were resected en bloc. The SVC was replaced with an 18 F PTFE (Goretex) graft, and the left innominate vein was reconstructed with a tubularized bovine pericardial conduit anastomosed end-to-side to the SVC graft, creating a Y-shaped reconstruction. RESULTS: Operative time was 315 min with 800mL blood loss. Recovery was uneventful. Pathology confirmed WHO type B2 thymoma, Masaoka-Koga stage III, and adjuvant radiotherapy was given. During follow-up, the prosthetic graft remained patent and no recurrence was detected. CONCLUSION: A hybrid VATS-assisted approach with limited sternal incision enables reliable vascular reconstruction while reducing invasiveness, representing a feasible and safe option for invasive thymomas involving the SVC. Multidisciplinary evaluation, appropriate patient selection and proficiency in both minimally invasive techniques and open vascular reconstruction are essential to achieve R0 resection and favorable outcomes.
Risk factors for massive postoperative bleeding after orthotopic heart transplantation: a retrospective cohort study.
Maruniak D, Sudakevych S, Kovtun H … +3 more , Melnyk A, Todurov B, Maruniak S
J Cardiothorac Surg · 2026 Jun · PMID 42316238 · Full text
BACKGROUND: Orthotopic heart transplantation (OHT) remains the gold standard for patients with end-stage heart failure; however, postoperative bleeding is a frequent and clinically significant complication associated wit...
BACKGROUND: Orthotopic heart transplantation (OHT) remains the gold standard for patients with end-stage heart failure; however, postoperative bleeding is a frequent and clinically significant complication associated with increased morbidity and transfusion requirements. Data on predictors of massive bleeding in this population remain limited, particularly regarding the role of viscoelastic testing. METHODS: We conducted a single-center retrospective cohort study including 75 adult patients who underwent OHT between 2019 and 2025. Patients with incomplete data or without preoperative viscoelastic testing (ClotPro) were excluded. The primary endpoint was massive postoperative bleeding defined as ≥BARC III. Secondary endpoints included transfusion requirements, reoperation for bleeding, and postoperative blood loss. Univariate and multivariable logistic regression analyses were performed to identify independent predictors. Receiver operating characteristic (ROC) analysis was used to assess discriminative performance. This study was conducted in accordance with the principles of the Helsinki Declaration and the Istanbul Declaration. No organs were procured from prisoners or from individuals subjected to coercion or financial incentives. RESULTS: Massive postoperative bleeding occurred in 31 patients (41.3%). Transfusion requirements were high, with red blood cells administered in 69.3%, plasma in 90.7%, and cryoprecipitate in 34.7% of patients. Reoperation for bleeding was required in 16.0% of cases. In univariate analysis, ECMO support, lower platelet count, lower fibrinogen, elevated INR, lower EX-test MCF, higher TPA-test ML, and longer cardiopulmonary bypass duration were associated with bleeding. In multivariable analysis, only EX-test MCF remained an independent predictor (OR 0.91 per 1 mm increase; 95% CI 0.85-0.98; p = 0.011). CONCLUSIONS: Massive bleeding after OHT is common and associated with significant transfusion burden. Reduced EX-test MCF is an independent predictor of bleeding and may serve as a valuable tool for early risk stratification and personalized hemostatic management in heart transplant recipients.
Identification and validation of five hypoxia- and immune-related hub targets in atrial fibrillation.
Weng J, Huang D, Wu Q … +3 more , Chen Z, Chen J, Pang Z
J Cardiothorac Surg · 2026 Jun · PMID 42316227 · Full text
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia, with increasing incidence and prevalence. Hypoxia and immune response are closely related to the progression of AF. This study aims to explore hub hypox...
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia, with increasing incidence and prevalence. Hypoxia and immune response are closely related to the progression of AF. This study aims to explore hub hypoxia- and immune-related genes associated with AF. METHODS: Multiple AF datasets from the Gene Expression Omnibus database were downloaded. Hypoxia- and immune-related genes associated with AF were identified by integrating differential expression analysis, weighted gene co-expression network analysis (WGCNA), and protein-protein interaction (PPI) network. Functional enrichment analysis was used to evaluate the functions of key genes. Immune cell infiltration analysis was conducted using CIBERSORT and xCell. To experimentally validate the identified hub genes, RT-qPCR was performed on whole blood samples collected from healthy controls and AF patients. RESULTS: A total of 13 crucial hypoxia- and immune-related genes associated with AF were identified. Among them, the expressions of IL6, JUN, FOS, FOSL2, and MAFF were significantly higher in the AF group than in the sinus rhythm (SR) group, which was further validated by RT-qPCR showing increased mRNA expression in clinical whole blood samples from AF patients. Notably, transcription factors JUN, FOS, FOSL2, and MAFF exhibited clear binding peaks at promoter region of IL6. Functional enrichment analysis by GSEA revealed that these five hub genes were simultaneously involved in the cAMP signaling pathway, and four of them (JUN, FOS, FOSL2, and MAFF) were also associated with the calcium signaling pathway, indicating a potential cAMP-dependent Ca²⁺ handling mechanism in AF pathogenesis. Immune cell infiltration analysis further showed that these genes were significantly correlated with differential infiltration of various immune cells, including gamma delta T cells, monocytes, macrophages, neutrophils, and NK cells. CONCLUSION: This study successfully identified JUN, FOS, IL6, FOSL2, and MAFF as crucial hypoxia- and immune-related genes associated with AF, providing potential new targets for the treatment of AF.
Combined cervicothoracic surgical repair of an extensive tracheal laceration following endotracheal intubation: a case report.
Sun F, Zhang P, Xie Y … +2 more , Wang F, Shen J
J Cardiothorac Surg · 2026 Jun · PMID 42310797 · Full text
BACKGROUND: Tracheal membranous laceration is a rare but life-threatening complication of endotracheal intubation. Most reported tears are short (< 4 cm) and confined to either the cervical or the thoracic trachea. We pr...
BACKGROUND: Tracheal membranous laceration is a rare but life-threatening complication of endotracheal intubation. Most reported tears are short (< 4 cm) and confined to either the cervical or the thoracic trachea. We present a case of an exceptionally extensive posterior tracheal laceration (estimated length spanning nearly the entire intrathoracic trachea) that required a combined cervicothoracic surgical approach, highlighting a reproducible repair strategy. CASE PRESENTATION: A 66-year-old man underwent endoscopic submucosal dissection under general anesthesia. Twenty minutes after uneventful intubation, a sudden air leak and cuff rupture occurred. Bronchoscopy revealed a full-thickness longitudinal tear from approximately 3 cm below the vocal cords to 2 cm above the carina. Emergent repair used a combined right thoracoscopic (VATS) and cervical approach: the thoracic portion was closed with interrupted 3 - 0 non-absorbable sutures after division of the azygos vein, and the cervical portion was repaired through a longitudinal anterior tracheotomy. No intraoperative complications occurred. The patient was extubated on postoperative day 1 and discharged on day 12. At 3-month follow-up, complete healing without stenosis was observed. CONCLUSIONS: This case demonstrates that a combined cervicothoracic approach is safe and effective for extensive tracheal lacerations that cannot be adequately exposed by a single incision. The technique provides complete visualization, allows tension-free watertight closure, and minimizes recurrent laryngeal nerve injury.
The potential clinical value of combining serum miR-769-5p with lung ultrasound for the diagnosis of acute lung injury.
Ke Z, Guan W, Chen J … +3 more , Yue X, Li S, Huang X
J Cardiothorac Surg · 2026 Jun · PMID 42310790 · Full text
BACKGROUND: Acute lung injury (ALI) represents a life-threatening condition triggered by diverse etiological factors. The expression and function of miR-769-5p within the context of ALI remain poorly characterized. PURPO...
BACKGROUND: Acute lung injury (ALI) represents a life-threatening condition triggered by diverse etiological factors. The expression and function of miR-769-5p within the context of ALI remain poorly characterized. PURPOSE: This study aims to examine the expression levels of miR-769-5p in the serum of ALI patients and assess its synergistic diagnostic potential when combined with the lung ultrasound (LUS) score for ALI. METHODS: Serum miR-769-5p expression levels were quantified using reverse transcription quantitative polymerase chain reaction (RT-qPCR). The diagnostic accuracy of miR-769-5p and the LUS score for ALI was evaluated via receiver operating characteristic (ROC) curve analysis. Binary logistic regression was used to analyze their impact on ALI. Serum nuclear factor kappa B (NF-κB) and reactive oxygen species (ROS) levels were measured by enzyme-linked immunosorbent assay (ELISA). Pearson correlation assessed relationships between miR-769-5p and NF-κB, ROS, and LUS score. In lipopolysaccharide (LPS)-A549 cells, RT-qPCR and flow cytometry evaluated how miR-769-5p modulated NF-κB, ROS, and apoptosis. RESULTS: ALI patients exhibited significantly decreased serum miR-769-5p expression. Combining miR-769-5p with the LUS score enhanced diagnostic accuracy, with both correlating significantly with ALI risk. Serum NF-κB and ROS levels were elevated in ALI and inversely correlated with miR-769-5p. In LPS-A549 cells, miR-769-5p overexpression suppressed LPS-induced NF-κB activation, ROS generation, and cellular apoptosis. CONCLUSIONS: The combined application of miR-769-5p and the LUS score demonstrated enhanced diagnostic efficacy. Furthermore, miR-769-5p overexpression effectively attenuated NF-κB activation, ROS production, and cellular apoptosis.
A rare giant asymptomatic biatrial myxoma.
Liu Y, Cao J, Wang D … +2 more , Ge J, Fan Y
J Cardiothorac Surg · 2026 Jun · PMID 42310784 · Full text
BACKGROUND: The left atrial myxoma is the most common type in clinical practice, whereas biatrial myxomas are extremely rare (less than 3%). Over the past five decades, approximately 50 cases of biatrial myxoma have been...
BACKGROUND: The left atrial myxoma is the most common type in clinical practice, whereas biatrial myxomas are extremely rare (less than 3%). Over the past five decades, approximately 50 cases of biatrial myxoma have been reported in the literature. Here, we report a rare, large, asymptomatic biatrial myxoma, involving the inferior vena cava (IVC) and part of the posterior wall of the left atrium (LAPW). CASE PRESENTATION: In this case, a 75-year-old elderly woman was incidentally found to have a biatrial myxoma with atrial flutter after chest trauma. Further evaluation with cardiac computed tomography angiography (CTA) was performed on patient for delineating the tumor's size, morphology, attachment site, extension, internal enhancement characteristics, and to rule out concomitant coronary artery disease. Intraoperative findings showed the tumor extended into the IVC and the LAPW. Finally, the patient underwent surgical resection of the tumor under cardiopulmonary bypass (CPB), along with excision of the left atrial appendage, and we reconstructed LAPW and IVC. The patient recovered uneventfully and was discharged on postoperative day 10. At a 5-month follow-up, no recurrence of atrial myxoma was observed. CONCLUSIONS: Biatrial myxoma is extremely rare and sometimes can be challenging to diagnose. Currently, there are no guidelines or consensus statements regarding the best diagnostic methods. Based on our case, we suggest that computed tomography (CT) and cardiac CTA can provide sufficient details about diagnostic value in cases where transthoracic echocardiography (TTE) fails to provide a clear diagnosis. Surgery is mandatory once cardiac myxoma is diagnosed. In cases of giant cardiac myxomas involving the IVC and the LA, careful preoperative planning is required, including venous cannulation for CPB and reconstruction of cardiac structures after complete tumor excision.
A nomogram to predict postoperative deep vein thrombosis combined with pulmonary embolism in patients with a tibial plateau fracture: a retrospective study.
Zhuo-Dong T, Ming-You W, Xun-Zhou S … +4 more , Shao-Jiang L, Yu-Ping L, Hong-Ping W, Ting-Yan L
J Cardiothorac Surg · 2026 Jun · PMID 42310776 · Full text
BACKGROUND: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are serious postoperative complications in patients with tibial plateau fractures. The aim of this study was to investigate the risk factors for postoper...
BACKGROUND: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are serious postoperative complications in patients with tibial plateau fractures. The aim of this study was to investigate the risk factors for postoperative DVT complicated with PE in patients with tibial plateau fractures, establish a risk prediction model and verify its predictive efficacy. METHODS: We conducted a retrospective study from January 1, 2023, to December 31, 2025. The primary endpoint of this study was the risk factors for DVT complicated with PE after tibial plateau fracture. Univariate analysis and multifactor logistic regression analysis were performed to analyze the relevant risk factors, and nomogram models were established to verify the predictive efficacy of the model via receiver operating characteristic (ROC) curves, calibration curves, and clinical decision curve analysis (DCA) curves. RESULTS: Among the 224 patients, 36 (16.07%) developed DVT complicated with PE after surgery. Univariate analysis revealed significant differences in age (P = 0.001), time from injury to surgery (P = 0.041), intraoperative blood loss (P = 0.008) and D-dimer level (P < 0.001) between the two groups. Multivariate logistic regression analysis indicated that age (OR = 1.051, 95% CI = 1.003-1.102, P = 0.036) and D-dimer level (OR = 1.001, 95% CI = 1.000-1.001, P < 0.001) were independent risk factors for postoperative DVT complicated with PE in patients with tibial plateau fractures. The ROC curve revealed that the area under the curve (AUC) of the nomogram model was 0.779, the χ value of the calibration curve was 11.295, P = 0.186, and the DCA curve indicated that the net clinical benefit of the model was high within the threshold range. CONCLUSION: Age ≥ 52 years and a D-dimer level ≥ 4131.5 ng/mL are independent risk factors for postoperative deep vein thrombosis (DVT) complicated with pulmonary embolism (PE) in patients with tibial plateau fractures. The constructed nomogram model therefore has a certain predictive efficacy.
Untreated mild-moderate mitral regurgitation after isolated aortic valve replacement for aortic stenosis.
Misumi Y, Maeda K, Shimamura K … +11 more , Yoshioka D, Kawamura A, Yamashita K, Taguchi T, Handa K, Ohtani A, Ohmori T, Hiraoka A, Yoshitaka H, Kondoh H, Miyagawa S
J Cardiothorac Surg · 2026 Jun · PMID 42310774 · Full text
BACKGROUND: Postoperative persistent/worsening mitral regurgitation (MR) is reported to be a prognostic marker in patients undergoing isolated aortic valve replacement (AVR). However, there is little evidence regarding t...
BACKGROUND: Postoperative persistent/worsening mitral regurgitation (MR) is reported to be a prognostic marker in patients undergoing isolated aortic valve replacement (AVR). However, there is little evidence regarding the surgical indication for coexisting mild-to-moderate MR in patients undergoing isolated surgical AVR. This study evaluates the relationship between untreated mild-to-moderate MR and postoperative significant MR after surgical AVR. METHODS: Between 2016 and 2021, 430 patients with severe aortic stenosis underwent isolated surgical AVR with untreated mild-to-moderate MR. The primary endpoint was significant (moderate or greater) MR at 1 year after surgery. Composite endpoint (mortality and heart failure readmission) was also retrospectively reviewed. The mean follow-up duration was 5.0 ± 2.0 years. RESULTS: At 1 year after surgery, 22 patients (5%) presented with moderate or greater MR. Multivariable analysis showed aortic valve peak velocity (OR, 0.44; 95% CI, 0.22-0.89; P= .021), moderate MR (OR, 11.9; 95% CI, 3.80-38.5; P = < 0.001), and left atrial dimension index (OR, 1.12; 95% CI, 1.02-1.25; P= .020) at baseline were risk factors for postoperative significant MR. The freedom from composite endpoint were significantly lower in patients with multiple risk factors for MR than those without (log-rank P= .041). CONCLUSIONS: In patients undergoing isolated surgical AVR with untreated mild-to-moderate MR, preoperative aortic velocity, left atrial dimension, and moderate MR were associated with postoperative significant MR, as well as increased heart failure readmission rates. These risk factors need to be considered in coexisting mild-to-moderate MR when treating aortic valvular lesion. CLINICAL REGISTRATION NUMBER: Approved by the Clinical Research Ethics Committee of Osaka University Hospital: Approval No.: 20,222 (T2).
Identification of PANoptosis-related hub genes in acute myocardial infarction: diagnostic potential, immune correlates, and therapeutic insights.
Wang X, Yin X, Teng L … +1 more , Tao D
J Cardiothorac Surg · 2026 Jun · PMID 42310773 · Full text
BACKGROUND: PANoptosis is an innate immune-inflammatory programmed cell death pathway that integrates the key features of apoptosis, pyroptosis, and necroptosis. However, the diagnostic potential and immune relevance of...
BACKGROUND: PANoptosis is an innate immune-inflammatory programmed cell death pathway that integrates the key features of apoptosis, pyroptosis, and necroptosis. However, the diagnostic potential and immune relevance of PANoptosis-related genes in acute myocardial infarction (AMI) remain unclear. METHODS: Transcriptional data were obtained from the GEO database, including the training set GSE66360 and validation set GSE59867. Differential expression, protein-protein interaction networks, and random forest analyses were conducted to identify PANoptosis-related hub genes associated with AMI pathogenesis. The diagnostic model and nomogram were built, and the diagnostic value was evaluated using receiver operating characteristic analysis. Immune infiltration, functional enrichment, and regulatory network analyses were performed to explore potential molecular mechanisms. Blood samples from healthy controls and AMI patients were collected to validate the expression of hub genes. RESULTS: A total of 438 DEGs and 109 PANoptosis-related genes were obtained. After intersecting these, 8 PANoptosis genes associated with AMI were found, enriched in apoptosis, immune, and inflammatory pathways. Two hub genes, IL1B and NLRP3, were identified as hub genes, with diagnostic models and nomograms showing good performance in both training and validation sets. These genes were significantly correlated with most immune cells that were dysregulated in AMI, revealing their immunomodulatory function. CEBPB and SPI1 were identified as common transcriptional regulators of the hub genes. Five drugs associated with hub genes were predicted from the DSigDB database. IL1B and NLRP3 showed consistent expression patterns across the training set, validation set, and real-time qPCR analysis. CONCLUSION: IL1B and NLRP3 may serve as PANoptosis-related biomarkers with potential immunomodulation in AMI, offering preliminary insights into the potential molecular mechanisms of PANoptosis in AMI. TRIAL REGISTRATION: Not applicable.
Primary left atrial spindle cell sarcoma with low-grade malignant features mimicking recurrent myxoma: a case report.
Zhang JW, Wang Y, Li W … +2 more , Yao FJ, Liu DH
J Cardiothorac Surg · 2026 Jun · PMID 42310759 · Full text
Primary cardiac spindle cell sarcoma is extremely rare, with atypical clinical manifestations and imaging features. This case report details a 54-year-old female patient with a primary cardiac spindle cell sarcoma of the...
Primary cardiac spindle cell sarcoma is extremely rare, with atypical clinical manifestations and imaging features. This case report details a 54-year-old female patient with a primary cardiac spindle cell sarcoma of the left atrium, initially thought to represent a recurrent cardiac myxoma. Despite utilizing multiple imaging techniques, the patient's complex clinical history complicated the diagnostic process, and the correct diagnosis was established after surgical resection and pathological evaluation. This case highlights the diagnostic pitfalls associated with presumed recurrent cardiac myxomas and underscores the importance of careful pathological assessment and long-term surveillance, even in tumors with low-grade malignant features.
Clinical role and mechanism of miR-4443 in coronary heart disease: a prognostic marker and regulator of vascular smooth muscle cell Function.
Sun R, Hao J, Jia G … +2 more , Liu F, Song S
J Cardiothorac Surg · 2026 Jun · PMID 42310744 · Full text
BACKGROUND: Dysregulation of vascular smooth muscle cell (VSMC) function is a key factor in coronary heart disease (CHD) pathogenesis. This study investigates the role of miR-4443 in regulating VSMC behavior and its pote...
BACKGROUND: Dysregulation of vascular smooth muscle cell (VSMC) function is a key factor in coronary heart disease (CHD) pathogenesis. This study investigates the role of miR-4443 in regulating VSMC behavior and its potential as a clinical biomarker. METHODS: Clinical data from 200 CHD patients were retrospectively analyzed. miR-4443 expression levels were quantified via RT-qPCR in paired plasma specimens and in VSMC exposed to oxidized low-density lipoprotein (ox-LDL). Prognostic relevance was evaluated through Kaplan-Meier analysis and multivariate Cox regression modeling. Cellular transfection, CCK-8, Transwell, and dual-luciferase reporter assays were employed to evaluate VSMC proliferation, migration, and gene regulatory mechanisms. RESULTS: CHD patients exhibited significantly higher serum levels of miR‑4443 relative to healthy controls. Univariate analysis revealed significant associations between the risk of major adverse cardiovascular events (MACEs) and miR‑4443, BMI, LDL‑C, and CRP. After multivariable adjustment, elevated miR‑4443 expression retained independent prognostic value for adverse outcomes (HR = 2.812, 95% CI: 1.130-6.997, P = 0.026). Kaplan-Meier analysis revealed an elevated cumulative incidence of MACEs in patients exhibiting high miR-4443 levels relative to those with low expression. In ox-LDL-induced VSMCs, miR-4443 expression was upregulated. Functionally, miR-4443 promoted VSMC proliferation and migration, while its inhibition suppressed these processes. TIMP2 expression was reduced in CHD patients. Furthermore, luciferase reporter assays confirmed TIMP2 as a direct target of miR-4443, through which miR-4443 regulates VSMC function. CONCLUSION: miR-4443 functions as a prognostic biomarker in CHD by targeting TIMP2 to regulate VSMC proliferation and migration, highlighting its dual diagnostic and therapeutic potential.
Preoperative systemic immune-inflammation index as an incremental predictor of postoperative refractory hypoxemia in acute type a aortic dissection.
Liu Z, Shen Y, Zou J … +1 more , Huang W
J Cardiothorac Surg · 2026 Jun · PMID 42310677 · Full text
BACKGROUND: Postoperative refractory hypoxemia (PRH) remains a clinically important pulmonary complication after surgery for acute type A aortic dissection (ATAAD). Because inflammation, coagulation activation, pulmonary...
BACKGROUND: Postoperative refractory hypoxemia (PRH) remains a clinically important pulmonary complication after surgery for acute type A aortic dissection (ATAAD). Because inflammation, coagulation activation, pulmonary vulnerability, and operative stress converge during ATAAD repair, a composite biomarker may provide more useful risk information than a single leukocyte-derived index. We evaluated whether the preoperative systemic immune-inflammation index (SII) was independently associated with PRH and whether it improved risk prediction beyond conventional clinical, pulmonary, and biomarker variables. METHODS: In this single-center retrospective cohort study, 490 patients undergoing surgery for ATAAD between January 2018 and December 2024 were analyzed. SII was calculated from absolute platelet, neutrophil, and lymphocyte counts and modeled primarily as a log2-transformed continuous variable, so that odds ratios represented the association per doubling of SII. The primary preoperative model included admission/preoperative variables, whereas an expanded perioperative model was used as a sensitivity analysis. Model discrimination, reclassification, decision-curve performance, and calibration were evaluated, and internal validation was performed using 1000 bootstrap resamples. RESULTS: PRH occurred in 158 of 490 patients (32.2%). Preoperative SII was higher in patients who developed PRH than in those who did not [1899.5 (1140.1-3043.6) vs. 667.5 (408.7-1173.7), P < 0.001]. In the primary preoperative prediction model, each doubling of SII was independently associated with PRH [adjusted odds ratio (OR), 2.80; 95% CI, 2.20-3.56; P < 0.001]. The base preoperative model had an AUC of 0.750 (95% CI, 0.705-0.794), whereas the SII-augmented model had an AUC of 0.846 (95% CI, 0.810-0.880). SII yielded the numerically largest incremental discrimination among SII, NLR, PLR, and MLR. Bootstrap validation of the SII-augmented model produced an optimism-corrected AUC of 0.834, calibration slope of 1.00, calibration intercept of 0.00, and Brier score of 0.153. CONCLUSIONS: Preoperative SII was independently associated with PRH after ATAAD surgery and provided incremental predictive information beyond conventional preoperative clinical, pulmonary, and biomarker variables. These findings support SII as a clinically accessible adjunctive risk-stratification marker rather than a stand-alone decision tool; external or temporal validation is required before routine implementation.
Escalation to transplantation in refractory stone heart syndrome: a case report of advanced mechanical circulatory support failure.
Holst T, Hanke J, Poyanmehr R … +7 more , Hinteregger M, Schmitto JD, Dogan G, Avsar M, Weymann A, Ruhparwar A, Schmack B
J Cardiothorac Surg · 2026 Jun · PMID 42304518 · Full text
BACKGROUND: Stone heart syndrome was first described by Denton Cooley in 1972 and represents an extremely rare but severe complication following cardiac surgery. The condition is characterized by an irreversible, concent...
BACKGROUND: Stone heart syndrome was first described by Denton Cooley in 1972 and represents an extremely rare but severe complication following cardiac surgery. The condition is characterized by an irreversible, concentric, spastic contracture of the myocardium occurring during reperfusion which does not respond to either pharmacological or mechanical interventions. The underlying pathophysiology remains poorly understood, but an association with suboptimal cardioprotection and prolonged ischemia time has been suggested. CASE PRESENTATION: A 22-year-old otherwise healthy patient was admitted for elective mitral valve surgery due to severe mitral regurgitation caused by bileaflet prolapse and a history of cardiomyopathy of unclear etiology. Upon weaning from cardiopulmonary bypass, the patient developed biventricular heart failure requiring veno-arterial extracorporeal membrane oxygenation. Transesophageal echocardiography showed a stone heart. In the following days, temporary mechanical circulatory support was escalated to veno-arterio-venous extracorporeal membrane oxygenation and Impella. On postoperative day 5, a durable left ventricular assist device was implanted. Due to refractory stone heart syndrome, the patient was evaluated for heart transplantation which was successfully performed on postoperative day 23. The subsequent course was largely uneventful. The patient was discharged to rehabilitation at 6 weeks post transplantation. CONCLUSION: Acute terminal heart failure due to perioperative stone heart is rare. In cases of irreversible global myocardial injury, orthotopic heart transplantation remains the only curative treatment option.
A study of postoperative pathologic complete response (pCR) following neoadjuvant chemoimmunotherapy in limited-stage small cell lung cancer (LS-SCLC).
Chunmao W, Ming H, Zitong W
J Cardiothorac Surg · 2026 Jun · PMID 42304496 · Full text
This retrospective study evaluated the efficacy and safety of neoadjuvant chemotherapy-immunotherapy combined with radical resection in 7 patients with limited-stage small cell lung cancer (LS-SCLC). Patients received a...
This retrospective study evaluated the efficacy and safety of neoadjuvant chemotherapy-immunotherapy combined with radical resection in 7 patients with limited-stage small cell lung cancer (LS-SCLC). Patients received a median of 3 cycles of neoadjuvant therapy with PD-1/PD-L1 inhibitor-based regimens (etoposide combined with cisplatin/carboplatin), followed by surgical resection and adjuvant chemoimmunotherapy. Imaging and biomarker assessments demonstrated significant tumor regression: 3 patients achieved partial response (PR) and 3 achieved complete response (CR) per RECIST criteria. Pathological examination confirmed complete pathological response (pCR) in all 7 patients. All patients successfully underwent R0 resection with low perioperative complication rates and no perioperative mortality. At median follow-up of 42 months, 6 patients maintained durable disease-free survival, while one patient developed left supraclavicular lymph node and cerebral metastases 16 months post-surgery, resulting in death 3 months after diagnosis. Treatment-related adverse events were manageable, predominantly mild to moderate in severity, with no treatment-related deaths. The findings suggest that neoadjuvant chemoimmunotherapy significantly induces tumor regression, enhances resectability, and improves long-term survival in LS-SCLC patients, though larger-scale clinical trials are needed to validate these results and optimize therapeutic strategies for this aggressive malignancy.
Florida elephant trunk hybrid aortic repair (FETHAR): a novel frozen elephant trunk technique with complete debranching sparing endograft modification.
Bobba CM, Sharaf OM, Contreras FJ … +3 more , Beaver TM, Martin TD, Jeng EI
J Cardiothorac Surg · 2026 Jun · PMID 42304493 · Full text
Treatment of aortic arch pathology is rapidly evolving. Current techniques utilize a combination of open and endovascular approaches. Existing techniques such as B-SAFER require endograft modification for complete arch d...
Treatment of aortic arch pathology is rapidly evolving. Current techniques utilize a combination of open and endovascular approaches. Existing techniques such as B-SAFER require endograft modification for complete arch debranching which may predispose the graft to failure or endoleak. We developed the FETHAR, a novel method for hybrid aortic repair and demonstrate its use in a patient who presented with an acute dissection with contained rupture. Following repair, we demonstrate excellent seal without endoleak on the post-operative CT scan. Ultimately, this repair allows for complete arch debranching, an anastomosis in zone 2 of the aortic arch, and no endograft modification.
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