Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
Comparison of the efficacy of the oXiris filter and the ST-100 filter in patients with postoperative cardiac surgery infections combined with acute kidney injury: a retrospective cohort study.
Wang R, Ren Y, Song Y … +4 more , Li Y, Ma B, Tong Y, Zhou W
J Cardiothorac Surg · 2026 Jun · PMID 42304487 · Full text
OBJECTIVE: Comparison of the efficacy of the oXiris filter and the ST-100 filter in patients with postoperative cardiac surgery infections combined with acute kidney injury. METHODS: This is a retrospective cohort study...
OBJECTIVE: Comparison of the efficacy of the oXiris filter and the ST-100 filter in patients with postoperative cardiac surgery infections combined with acute kidney injury. METHODS: This is a retrospective cohort study of patients with postoperative cardiac surgical infections combined with acute kidney injury who underwent continuous renal replacement therapy from January 2023 to April 2024 in the Critical Care Medicine Centre of the First Affiliated Hospital of Xinjiang Medical University. Based on the application of different filters, they were divided into the oXiris group and the ST-100 group, and the general condition, clinical data and related indexes of the two groups were collected at baseline (T0), 10 h after treatment (T1), 24 h after treatment (T2) and 48 h after treatment (T3), respectively, to compare the treatment effect, length of hospital stay and outcome events of the two groups at T1, T2 and T3, to explore the different therapeutic values of oXiris filter and ST-100 filter. RESULTS: A total of 33 patients were included, 11 (n = 11) in the oXiris group and 22 (n = 22) in the ST group.Intra-group comparisons between the two groups: of norepinephrine dose (F=6.799, P < 0.05), VIS (F=5.919, P < 0.05) and MAP (F=6.387, P < 0.05), with a time trend.IL-6 (F=3.262, P < 0.05) had a time-varying trend with a significant decrease.Comparison between the two groups: there was a significant difference in the magnitude of change in MAP (F=8.347, P < 0.05) and IL-6 (F= 6.779, P < 0.05).The magnitude of change in IL-6 was seen to be significantly better in the oXiris group than in the ST-100 group at the T0-1 time period (P = 0.003).Plotting the survival curve the overall survival rate was higher in the oXiris group than in the ST-100 group, and the Log-Rank test did not show a significant difference between the two groups (P = 0.311). CONCLUSION: This study indicates the oXiris filter effectively removes inflammatory mediators in patients with postoperative infections and acute kidney injury(characteristically manifested in the first 10 h), compared to the ST-100 filter. It also aids hemodynamic stability and reduces vasopressor doses, but shows no statistical improvement in organ function or patient prognosis.
Negative-pressure assistance for intraoperative cone-beam computed tomography localization in lung tumor resection: comparative study.
Kuo SW, Huang PM
J Cardiothorac Surg · 2026 Jun · PMID 42304428 · Full text
PURPOSE: To evaluate the effectiveness of wound negative-pressure-assisted (NPA) localization in facilitating pulmonary expansion during intraoperative cone-beam computed tomography (CBCT) localization for thoracoscopic...
PURPOSE: To evaluate the effectiveness of wound negative-pressure-assisted (NPA) localization in facilitating pulmonary expansion during intraoperative cone-beam computed tomography (CBCT) localization for thoracoscopic resection of small pulmonary nodules. METHODS: A retrospective comparative study included 55 consecutive patients who underwent wedge resection for small lung tumors using uniportal video-assisted thoracoscopic surgery (VATS) with CBCT localization between June 2022 and December 2024. Patients were grouped by localization technique: Group 1 received NPA and Group 2 did not. Primary outcomes were CBCT localization workflow time and CBCT-defined incomplete lung expansion/residual pleural air (CTILA) occurrence. Univariate comparisons used Welch's t-test for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression assessed factors associated with CTILA, and multivariable linear regression analyzed CBCT localization workflow time. RESULTS: Baseline demographic and clinical characteristics were similar between groups. CBCT localization workflow time was significantly shorter in Group 1 than in Group 2 (17.31 ± 7.13 vs. 25.69 ± 9.57 min; mean difference - 8.38 min; 95% CI - 13.00 to - 3.76; p = 0.0007; Hedges' g = - 0.987). CTILA occurred less frequently in Group 1 (3/29, 10.3%) than in Group 2 (13/26, 50.0%) (risk difference - 39.7%, 95% CI - 61.8% to - 17.5%; Fisher's exact p = 0.0023; odds ratio 8.67). In a multivariable model adjusted for airway management type, smoking exposure, and nodule depth, the non-NPA group remained associated with a higher likelihood of CBCT-defined incomplete lung expansion/residual pleural air (adjusted OR 7.56, 95% CI 1.03-55.61; p = 0.047). CONCLUSION: NPA localization was associated with shorter CBCT localization workflow time and a lower rate of CTILA during intraoperative CBCT localization for thoracoscopic resection of small pulmonary nodules.
Outcomes of cannulation strategies under antegrade cerebral perfusion in type a aortic dissection surgery: a systematic review and meta-analysis.
Zito F, Govers PJ, Veen KM … +7 more , Bekkers JA, Sjatskig J, van Leeuwen WJ, Melina G, Takkenberg JJM, Kluin J, Arabkhani B
J Cardiothorac Surg · 2026 Jun · PMID 42304427 · Full text
OBJECTIVE: Arterial cannulation strategies remain a topic of debate in type A aortic dissection (ATAAD) repair surgery due to their variability and the inconsistent use of concomitant cerebral perfusion techniques. This...
OBJECTIVE: Arterial cannulation strategies remain a topic of debate in type A aortic dissection (ATAAD) repair surgery due to their variability and the inconsistent use of concomitant cerebral perfusion techniques. This study aims to compare clinical outcomes associated with different arterial cannulation strategies in patients undergoing ATAAD repair with antegrade cerebral perfusion (ACP). METHODS: A systematic literature search was conducted to identify studies comparing clinical outcomes of at least two arterial cannulation strategies (subclavian, femoral or direct aortic) in ATAAD repair surgery with ACP. Primary outcomes were both early mortality and postoperative stroke (in-hospital events or within 30-days after surgery). RESULTS: Six studies were included from 921 screened, comprising 1694 subclavian, 315 femoral, and 132 direct cannulation cases. The underlying patient characteristics of within-study comparisons were not balanced. Especially the femoral-subclavian comparison was characterized by more presenting symptoms (cardiac tamponade, hemodynamic shock) in the femoral group. Subclavian cannulation was associated with significantly lower early mortality compared to femoral cannulation (OR:0.64,95%CI:0.44-0.93, p = 0.022), but no significant difference in favor of direct cannulation was observed (OR:0.82,95%CI:0.37-1.85, p = 0.13) or between femoral and direct aortic cannulation (OR: 1.80, 95% CI: 0.22-15.33; p = 0.15). No significant differences in early postoperative stroke incidence were observed among the strategies: subclavian vs. femoral (OR:0.91,95%CI:0.55-1.49, p = 0.72), direct vs. femoral (OR:0.63, 95%CI:0.18-2.12, p = 0.45), and direct vs. subclavian (OR: 0.69,95%CI:0.19-2.51, p = 0.81). CONCLUSIONS: In acute type A aortic dissection surgery with antegrade cerebral perfusion, existing evidence is limited by confounding from patient risk profiles and lack of power. Early mortality was lower with subclavian cannulation compared to femoral cannulation. No significant differences were observed between other strategies, although the direction of effect suggests a potential benefit of direct over femoral cannulation. Larger, adequately powered studies are needed to define technique-specific benefits in different patient subgroups.
MUC1 promotes the proliferation and invasion of lung cancer cells by regulating PI3K/AKT pathway.
Liu Y, Lv Z
J Cardiothorac Surg · 2026 Jun · PMID 42304395 · Full text
Mucin 1 (MUC1) has been found to be significantly up-regulated in various types of cancer. However, the precise role and underlying mechanisms of MUC1 in lung cancer remain elusive. In this study, MUC1 expression was mar...
Mucin 1 (MUC1) has been found to be significantly up-regulated in various types of cancer. However, the precise role and underlying mechanisms of MUC1 in lung cancer remain elusive. In this study, MUC1 expression was markedly elevated in lung cancer tissues and cell lines. Patients with low MUC1 expression showed improved overall survival rates compared to those with high expression levels. Additionally, knockdown of MUC1 significantly inhibited the viability and proliferation of A549 and H1299 cells, as demonstrated by CCK-8, EdU and colony formation assays. Flow cytometry analysis revealed that down-regulation of MUC1 induced apoptosis, decreased the protein expression levels of Bcl-2, and increased the expressions of Bax, caspase-3 and caspase-9 in both cell lines. Additionally, wound healing, Transwell migration and invasion assays indicated that down-regulation of MUC1 suppressed the migration and invasion capacities of A549 and H1299 cells, while also reducing the expression levels of MMP-2, MMP-9 and COX-2. Moreover, sh-MUC1 inhibited the epithelial-mesenchymal transition (EMT) progress in both cell lines. Interestingly, low MUC1 expression was associated with reduced activation of the PI3K/AKT signaling pathway. As expected, over-expression of MUC1 exerted the opposite effects. Furthermore, the PI3K/AKT inhibitor LY294002 enhanced the effects of sh-MUC1 on the proliferation, apoptosis, migration, invasion and EMT progress, while the activator SC79 partially restored these effects. Finally, down-regulation of MUC1 inhibited the tumorigenesis in nude mice by modulating the PI3K/AKT signaling pathway. To conclude, these findings suggested that MUC1 played an important role in lung cancer progression, potentially through the PI3K/AKT pathway. This positioned MUC1 as a molecule worthy of further investigation for its therapeutic potential.
Right anterolateral mini-thoracotomy and full sternotomy approaches for Wheat procedure: a propensity-matched comparison.
Kong M, Sun Y, Zhu X … +3 more , Li X, Wei D, Dong A
J Cardiothorac Surg · 2026 Jun · PMID 42304374 · Full text
BACKGROUND: As the prevalence and technological advancements of minimally invasive heart surgery continue to increase, aortic valve replacement(AVR) via right anterolateral mini-thoracotomy (RAMT) has matured, however, p...
BACKGROUND: As the prevalence and technological advancements of minimally invasive heart surgery continue to increase, aortic valve replacement(AVR) via right anterolateral mini-thoracotomy (RAMT) has matured, however, problems associated with Wheat's procedure (replacement of the ascending aorta(AAR) concomitant AVR) via RAMT approach have not been reported. The objective of this study was to compare the surgical quality, postoperative outcomes, and patient safety in patients undergoing Wheat's procedure via Full sternotomy (FS) versus RAMT. METHODS: A retrospective analysis was conducted on the clinical data of 163 patients who underwent Wheat procedure between January 2022 and December 2024. Out of the 163 patients, 59 underwent the Wheat procedure via a right anterior minimally invasive incision. After 1:1 propensity score matching, by comparing various intraoperative and postoperative indicators, the outcomes of patients undergoing RAMT and FS were compared. RESULTS: Propensity scores identified 43 patients per group with similar baseline profiles. The results from the propensity-matched cohort are as follows. Although patients in RAMT group had longer cardiopulmonary bypass (RAMT 167 ± 57 vs FS 141 ± 40 min; P = 0.04) and cross-clamp (RAMT 128 ± 39 vs FS 110 ± 29 min; P = 0.04) time, they experienced reduced intraoperative blood loss (RAMT 317 ± 147 vs FS 456 ± 229 ml; P = 0.005). No patients in the RAMT group required intraoperative conversion to Full sternotomy. There was no statistically difference in the in-hospital mortality between the two groups (0% and 0% in RAMT and FS, respectively). RAMT was correlated with a reduced incidence of postoperative atrial fibrillation (RAMT 3 [7.0%] vs FS 13 [23.3%]; P = 0.04). Receiving RAMT can lead to a reduction in postoperative NRS pain scores and an earlier discharge for patients. RAMT not only enables shorter incisions (RAMT 6.0 cm vs FS 15.2 cm; P < 0.001) but also has no impact on the size or type of the artificial valve or vessel implanted, thereby ensuring that the surgical effection is non-inferior to the FS group. CONCLUSIONS: In the Wheat procedure, the perioperative outcomes of RAMT closely resemble those of full sternotomy, and may be transferred in the field of cardiac surgery.
Predictors of postoperative visual and auditory hallucinations in hypertensive vs. non-hypertensive cardiac surgery patients: insights from the prospective multicenter VAACS study.
Abu Khadija H, Darwish A, Kamel MA … +19 more , Najajra D, Masu'd M, Fraitekh YZ, Zahran A, Othman WSA, Asaireh A, Abu Ghayadah M, Almharmah M, Maqboul M, Shuurab MSM, Abu-Khazneh O, Khader M, Majadleh S, Alkhatib H, Tamimi HM, Rubi A, Al-Aydi NN, Abu Hamdeh N, Alnees M
J Cardiothorac Surg · 2026 Jun · PMID 42304176 · Full text
BACKGROUND: Hallucinations are common yet under-recognized after cardiac surgery and contribute to postoperative morbidity. Hypertension (HTN), the most prevalent comorbidity in surgical candidates, may alter susceptibil...
BACKGROUND: Hallucinations are common yet under-recognized after cardiac surgery and contribute to postoperative morbidity. Hypertension (HTN), the most prevalent comorbidity in surgical candidates, may alter susceptibility through impaired cerebrovascular autoregulation. Whether HTN modifies predictors of postoperative visual and auditory hallucinations remains unclear. METHODS: In the prospective, multicenter VAACS study, 1,332 adults undergoing CABG or valve surgery were stratified by hypertension (HTN, n = 517; non-HTN, n = 815). Visual and auditory hallucinations within 7 days were assessed with the Questionnaire for Psychotic Experiences. Multivariable Cox regression was performed separately in the HTN and non-HTN cohorts. RESULTS: Visual hallucinations occurred in 12.0% of HTN and 11.3% of non-HTN patients; auditory hallucinations in 6.2% and 7.4%, respectively. In HTN patients, visual hallucinations were independently predicted by higher EuroSCORE II (adjusted HR, 1.041; 95% CI, 1.021-1.061; p < 0.001) and higher neutrophil counts (adjusted HR, 1.018; 95% CI, 1.008-1.028; p < 0.001), while longer postoperative ventilation was associated with a reduced risk (adjusted HR, 0.861; 95% CI, 0.780-0.950; p = 0.003). For auditory hallucinations in HTN patients, younger age (adjusted HR, 0.965; 95% CI, 0.932-0.998; p = 0.039), prior antibiotic use (adjusted HR, 2.464; 95% CI, 1.550-3.916; p < 0.001), higher neutrophil counts (adjusted HR, 1.016; 95% CI, 1.005-1.027; p = 0.004), and shorter ventilation duration (adjusted HR, 0.791; 95% CI, 0.709-0.883; p < 0.001) were independently associated with risk. In non-HTN patients, EuroSCORE II was independently associated with visual hallucinations (adjusted HR, 1.051; 95% CI, 1.043-1.060; p < 0.001). For auditory hallucinations in non-HTN patients, a higher EuroSCORE II increased the risk (adjusted HR 1.101, 95% CI 1.086-1.117, p < 0.001), while valve surgery versus CABG was protective (adjusted HR 0.463, 95% CI 0.221-0.970, p = 0.041). ROC analysis of a simple model (EuroSCORE II, ventilation, neutrophils) showed better discrimination in HTN (AUC 0.68) than in non-HTN (AUC 0.54; p ≈ 0.04-0.045). CONCLUSIONS: Predictors of postoperative hallucinations differ by HTN status. In HTN patients, inflammatory burden, age-related vulnerability, antibiotic exposure, and ventilatory course were the dominant determinants of risk. In non-HTN patients, overall operative risk as reflected by EuroSCORE II and surgery type played a more prominent role. CLINICAL TRIAL NUMBER: Not applicable.
Paradoxical sparing of cerebral circulation in massive TAVR-associated endocarditis.
An K, Gillinov M, Svensson LG … +1 more , Pasic M
J Cardiothorac Surg · 2026 Jun · PMID 42298723 · Full text
BACKGROUND: Prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) is an uncommon but life-threatening complication associated with high embolic risk. CASE PRESENTATION: A 82-year-old wom...
BACKGROUND: Prosthetic valve endocarditis (PVE) after transcatheter aortic valve replacement (TAVR) is an uncommon but life-threatening complication associated with high embolic risk. CASE PRESENTATION: A 82-year-old woman with prior TAVR presented with fever and malaise and was diagnosed with PVE due to Streptococcus Mutans. Transesophageal echocardiography revealed a large, highly mobile vegetation attached to the transcatheter valve, floating in the systolic jet of blood flow. Computed tomography demonstrated progressive splenic infarction and embolic involvement of the kidneys and mesenteric circulation, while no cerebral embolization occurred. At surgery, the previously visualized vegetation was no longer present, suggesting interval embolization. The transcatheter valve was explanted using cardiopulmonary bypass and cardioplegia. Radical debridement and annular enlargement with bovine pericardium were performed, followed by implantation of a surgical bioprosthesis using infection-conscious techniques. The patient recovered uneventfully. Post hoc analysis may suggest that proximal origin of the supra-aortic vessels (type III aortic arch configuration with the innominate artery originates below the horizontal plane of the inner curvature of the aortic arch) in the setting of an elongated aorta in this patient may explain the absence of cerebral embolization. This could possibly be relevant in combination with the centrally located floating vegetation, which was ejected along the strong central flow stream and consequently embolized to the abdominal organs. However, this excludes a generalization of the statement, and therefore the classic surgical principle of early surgery in patients with huge floating vegetations should be applied in similar cases. CONCLUSIONS: This case illustrates the embolic potential of large, mobile vegetations in TAVR-associated endocarditis and supports early surgical intervention in accordance with both American and European infective endocarditis guidelines. The absence of cerebral embolization in the presence of massive systemic emboli should not be mistaken for anatomical protection.
Construction of PANoptosis-related lncRNA prognostic model and immunotherapy sensitivity analysis in lung adenocarcinoma.
Xiong X, Ding J, Yao C
J Cardiothorac Surg · 2026 Jun · PMID 42298613 · Full text
BACKGROUND: Lung cancer is the cancer with the highest mortality rate worldwide. PANoptosis is characterized by inflammatory lytic cell death facilitated by caspases and RIPKs. We determined the construction of PANoptosi...
BACKGROUND: Lung cancer is the cancer with the highest mortality rate worldwide. PANoptosis is characterized by inflammatory lytic cell death facilitated by caspases and RIPKs. We determined the construction of PANoptosis-related lncRNA, constructed a prognosis-related model, and further screened potential therapeutic drugs. METHODS: The TCGA database was used to obtain the RNA-seq-based transcriptome profiling data, clinical information, and mutation data. We used multivariable Cox regression analysis to obtain PANoptosis-related lncRNAs. We then used the training group to build the prognostic model and used the testing group to verify the accuracy of the model. Calibration curves showed the difference between the predicted and observed outcomes. PCA analysis was used to explore the distribution of LUAD patients with high- and low-risk groups. The GO and GSEA enrichment analyses were performed. Immune cell infiltration and TMB analysis were performed using CIBERSORT and maftools algorithm. The TIDE algorithm was used to predict immunotherapy sensitivity and further predicted anti-tumor immune drugs. qPCR was used for experimental verification. RESULTS: We identified 163 PANoptosis-related lncRNAs and identified 6 lncRNAs as independent prognostic factors. The PFS and OS of the low-risk group were significantly higher than those of the high-risk group. The risk signature is a prognostic factor, independent of other factors. Different stages (stages I-II and III-IV) could well predict the survival rate of LUAD patients and these lncRNAs can reliably stratify patient prognosis. GSEA analysis showed that chromosome segregation and activation of immune response were significantly enriched in the high- and low-risk groups. The high-risk group showed a lower fraction of T cells CD4 memory resting and a higher proportion of NK cells resting. The OS of the low TMB group was significantly lower than the high TMB group. Furthermore, the drug sensitivity of the high-risk group is significantly higher than the low-risk group. And the high-risk lncRNAs may serve as therapeutic targets. CONCLUSIONS: In summary, the 6 PANoptosis-related lncRNAs can well predict the prognosis of LUAD patients, which may provide new insight for survival prediction and clinical immunotherapy of LUAD patients.
Two-year outcomes of transcatheter aortic valve replacement with the vitaflow libertyTM system in high-surgical-risk patients with severe aortic stenosis.
Chen S, Zhan Z, Chen D … +6 more , Jin Q, Zhang Y, Zhang X, Pan W, Zhou D, Ge J
J Cardiothorac Surg · 2026 Jun · PMID 42298602 · Full text
BACKGROUND: Mid-term clinical evidence for the VitaFlow LibertyTM transcatheter aortic valve system in anatomically complex populations is limited. METHODS: This was a prospective, multicenter, single-arm Objective Perfo...
BACKGROUND: Mid-term clinical evidence for the VitaFlow LibertyTM transcatheter aortic valve system in anatomically complex populations is limited. METHODS: This was a prospective, multicenter, single-arm Objective Performance Criteria study performed at 22 Chinese sites, with follow-up at 30 days, 6 months, 1 year, and annually through 5 years. The prespecified primary endpoint of the parent study was 1-year all-cause mortality. Other clinical events were adjudicated according to Valve Academic Research Consortium-2 definitions. RESULTS: A total of 163 patients underwent transcatheter aortic valve replacement (TAVR) with the VitaFlow LibertyTM system. The mean age was 76.8 ± 5.0 years, 65.0% were male, the mean STS-PROM score was 7.87 ± 2.70, and 46.6% had bicuspid aortic valve anatomy. At 2 years, all-cause mortality was 13.5%, any stroke occurred in 7.6%, and new permanent pacemaker implantation was required in 19.5%. Mean aortic valve gradient improved from 59.22 ± 19.76 mmHg at baseline to 9.04 ± 6.07 mmHg at 2 years, and effective orifice area improved from 0.57 ± 0.21 cm to 2.00 ± 0.51 cm. Moderate paravalvular leak was present in 4.5% of patients at 2 years. CONCLUSIONS: TAVR with the VitaFlow LibertyTM system demonstrated favorable 2-year safety and efficacy in a challenging population, with sustained hemodynamic performance. TRIAL REGISTRATION: NCT04414878.
Uniportal robot-assisted resection and reconstruction of the left bronchial secondary carina in a pediatric patient.
Gonzalez-Rivas D, Li C, He Z … +4 more , Li G, Lu X, Huang H, Zhao J
J Cardiothorac Surg · 2026 Jun · PMID 42298595 · Full text
BACKGROUND: Bronchial carcinoid tumors are rare in children and often present central airway involvement, posing challenges for lung-sparing surgery. Robotic systems enable enhanced precision and dexterity, but their app...
BACKGROUND: Bronchial carcinoid tumors are rare in children and often present central airway involvement, posing challenges for lung-sparing surgery. Robotic systems enable enhanced precision and dexterity, but their application in pediatric airway reconstruction remains limited. CASE PRESENTATION: A 13-year-old boy presented with a left secondary carinal bronchial carcinoid. After bronchoscopic tumor debulking, definitive surgery was performed using a uniportal robot-assisted approach with the da Vinci Xi system (Intuitive Surgical Inc., Sunnyvale, CA, USA). A single 4-cm incision was made at the fifth intercostal space along the midaxillary line. The secondary carina was resected, and airway continuity was reconstructed using three separate continuous 3-0 barbed sutures. The postoperative course was uneventful, and bronchoscopy at three months confirmed a patent, well-healed anastomosis. CONCLUSIONS: This case demonstrates the feasibility and safety of uniportal robot-assisted secondary carina reconstruction in a pediatric patient, providing a minimally invasive option for complex airway surgery.
Thoracoscopic resection of the second rib via a periareolar approach: a case report.
Zhang J, Zhao X, Zhang J … +4 more , You Z, Yang C, Yu X, Fang J
J Cardiothorac Surg · 2026 Jun · PMID 42289746 · Full text
BACKGROUND: Thoracoscopic minimally invasive techniques have been applied in rib resection. Although they significantly reduce trauma compared with traditional thoracotomy, they still leave noticeable surgical scars on t...
BACKGROUND: Thoracoscopic minimally invasive techniques have been applied in rib resection. Although they significantly reduce trauma compared with traditional thoracotomy, they still leave noticeable surgical scars on the lateral chest wall. The periareolar incision offers superior cosmetic outcomes compared with conventional incisions; however, its application in rib tumor resection has not yet been reported. CASE PRESENTATION: We report a case of thoracoscopic resection of the second rib via a periareolar approach. A 34-year-old male presented with a mass in the right second rib detected during a routine physical examination. PET-CT revealed osteolysis with increased FDG uptake (SUVmax 11.7), suggestive of a primary bone tumor. The patient underwent thoracoscopic rib resection using a Gigli saw through a 2-cm periareolar incision combined with a 1-cm thoracoscopic port. The operative time was 110 min, with an estimated blood loss of 30 mL. The chest tube was removed on postoperative day 3, and the patient was discharged uneventfully. Postoperative pathology confirmed Langerhans cell histiocytosis with negative margins. At the 4-week and 6-month follow-ups, the patient recovered well, was satisfied with the cosmetic appearance of the incision, and experienced no complications. CONCLUSIONS: Thoracoscopic rib resection via the periareolar approach is safe and feasible. This technique significantly improves cosmetic outcomes, reduces surgical trauma, and may serve as a new option for rib resection.
TM and t-PAIC may be possible biomarkers to predict postoperative infection after cardiac surgery with cardiopulmonary bypass.
Wang L, Chen Q, Wu W … +1 more , Long Y
J Cardiothorac Surg · 2026 Jun · PMID 42289744 · Full text
BACKGROUND: While cardiac surgery and cardiopulmonary bypass (CPB) are on rise, postoperative infections have become an increasingly prominent problem. We designed this study to compare the four coagulation indicators in...
BACKGROUND: While cardiac surgery and cardiopulmonary bypass (CPB) are on rise, postoperative infections have become an increasingly prominent problem. We designed this study to compare the four coagulation indicators involving endothelial injury and identify important predictors of postoperative infection after cardiac surgery with CPB. METHODS: This is a single-center, prospective, observational study of postoperative cardiac surgery patients admitted to the department of critical care medicine, Peking Union Medical College Hospital from July 15, 2024 to August 26, 2024. Patients postoperatively after cardiac surgery with CPB during the study period were included. A total of 40 patients were included finally, comprising 34 in the Control group and 6 in the Infection group. Data on coagulation and inflammatory markers of above patients were collected. Above markers included thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2-plasmininhibitor complex (PIC), and tissue plasminogen activator-inhibitor complex (t-PAIC), tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, and IL-10 concentration. RESULTS: Postoperative infection after cardiac surgery with CPB was 15% (6 / 40) in this study. Blood TM and t-PAIC levels in the Infection group increased significantly compared to the Control group (P < 0.05). There was no statistically significant difference in TAT, PIC, TNF-α, IL-6, IL-8, and IL-10 levels the Control group and the Infection group. For postoperative infection after cardiac surgery with CPB, the AUROC of blood TM levels was 0.806 ([95% CI], [0.643, 0.970]) and the AUROC of blood t-PAIC levels was 0.730 ([95% CI], [0.473, 0.988]). CONCLUSIONS: TM and t-PAIC were higher in patients who developed postoperative infection after cardiac surgery with CPB and may be possible biomarkers, but larger studies are needed to confirm their value. TRIAL REGISTRATION: registry: Chinese Clinical Trial Registry, trial registration number: ChiCTR2600118480 (https://www.chictr.org.cn), data of registration: 2026/2/6, retrospectively registered.
Identification of mitochondrial energy metabolism-related candidate genes UQCR10 and NDUFA6 in pediatric tetralogy of fallot: an exploratory bioinformatics study.
Qin Y, Lang T
J Cardiothorac Surg · 2026 Jun · PMID 42289731 · Full text
BACKGROUND: Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases in infants and young children. Its molecular basis remains incompletely understood. This study aimed to identify mitochon...
BACKGROUND: Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases in infants and young children. Its molecular basis remains incompletely understood. This study aimed to identify mitochondrial energy metabolism-related candidate genes associated with pediatric TOF using public heart tissue transcriptomic datasets from the GEO database. METHODS: Datasets GSE146218 and GSE217772 were downloaded and merged, followed by batch-effect correction. Differential expression analysis was performed to identify differentially expressed genes (DEGs). Functional enrichment analysis, weighted gene co-expression network analysis (WGCNA), and protein-protein interaction (PPI) network analysis were used to prioritize candidate genes. The Comparative Toxicogenomics Database (CTD) was used as an exploratory literature-based tool to summarize gene-disease associations. RESULTS: A total of 960 DEGs were identified. Functional enrichment analyses showed that these genes were mainly enriched in mitochondrial energy metabolism-related pathways, including oxidative phosphorylation and the mitochondrial respiratory chain. WGCNA and PPI network analyses further prioritized UQCR10 and NDUFA6 as candidate genes, and both genes showed increased expression in TOF heart tissue samples. CTD analysis suggested literature-based associations between these genes and cardiovascular or developmental disease-related terms. CONCLUSION: This exploratory bioinformatics study identified UQCR10 and NDUFA6 as mitochondrial energy metabolism-related candidate genes upregulated in pediatric TOF heart tissue. These findings suggest that mitochondrial respiratory chain-related transcriptional alterations may be involved in TOF-associated myocardial remodeling or stress responses. Further experimental and clinical validation is required to confirm their biological relevance.
Targeting cardiac myosin in HFrEF: mechanism, clinical evidence, and the role of omecamtiv mecarbil.
Abady E, Elewa M, Karam KN … +7 more , Mathew KT, Bedair M, Almashaqbeh SN, Alwarraqi AG, AbuEl-Enien H, Samadi Y, Abouelmad K
J Cardiothorac Surg · 2026 Jun · PMID 42289718 · Full text
The morbidity and mortality associated with heart failure with reduced ejection fraction (HFrEF) remain high despite significant advances in treatment. Current guideline-directed medical therapies (GDMT) primarily target...
The morbidity and mortality associated with heart failure with reduced ejection fraction (HFrEF) remain high despite significant advances in treatment. Current guideline-directed medical therapies (GDMT) primarily target neurohormonal pathways. However, traditional positive inotropes, which enhance contractility, are limited by adverse events including increased myocardial oxygen consumption and arrhythmogenesis. Omecamtiv Mecarbil (OM) is a first-in-class selective cardiac myosin activator that addresses this gap by directly targeting the cardiac sarcomere. OM binds to cardiac myosin, stabilizing it in a force-generating state, thereby prolonging systolic ejection time and improving contractility without increasing intracellular calcium or heart rate. The Phase III GALACTIC-HF trial, which enrolled over 8,200 patients with HFrEF, reported an 8% relative risk reduction in the composite endpoint of heart failure events or cardiovascular death (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.86-0.99, P = 0.025). This benefit was primarily driven by a reduction in heart failure hospitalizations, with no significant difference in cardiovascular mortality. Subgroup analysis revealed that the clinical benefit was most pronounced in patients with a left ventricular ejection fraction (LVEF) of ≤ 28%. OM was generally well-tolerated, with a safety profile comparable to placebo, though it possesses a narrow therapeutic window, with higher plasma concentrations associated with an increased risk of ischemic events. In summary, OM represents a novel, mechanistically distinct therapeutic option for symptomatic HFrEF patients, particularly those with severe systolic dysfunction, who remain at high risk despite optimized GDMT.
Relationship between endothelial activation and stress index and radial artery occlusion in patients undergoing radial access percutaneous coronary intervention.
Özkoç M, Aydemir S, Özmen M … +1 more , Ocak A
J Cardiothorac Surg · 2026 Jun · PMID 42289716 · Full text
BACKGROUND: One of the most common complications observed after transradial coronary angiography is radial artery occlusion (RAO). Endothelial damage plays an important role in the pathophysiology of RAO. AIMS: In our st...
BACKGROUND: One of the most common complications observed after transradial coronary angiography is radial artery occlusion (RAO). Endothelial damage plays an important role in the pathophysiology of RAO. AIMS: In our study, we plan to investigate the predictive value of the endothelial activation and stress index (EASIX), which is considered an indirect marker of endothelial damage, for RAO. METHODS: Our study was designed as a retrospective study and includes patients who underwent transradial coronary angiography and percutaneous coronary intervention in our clinic. EASIX values were calculated from blood tests taken before the procedure. The primary endpoint of our study was determined as RAO and patients were divided into two groups according to RAO status. Variables independently associated with RAO were determined using logistic regression analysis. To evaluate the predictive capacity of the EASIX for RAO, ROC-Curve analysis was applied and the area under the curve was determined. RESULTS: Our study included 2342 patients. The RAO rate in the sample was 3.3% (78 patients). As a result, EASIX was independently associated with RAO (P = 0.009) and predicted RAO with a cut-off value of 1.2, 76.9% sensitivity and 77.1% specificity in ROC-Curve analysis (AUC: 0.803, 95% CI: 0.755-0.851, P < 0.001). CONCLUSION: In our study, we observed that EASIX was an independent predictor of RAO after transradial intervention. We believe that EASIX may be useful in early detection of patients at high risk of developing RAO, especially before transradial catheterization, and in taking the necessary precautions against this complication.
Targeted strategies for managing seasonal blood pressure swings in high-risk hemodialysis patients.
Lan S, Wu Z
J Cardiothorac Surg · 2026 Jun · PMID 42289714 · Full text
OBJECTIVE: To examine the subgroup characteristics of seasonal blood pressure (BP) fluctuations in maintenance hemodialysis (MHD) patients and to evaluate their association with cardiovascular and cerebrovascular events...
OBJECTIVE: To examine the subgroup characteristics of seasonal blood pressure (BP) fluctuations in maintenance hemodialysis (MHD) patients and to evaluate their association with cardiovascular and cerebrovascular events (CCVE). METHODS: A total of 154 eligible MHD patients treated at our center between May 2018 and October 2021 were retrospectively enrolled with informed consent. Systolic (SBP) and diastolic (DBP) BP values were collected and analyzed across different seasons, stratified by sex, age, and primary disease. The seasonal distribution of intradialytic hypertension, intradialytic hypotension, CCVE incidence, and mortality was further assessed. The interaction between season, age, and gender on BP was analyzed after using a multi-factor nonlinear mixed effects model, to correct for antihypertensive drug prescription, ultrafiltration rate, and dry body weight fluctuations. RESULTS: BP demonstrated significant seasonal variation (P < 0.05), with the lowest SBP and DBP observed in summer and the highest in winter, while spring and autumn showed intermediate values. Across all seasons, BP rose progressively with age: SBP and DBP were significantly higher in the 45-60 year group compared with < 45 years (P < 0.05), and highest in patients > 60 years (P < 0.05). Male patients consistently exhibited higher SBP and DBP than females in both warm (spring-summer) and cold (autumn-winter) seasons (P < 0.05). Compared with spring-summer, autumn-winter was associated with a higher proportion of intradialytic hypertension (37.66% vs. 20.78%, P < 0.01), a lower proportion of intradialytic hypotension (13.64% vs. 29.22%, P < 0.001), and increased CCVE incidence (22.73% vs. 11.69%) and mortality (7.79% vs. 3.25%, both P < 0.05). The amplitude of seasonal SBP fluctuation was greatest in patients > 60 years (19.72 ± 6.13 mmHg) compared with 45-60 years (14.13 ± 4.92 mmHg) and < 45 years (8.52 ± 3.21 mmHg, all P < 0.05). Male patients also showed larger SBP fluctuations than females (16.82 ± 5.73 mmHg vs. 11.53 ± 4.82 mmHg, P < 0.001), while no significant differences were observed among subgroups stratified by primary disease (P > 0.05). After multi-factor model correction, the interaction between season and age (P = 0.018) and season and gender (P = 0.025) remained significant, indicating that the seasonal increase in BP in elderly and male patients was independent effect of antihypertensive medication adjustment, ultrafiltration rate, and dry body weight fluctuations. CONCLUSION: BP in MHD patients was jointly influenced by season, age, and sex. The highest values and greatest fluctuations occurred in autumn-winter, in males, and in patients > 60 years. These subgroups represented high-risk populations for adverse cardiovascular and cerebrovascular outcomes during colder months. Targeted, season- and subgroup-specific BP management strategies might have helped mitigate CCVE risk and improve survival in MHD patients.
Prognostic value of X-box binding protein 1 and phospholipase A2 in myocardial injury after ST-segment elevation myocardial infarction: a prospective observational study.
Wang F, Ning M, Liu Y
J Cardiothorac Surg · 2026 Jun · PMID 42289708 · Full text
OBJECTIVE: This study explored the role of X-box binding protein 1 (XBP1), phospholipase A2 (PLA2), and B-type natriuretic peptide (BNP) as biomarkers for diagnosing and predicting myocardial injury in patients with ST-s...
OBJECTIVE: This study explored the role of X-box binding protein 1 (XBP1), phospholipase A2 (PLA2), and B-type natriuretic peptide (BNP) as biomarkers for diagnosing and predicting myocardial injury in patients with ST-segment elevation acute myocardial infarction (STEMI). METHODS: This prospective cohort study enrolled 283 adult patients with Acute Coronary Syndrome (ACS) admitted to Tianjin Third Central Hospital between October 2021 and October 2022. Patient selection followed strict criteria: inclusion required ACS diagnosis or high ACS risk with informed consent; exclusion criteria were history of myocardial infarction, ejection fraction < 30%, or comorbidities (e.g., cardiomyopathy, renal disease). Patients were divided into STEMI and non-STEMI/unstable angina groups based on electrocardiogram findings. Serum levels of XBP1, PLA2, and other related indicators were measured using enzyme-linked immunosorbent assay (ELISA) kits. The relationships between these biomarkers and myocardial injury were analyzed. RESULTS: XBP1 and PLA2 levels were significantly elevated in patients with myocardial ischemia-reperfusion injury (MIRI), myocardial injury, and those undergoing intervention. Recombinant human BNP (rhBNP) treatment was associated with lower XBP1 and PLA2 levels 24 h post-surgery. Logistic regression analysis identified smoking history, neutrophil percentage, sICAM-1, and PLA2 as independent risk factors for myocardial injury. XBP1, PLA2, and BNP levels were independently related to myocardial injury and showed significant positive correlations with each other. ROC curve analysis indicated that XBP1 and PLA2 levels had significant diagnostic efficacy for postoperative myocardial injury, with the combined diagnostic approach yielding the best performance. CONCLUSION: Pre-treatment serum PLA2 and XBP1 levels, alone or in combination, may serve as significant predictors of myocardial injury in ACS patients undergoing PCI. rhBNP may protect the myocardium and improve cardiac function by reducing XBP1 and PLA2 levels. These findings suggest that pre-treatment serum PLA2 and XBP1 levels could be used as practical biomarkers for risk stratification in ACS patients undergoing PCI, aiding clinicians in decision-making regarding rhBNP therapy. Further studies are needed to validate these results and integrate them into clinical guidelines.
Definitive diagnosis and surgical management of pleural and diaphragmatic endometriosis: a case report.
Gochi AM, Williams KM, Kimura MM … +2 more , Sze ND, Velotta JB
J Cardiothorac Surg · 2026 Jun · PMID 42289706 · Full text
BACKGROUND: Thoracic endometriosis is an uncommon and frequently under recognized manifestation of endometriosis involving the pleura, diaphragm, or lung parenchyma. Patients often present with nonspecific cyclical thora...
BACKGROUND: Thoracic endometriosis is an uncommon and frequently under recognized manifestation of endometriosis involving the pleura, diaphragm, or lung parenchyma. Patients often present with nonspecific cyclical thoracic or upper abdominal pain, and diagnosis is frequently delayed. Surgical management with video-assisted thoracoscopic surgery (VATS) allows definitive diagnosis and surgical management of identified thoracic lesions, particularly when disease spans the thoracic and abdominal cavities. CASE PRESENTATION: A 40-year-old woman with six years of cyclical right upper quadrant pain refractory to hormonal therapy was found to have suspected thoracic and diaphragmatic endometriosis on imaging. Multidisciplinary surgical management with combined VATS and laparoscopy revealed pleural, diaphragmatic, and pelvic endometrial implants, which were completely excised. Pathology confirmed thoracic and pelvic endometriosis. The patient has experienced sustained symptom resolution past 12-month follow-up. CONCLUSIONS: Thoracic endometriosis should be considered in reproductive-age women with unexplained cyclical thoracoabdominal pain. Combined minimally invasive thoracic and abdominal exploration enables comprehensive evaluation and complete resection of disease across the diaphragm, leading to durable symptom control. Early multidisciplinary recognition is essential to optimize outcomes.
The potential of TRPC channel-mediated autophagy in myocardial ischemia-reperfusion injury.
Han H, Wang Y, Li S
J Cardiothorac Surg · 2026 Jun · PMID 42289702 · Full text
BACKGROUND: Myocardial ischemia/reperfusion injury (MI/RI) is a common complication in the treatment of acute myocardial infarction, which is often accompanied by high disability rate and mortality.Autophagy is a highly...
BACKGROUND: Myocardial ischemia/reperfusion injury (MI/RI) is a common complication in the treatment of acute myocardial infarction, which is often accompanied by high disability rate and mortality.Autophagy is a highly conserved cellular process widely observed in eukaryotic cells, serving as a critical mechanism for the removal of damaged, dysfunctional, or aged intracellular components. As a vital self-protective pathway, autophagy plays an essential role in maintaining cellular homeostasis. Accumulating evidence indicates that autophagy is implicated in calcium overload during MI/RI. The transient receptor potential canonical (TRPC) channels, which function as Ca²⁺-permeable non-selective cation channels, are known to participate in various Ca²⁺-related pathological processes. METHODS: A comprehensive literature review was conducted using established scientific databases, including ScienceDirect, PubMed, and Google Scholar. This article focuses on the pathogenesis of MI/RI, the TRPC channel family, and their interrelationships. Relevant research findings were systematically summarized, and potential directions for future investigation were discussed. MAIN BODY: This review examines the key pathophysiological mechanisms underlying myocardial ischemia-reperfusion injury, including inflammatory responses, calcium overload, and oxidative stress. Particular emphasis is placed on calcium overload, with a detailed exploration of its molecular mechanisms. Furthermore, autophagy and the associated signaling pathways-specifically the CaMKKβ/AMPK/mTOR axis-are discussed to elucidate the interplay between autophagy and calcium regulation, as well as the protective effects of autophagy in the context of MI/RI. Additionally, the structure, function, and current research progress on the TRPC channel family in relation to MI/RI are reviewed, providing insights into potential future research avenues. CONCLUSION: Currently, the effective treatment of myocardial ischemia-reperfusion injury remains a significant clinical challenge. Evidence suggests that downregulation of TRPC channel expression may mitigate Ca²⁺ overload and thereby reduce cellular damage. However, whether this protective effect is mediated through autophagy requires further experimental validation and mechanistic investigation.
Successful snare retrieval of a dislodged AVEIR leadless pacemaker from right pulmonary artery: a case report.
Song X, Wang F, Zhang F … +2 more , Qi X, Dang Y
J Cardiothorac Surg · 2026 Jun · PMID 42289691 · Full text
BACKGROUND: Leadless pacemakers (LPs) are safer and more effective alternatives to traditional transvenous pacemakers, but LP detachment and displacement are serious complications. CASE PRESENTATION: We report a case of...
BACKGROUND: Leadless pacemakers (LPs) are safer and more effective alternatives to traditional transvenous pacemakers, but LP detachment and displacement are serious complications. CASE PRESENTATION: We report a case of AVEIR LP implantation, immediate dislodgement into the right pulmonary artery, and retrieval in an 82-year-old woman. CONCLUSION: The device was retrieved successfully using a gooseneck snare and the tri-loop snare of the retrieval catheter, then re-implanted.
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