Journal Of Cardiothoracic Surgery[JOURNAL]
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200 papers
Identification of TGF-β1 as a key regulator in DOX-induced cardiotoxicity.
Mao C, Zhang Z, Xiao D … +6 more , He J, Leng X, Zhao W, Zeng M, Zhong K, Chen Y
J Cardiothorac Surg · 2026 Jun · PMID 42289684 · Full text
BACKGROUND: Doxorubicin (DOX) is a widely used chemotherapeutic agent, but its severe cardiotoxicity limits its clinical application. Many biological processes and molecular mechanisms have been implicated in DOX-induced...
BACKGROUND: Doxorubicin (DOX) is a widely used chemotherapeutic agent, but its severe cardiotoxicity limits its clinical application. Many biological processes and molecular mechanisms have been implicated in DOX-induced cardiotoxicity. However, the mechanisms underlying DOX-induced cardiotoxicity remain largely unknown. This study aimed to identify key regulatory genes and select targeted drugs for DOX-induced cardiotoxicity. METHODS: RNA-seq analysis was used to identify differentially expressed genes (DEGs) in DOX-treated cardiomyocytes. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis was used to elucidate the biological significance of the DEGs. Protein-protein interaction (PPI) network and maximum clique centrality (MCC) algorithm in Cytoscape software were used to identify central regulatory genes. Gene Set Enrichment Analysis (GSEA) was used to verify the key gene involved in DOX-induced cardiotoxicity. Molecular docking analysis was used to identify the inhibitors of the key gene. Cell Counting Kit-8 (CCK-8) assay, Western blot, creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) detection kits, and Hematoxylin and Eosin (HE) staining were used to investigate the protective effect of SB-431,542 against DOX-induced cardiomyocyte injury. RESULTS: RNA-seq analysis revealed significant transcriptional changes. Upregulated genes wereassociated with oxidative stress and apoptosis, while downregulated genes were linked to disrupted signaling pathways. Differential expression analysis identified interleukin-6 (Il6), transforming growth factor-beta 1 (TGF-β1), intercellular adhesion molecule-1 (Icam1), serine peptidase inhibitor clade E member 1 (Serpine1), and angiotensinogen (Agt) as central regulators of DOX-induced cellular responses. Functional enrichment analysis highlighted the involvement of mitogen-activated protein kinase (MAPK), receptor for advanced glycation endproducts (RAGE), and TGF-β signaling pathways. Further analysis identified TGF-β1 as a key regulatory hub connecting the MAPK pathway and protein-protein interaction networks. GSEA confirmed TGF-β pathway enrichment, emphasizing its role in inflammation, fibrosis, and oxidative stress. Notably, SB-431,542, a TGF-β receptor kinase inhibitor, mitigated DOX-induced apoptosis, improved cell viability, and ameliorated DOX-induced cardiotoxicity by inhibiting the phosphorylation of Smad2/3. CONCLUSION: Our study identifies TGF-β1 as a central regulator of DOX-induced cardiotoxicity and highlights SB-431,542 as a promising therapeutic agent for mitigating cardiomyocyte apoptosis by targeting Smad2/3. Our study suggests that TGF-β1 may serve as a potential therapeutic target for reducing DOX-induced cardiotoxicity.
Single-center experience with aortopexy in pediatric tracheomalacia: a case series.
Tadayon A, Yousufzai S, Forooghi M … +7 more , Abooali S, Zare P, Hosseini H, Yousefi A, Poorkhosravani M, Moqadas M, Azh O
J Cardiothorac Surg · 2026 Jun · PMID 42288887 · Full text
BACKGROUND: Tracheomalacia in infants often results from vascular compression and is frequently associated with multiple congenital anomalies. Aortopexy is a well-established surgical treatment for severe cases; however,...
BACKGROUND: Tracheomalacia in infants often results from vascular compression and is frequently associated with multiple congenital anomalies. Aortopexy is a well-established surgical treatment for severe cases; however, long-term outcomes vary significantly, especially in patients with syndromic conditions. OBJECTIVE: This study aims to present the clinical, surgical, and long-term outcomes of aortopexy performed in six infants diagnosed with severe tracheomalacia and multiple congenital anomalies, focusing on determining whether persistent morbidity and mortality are attributable to the airway intervention itself or to underlying comorbidities. METHODS: We conducted a single-center case series involving six infants diagnosed with tracheomalacia confirmed by rigid bronchoscopy. All subjects underwent open aortopexy combined with thymectomy (partial, subtotal, or total). Data collected included preoperative respiratory support status, bronchoscopic findings-specifically the degree of airway collapse and posterior wall dynamics-perioperative details, and long-term follow-up outcomes. Due to the small sample size and lack of a control group, no formal analysis was performed to determine the independent effects of thymectomy. RESULTS: Each patient presented with multiple congenital anomalies, with symptom onset ranging from 6 days to 1 year of age. Surgical approaches included thoracotomy in five cases and cervicotomy in one. Preoperative respiratory support varied: two patients required invasive mechanical ventilation, two received non-invasive support, one was on supplemental oxygen, and one required no respiratory assistance. Thymectomy was successfully performed in all cases (partial in four, subtotal in one, and total in one) without intraoperative complications. No major early postoperative complications were observed; however, two patients required reintervention-one for tracheal stenosis and one for tracheostomy plug removal-and two patients died from comorbidity-related causes (acute respiratory distress syndrome and pulmonary hypertension complicated by COVID-19). Among the four patients with extended follow-up (up to eight years), persistent morbidities such as tracheal stenosis, gastroesophageal reflux disease, and scoliosis were common, with half reporting poor or fair quality of life. CONCLUSION: Aortopexy effectively alleviates airway obstruction in infants with tracheomalacia secondary to vascular compression, especially when guided by intraoperative bronchoscopy. However, long-term outcomes are primarily influenced by associated congenital anomalies rather than procedural failure. Although routine thymectomy was feasible, its additional benefit remains unproven. Future multicenter prospective studies and investigations into adjunctive surgical techniques, such as posterior tracheopexy, are warranted to improve prognosis in this complex patient population.
Association of surgeon sex with postoperative adverse outcomes in adult cardiac surgery: a nationwide cohort study.
Arnreiter M, Kaider A, Pljakova M … +7 more , Angleitner P, Osipenko K, Klaus N, Zimpfer D, Zuckermann A, Gaudino M, Sandner S
J Cardiothorac Surg · 2026 Jun · PMID 42288795 · Full text
BACKGROUND: Sex-based differences in outcomes after cardiac surgery are consistently reported, with women frequently experiencing higher postoperative morbidity and mortality. While emerging evidence suggests that patien...
BACKGROUND: Sex-based differences in outcomes after cardiac surgery are consistently reported, with women frequently experiencing higher postoperative morbidity and mortality. While emerging evidence suggests that patient-physician sex concordance may improve outcomes in some medical fields, whether such an effect exists in cardiac surgery is unknown. METHODS: We conducted a nationwide cohort study using data from the Austrian Adult Cardiac Surgery Registry, including all patients undergoing one of four common non-emergent first-time cardiac surgery procedures between 2012 and 2022. The primary outcome was a composite of adverse postoperative outcomes, defined as death, readmission, or complications within 30 days after surgery. Multivariable generalized linear mixed models were used to assess patient-surgeon sex pairing effects. RESULTS: Among 57,729 patients (27.5% female) treated by 239 surgeons (22.2% female), patient-surgeon sex concordance was present in 63.9% of cases. Female patients had higher rates of the composite primary outcome compared to male patients (13.0% [female surgeon] and 13.3% [male surgeon] versus 11.0% [female surgeon] and 11.3% [male surgeon]). Surgeon sex was not independently associated with the primary composite outcome (aOR for female vs. male surgeon, 0.94; 95%CI, 0.84-1.06; P = 0.28), without significant interaction between patient and surgeon sex (p=0.61). CONCLUSION: In this nationwide cohort, patient-surgeon sex pairing was not associated with postoperative adverse outcomes after adult cardiac surgery. Improving outcomes should therefore center on clinical risk optimization rather than sex concordance.
Coronary thrombosis after Bentall's procedure in a patient with Ehlers-Danlos syndrome: a case report.
Zheng J, Yin Q, Wang Y … +2 more , Li X, Shi J
J Cardiothorac Surg · 2026 Jun · PMID 42286762 · Full text
BACKGROUND: Acute coronary syndrome (ACS) following cardiac valve replacement is a rare but severe complication. Patients with vascular Ehlers-Danlos syndrome (vEDS) may exhibit an increased propensity for coronary throm...
BACKGROUND: Acute coronary syndrome (ACS) following cardiac valve replacement is a rare but severe complication. Patients with vascular Ehlers-Danlos syndrome (vEDS) may exhibit an increased propensity for coronary thrombosis due to their genetic predisposition. After Bentall surgery, coronary manipulation and early postoperative anticoagulation instability may further contribute to thrombotic risk, particularly after mechanical valve implantation. CASE PRESENTATION: A 33-year-old male presenting with acute chest pain underwent a Bentall procedure for vEDS-complicated type A aortic dissection and received postoperative anticoagulation. Twenty days postoperatively, angiography and IVUS revealed a thrombus at the left anterior descending artery (LAD) ostium. Following a multidisciplinary discussion, percutaneous coronary intervention (PCI) was successfully performed to remove the thrombus and restore blood flow. CONCLUSIONS: We discuss the risk of ACS following cardiac surgery, especially in vEDS patients, as well as strategies for early identification, timely intervention, and optimization of perioperative anticoagulation management.
Recurrent pulmonary vein stenosis potentially aggravated by posterior compression in a patient with asplenia.
Nishino T, Ando M
J Cardiothorac Surg · 2026 Jun · PMID 42286759 · Full text
Pulmonary vein stenosis after repair of total anomalous pulmonary venous connection (TAPVC) is a life-threatening complication that frequently recurs, particularly in patients with asplenia. Although intrinsic mechanisms...
Pulmonary vein stenosis after repair of total anomalous pulmonary venous connection (TAPVC) is a life-threatening complication that frequently recurs, particularly in patients with asplenia. Although intrinsic mechanisms such as ostial narrowing and progressive neointimal proliferation are well recognized, extrinsic mechanical factors are less commonly emphasized in congenital heart disease. We report a case of recurrent pulmonary vein stenosis in a patient with asplenia in whom intrinsic susceptibility and possible posterior extrinsic compression may have acted synergistically. Serial computed tomography demonstrated persistent proximity between the left pulmonary vein and indwelling enteral feeding tubes. Sustained improvement was achieved after surgical relocation of the left pulmonary vein orifice to a site remote from the tubes. This case suggests that external mechanical influences may represent an underrecognized and potentially modifiable contributor to postoperative pulmonary vein stenosis in high-risk pediatric patients.
Ruptured infective sinus of valsalva aneurysm complicated by peripheral mycotic pulmonary artery aneurysm: a case report.
Nosaka Y, Murata A, Yamamoto Y … +5 more , Ueda H, Nakabori H, Sakai A, Ushijima M, Iino K
J Cardiothorac Surg · 2026 Jun · PMID 42286754 · Full text
BACKGROUND: Ruptured sinus of Valsalva aneurysm associated with infective endocarditis is a rare but life-threatening condition. Peripheral mycotic pulmonary artery aneurysm is even rarer and carries a high risk of ruptu...
BACKGROUND: Ruptured sinus of Valsalva aneurysm associated with infective endocarditis is a rare but life-threatening condition. Peripheral mycotic pulmonary artery aneurysm is even rarer and carries a high risk of rupture. The coexistence of infective ruptured sinus of Valsalva aneurysm and a peripheral mycotic pulmonary artery aneurysm has not been previously reported. CASE PRESENTATION: A 58-year-old woman developed pneumonia and infective endocarditis with mobile vegetation in the right ventricular outflow tract, resulting in right ventricular outflow tract stenosis and septic pulmonary embolism. During antibiotic therapy, computed tomography incidentally revealed a peripheral mycotic pulmonary artery aneurysm. Because of the high risk of rupture, urgent transcatheter coil embolization was performed. Both transthoracic echocardiography and cardiac CT suggested a communication; however, neither modality allowed definitive differentiation between ventricular septal defect and ruptured sinus of Valsalva aneurysm due to severe right ventricular outflow tract obstruction. Subsequent transesophageal echocardiography clearly demonstrated a ruptured sinus of Valsalva aneurysm originating from the right coronary sinus and draining into the right ventricle, and definitive surgical repair was successfully performed. The postoperative course was uneventful, with no recurrence of infection or aneurysm enlargement during a two-year follow-up period. CONCLUSIONS: This case highlights the importance of early recognition and multidisciplinary decision-making in patients with infective endocarditis complicated by rare vascular lesions. Prioritizing endovascular treatment of a peripheral mycotic pulmonary artery aneurysm before open heart surgery may reduce the risk of catastrophic pulmonary hemorrhage during cardiopulmonary bypass.
EGF-supplemented decellularized tracheal matrix hydrogels promote tracheal defect repair.
Hao Q, Song W, Zuo P … +1 more , Pan L
J Cardiothorac Surg · 2026 Jun · PMID 42286743 · Full text
BACKGROUND: Tracheal defect repair is a major clinical challenge in thoracic surgery, with long-segment defects having a low clinical repair rate. Autologous cartilage transplantation is limited by high postoperative ste...
BACKGROUND: Tracheal defect repair is a major clinical challenge in thoracic surgery, with long-segment defects having a low clinical repair rate. Autologous cartilage transplantation is limited by high postoperative stenosis and insufficient autologous tissue, while traditional artificial tracheal materials have poor biocompatibility and no epithelial regeneration-inducing capacity, leading to poor long-term efficacy. This study aimed to fabricate a biomimetic composite hydrogel and evaluate its physicochemical properties and tracheal repair efficacy, providing a new tissue-engineered strategy for clinical tracheal defect management. METHODS: A PEGDA/DCM/EGF composite hydrogel was prepared via photopolymerization. Its physicochemical properties and EGF release pattern were characterized. In vitro experiments on rat tracheal epithelial cells assessed cell viability, proliferation and migration. A tracheal defect model was established in SD rats, with the hydrogel implanted; gross observation, HE staining and immunohistochemistry were performed at 2 weeks post-implantation to evaluate repair efficacy, with statistical methods used for intergroup comparisons. RESULTS: The PEGDA/DCM hydrogel had optimized microstructure and mechanical properties matching native trachea, maintained structural stability under physiological conditions, and achieved sustained EGF release without burst effect. The PEGDA/DCM/EGF hydrogel significantly promoted the viability, proliferation and migration of rat tracheal epithelial cells in vitro. In vivo, implanted SD rats had intact tracheal architecture and unobstructed lumens at 2 weeks; HE staining and immunohistochemistry confirmed continuous epithelial layer formation and successful epithelialization at the defect site. CONCLUSIONS: The PEGDA/DCM/EGF composite hydrogel has favorable physicochemical properties, excellent biocompatibility and effective tracheal repair efficacy, with DCM optimizing hydrogel performance and sustained EGF release accelerating epithelial regeneration. This study provides a promising tissue-engineered strategy for tracheal defect repair, with significant clinical translation potential for thoracic surgery clinical practice.
Timing matters: association of persistent postoperative anemia with adverse outcomes in cardiac surgery.
Zhang X, Nie Y, Zhang R … +2 more , Zhang Q, Wang X
J Cardiothorac Surg · 2026 Jun · PMID 42286741 · Full text
OBJECTIVE: To investigate the dynamic impact of anemia at different perioperative timepoints (preoperative, postoperative day 1, 3, and 7) on adverse events in patients undergoing cardiac surgery. METHODS: This single-ce...
OBJECTIVE: To investigate the dynamic impact of anemia at different perioperative timepoints (preoperative, postoperative day 1, 3, and 7) on adverse events in patients undergoing cardiac surgery. METHODS: This single-center retrospective cohort study included 315 adult patients who underwent cardiac surgery between January 2020 and June 2025. Anemia was defined according to World Health Organization (WHO) criteria. Baseline characteristics, perioperative indicators, and postoperative outcomes were compared between the preoperative anemia and non-anemia groups. Multivariable logistic regression models were used to assess the independent association of anemia at different timepoints with three pre‑specified primary outcomes: increased postoperative hospital stay, pulmonary infection, and low cardiac output syndrome (LCOS), after adjusting for potential confounders. RESULTS: Results: The prevalence of preoperative anemia was 48.6% (153/315). For the three pre‑specified primary outcomes, compared to the non‑anemia group, the preoperative anemia group had significantly higher rates of postoperative pulmonary infection (32.03% vs. 17.28%, p = 0.003) and increased postoperative hospital stays (median 10.0 [IQR 9.0-15.0] vs. 10.0 [7.0-12.0] days, p = 0.026). Multivariable analysis revealed that anemia on postoperative day 7 was an independent risk factor for increased postoperative hospital stays (OR = 3.033, 95% CI: 1.547-5.946, p = 0.001) and pulmonary infection (OR = 2.526, 95% CI: 1.235-5.167, p = 0.011). Furthermore, anemia on postoperative day 7 was a strong independent predictor of low cardiac output syndrome (LCOS) (OR = 8.494, 95% CI: 2.316-31.156, p = 0.001), whereas anemia on postoperative day 1 was associated with a lower risk of LCOS (OR = 0.146, 95% CI: 0.041-0.517, p = 0.003). RBC transfusion was associated with a reduced risk of adverse outcomes. CONCLUSION: Postoperative anemia, particularly persistent anemia on postoperative day 7, is an independent risk factor for increased postoperative hospital stays, pulmonary infection, and LCOS in cardiac surgery patients. Dynamic monitoring of postoperative hemoglobin levels is crucial for risk stratification and individualized blood management. However, the modest sample size (n = 315) limits the precision of estimates for infrequent outcomes, and these findings therefore require validation in larger studies.
mA-modified ATF4 regulates glucose/lipid metabolism via the Sestrin2/GSK3β axis to alleviate myocardial ischemia-reperfusion injury.
Wu J, Tong J, Zhang F … +3 more , Li X, Liu X, Dong Y
J Cardiothorac Surg · 2026 Jun · PMID 42286721 · Full text
BACKGROUND: Myocardial ischemia-reperfusion injury (MIRI) is a critical complication in the treatment of cardiovascular diseases, and its pathogenesis is closely associated with mitochondrial dysfunction and the imbalanc...
BACKGROUND: Myocardial ischemia-reperfusion injury (MIRI) is a critical complication in the treatment of cardiovascular diseases, and its pathogenesis is closely associated with mitochondrial dysfunction and the imbalance of glucose/lipid metabolism. This study aims to investigate the molecular mechanisms underlying glucose/lipid metabolism in MIRI and identify potential therapeutic targets. METHODS: Key genes and prognostic biomarkers related to MIRI were identified through bioinformatics analysis, and a hypoxia/reoxygenation (H/R) model using HL-1 cardiomyocytes was employed to simulate the pathological process of MIRI. RNA interference was used to knock down ATF4, and bioinformatics analysis identified key molecules involved in mA methylation. The regulatory mechanism of ATF4 mRNA stability mediated by RBM15 was further explored. Flow cytometry, mitochondrial membrane potential, and ATP assays were conducted to evaluate cell apoptosis, glucose uptake, fatty acid oxidation, and mitochondrial function. RESULTS: Bioinformatics analysis and the H/R model experiments in HL-1 cardiomyocytes revealed that ATF4 was highly expressed in MIRI. Knockdown of ATF4 exacerbated H/R-induced cell apoptosis and metabolic disturbances. mA methyltransferase RBM15 modulated the stability and expression of ATF4 mRNA through methylation. Further investigation showed that ATF4 upregulates Sestrin2 to inhibit GSK3β activity, thereby maintaining mitochondrial membrane potential and ATP production, promoting glucose uptake, and enhancing fatty acid oxidation. CONCLUSION: This study is the first to reveal the molecular mechanism by which the mA modified ATF4-Sestrin2/GSK3β signaling axis alleviates MIRI through dual regulation of glucose/lipid metabolism homeostasis and mitochondrial energy supply. It elucidates the bridging role of RBM15-mediated mA epigenetic modification in this process. These findings provide a new strategy for targeting metabolic reprogramming in MIRI therapy and suggest that ATF4 may serve as an intervention target.
Left main ostium dissection due to the ATAAD with coronary malperfusion.
Kravchenko V, Sarhosh O, Ishchenko M
J Cardiothorac Surg · 2026 Jun · PMID 42286709 · Full text
INTRODUCTION: Acute aortic dissection is a life-threatening condition associated with extremely high mortality. The presence of malperfusion in this patient cohort significantly increases mortality, with coronary malperf...
INTRODUCTION: Acute aortic dissection is a life-threatening condition associated with extremely high mortality. The presence of malperfusion in this patient cohort significantly increases mortality, with coronary malperfusion being among the most critical and dangerous forms. Despite the existing consensus on the management of Neri type A and type C coronary ostial dissections, the optimal treatment strategy for Neri type B dissections remains controversial, with advocates of immediate coronary artery bypass grafting as well as proponents of coronary ostial repair. The low incidence of such cases underscores the clinical relevance of this case report. CASE REPORT: We present the case of a 58-year-old male who was admitted to our institution with a diagnosis of acute Stanford type A (DeBakey type II) aortic dissection hemodynamically stable. After admission to the intensive care unit, the patient suddenly developed signs of acute myocardial ischemia several hours later, manifested by electrocardiographic changes, elevated cardiac enzyme levels, and a reduction in left ventricular ejection fraction on echocardiography. Consequently, the patient was urgently transferred to the catheterization laboratory, where coronary angiography revealed a Neri type B dissection of the left coronary artery ostium with subtotal occlusion. Immediate surgical intervention-consisting of supracoronary replacement of the ascending aorta and the left coronary artery ostium repair -was performed directly following coronary angiography. In the postoperative period, follow-up coronary angiography confirmed the effectiveness of the repair. The patient was discharged in good clinical condition. A follow-up computed tomography scan was performed 8 months later. CONCLUSION: Performing suture repair for LCA ostial dissection Type B according to Neri, with accompanying coronary malperfusion, may be a feasible option for correcting this pathology in selected cases. Timely diagnosis of myocardial ischemia and prompt surgical correction of aortic dissection can lead to satisfactory postoperative outcomes in these high-risk patients. THE PURPOSE: To determine the effectiveness of left coronary artery ostium repair in cases of its dissection (Type B according to Neri classification) with concomitant coronary malperfusion.
Aortic arch surgery in real-life practice: is the frozen elephant trunk always a better option than conventional aortic arch replacement?
Zimmermann M, Pozzi M, Farhat F … +4 more , Vola M, Obadia JF, Millon A, Grinberg D
J Cardiothorac Surg · 2026 Jun · PMID 42286601 · Full text
OBJECTIVE: Management of aortic arch disease (AAD) is complex due to its involvement in multiple aortic segments and the variety of patient presentations. We compared the clinical outcomes of conventional aortic arch rep...
OBJECTIVE: Management of aortic arch disease (AAD) is complex due to its involvement in multiple aortic segments and the variety of patient presentations. We compared the clinical outcomes of conventional aortic arch repair (CAAR) and the Frozen Elephant Trunk (FET) technique across the main clinical indications: acute type A aortic dissection (ATAAD), chronic dissection and atheromatous aneurysm. MATERIALS AND METHODS: We conducted a retrospective, single-centre cohort study of 102 consecutive patients who underwent aortic arch repair between January 2012 and June 2023. Indication-specific subgroup analyses were the primary analytical framework. Patients were divided according to the surgical technique: CAAR (n = 45, 44.1%) or FET (n = 57, 55.9%). Pre- and post-operative CT-angiograms were analysed. The primary endpoint was one-year survival. Secondary endpoints included post-operative morbidity, aortic diameter evolution, and freedom from a composite aortic event. Time-to-event endpoints were estimated by the Kaplan-Meier method and compared with the log-rank test. RESULTS: One-year mortality was 27.5% (CAAR 28.9% vs. FET 26.3%; not statistically different in indication-specific subgroups). Mortality was driven by ATAAD (35.4%) and chronic dissection (30.8%); it was 4.2% in atheromatous aneurysm. In ATAAD, FET was associated with favourable aortic remodelling, with a 24.3% reduction in isthmus diameter compared with a 25.8% increase after CAAR (p = 0.0005). In chronic dissection, FET resulted in a 13.6% reduction in isthmus diameter at follow-up. In aneurysmal disease, FET stabilised aortic diameters whereas CAAR was associated with a 20.8% increase in isthmus diameter (p < 0.05). Reinterventions were more frequent after FET (42.1% vs. 17.8%); the great majority were planned staged TEVAR extensions. CONCLUSION: In experienced centres, the FET technique appears safe and is associated with favourable aortic remodelling. It represents a valuable option when downstream aortic disease or future endovascular extension is anticipated. Given the non-randomised design and indication imbalance, our data do not support a definitive claim of superiority over CAAR. Surgical strategy should remain anatomy- and indication-driven within a lifetime aortic management framework.
Patient and family-centered concerns in pediatric cardiac surgery: a Middle Eastern perspective.
Jha NK, Hassan AA, Elmahi M
J Cardiothorac Surg · 2026 Jun · PMID 42286594 · Full text
BACKGROUND: Congenital heart disease affects approximately 1% of live births worldwide and remains among the most significant contributors to neonatal morbidity and mortality. Approximately half of them require surgical...
BACKGROUND: Congenital heart disease affects approximately 1% of live births worldwide and remains among the most significant contributors to neonatal morbidity and mortality. Approximately half of them require surgical or percutaneous interventions at some stage. Patient care involves critical situations including clinical, psychological, social, regional, and cultural practices. Family and patients go through stressful experiences. Through this review, we aim to highlight issues faced by the patients or their families during management of complex cardiac conditions and hope that medical personnel, health authorities and institutions will benefit from the information provided. This will result in a better patient experience and outcomes. METHOD: To identify patient and family concerns, this narrative review is based on daily observations and literature reviews (Google, Google Scholar, PubMed) between 2013 and 2026, and regional perspectives. Key areas included parental and patient stress, communication breakdowns, health care coverage, regional cultural influence, family dynamics, and socio-economic considerations. RESULTS: Patient-centered concerns in pediatric cardiac surgery include clinical, psychological, socioeconomic, and regional factors. In addition, communication, stress, interruptions in education or employment, funding, and logistics also influence patient's experience. Effective interprofessional care, psychosocial counseling, finding ways to support the cost of treatment, and appropriate use of technology can foster a better patient experience. This is particularly imperative in the Middle East region, where family cohesion, religious beliefs, language diversity, and healthcare inequities shape the recovery path. CONCLUSIONS: Our review shows that pediatric cardiac care requires a multidimensional, culturally attuned model that incorporates interprofessional care, empathy, innovation, community support, and system-level solutions involving various professional agencies in health insurance, finance, hospital management, research, and medical education. In addition, healthcare communication, access, support, cultural and spiritual identity plays a significant role in shaping patient and family experience during medical management.
The perioperative effect of ERAS protocol in patients with lung cancer: a randomized controlled study.
Xiao D, Deng P, Feng Z … +2 more , Yao C, Yuan B
J Cardiothorac Surg · 2026 Jun · PMID 42286588 · Full text
OBJECTIVE: To Explore the Safety and Feasibility of the Enhanced Recovery After Surgery (ERAS) in the Perioperative Clinical Application for Patients with Lung Cancer. METHODS: Sixty patients with early-stage lung cancer...
OBJECTIVE: To Explore the Safety and Feasibility of the Enhanced Recovery After Surgery (ERAS) in the Perioperative Clinical Application for Patients with Lung Cancer. METHODS: Sixty patients with early-stage lung cancer who underwent uniportal video-assisted thoracoscopic surgery (UVATS) lobectomy at Shifang People's Hospital were selected and randomly divided into the ERAS group (E group) and the control group (C group). The differences in postoperative recovery and the incidence of complications between the two groups were compared. RESULTS: The postoperative pain score of patients in E group was lower than that in C group (P < 0.05). Postoperatively, the levels of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), and percentage of neutrophils (NEUT%) in E group were lower than those in C group (P < 0.05); the time to first ambulation after surgery, duration of drainage, length of hospital stay, and total hospitalization cost in E group were all less than those in C group (P < 0.05). Patient satisfaction in E group was higher (P < 0.05). The incidence of complications in E group was lower than that in C group, showing a trend toward reduction without reaching statistical significance (P > 0.05). No 14-day unplanned readmission or reoperation was found in both groups, and the postoperative quality of life in E group was better (P < 0.05). CONCLUSION: Lung cancer patients who undergo UVATS lobectomy and receive perioperative ERAS achieve faster recovery and higher satisfaction. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (ChiCTR2500111029) on 23/10/2025.
Boerhaave's syndrome associated with glucagon-like peptide-1 receptor agonist use: a case report.
Aubrey JM, Benner C, Lam GT
J Cardiothorac Surg · 2026 Jun · PMID 42286576 · Full text
BACKGROUND: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes and weight loss, with well known gastrointestinal side effects including nausea, vomiting, and delayed gas...
BACKGROUND: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes and weight loss, with well known gastrointestinal side effects including nausea, vomiting, and delayed gastric emptying. While mucosal injuries such as Mallory Weiss tears have been reported, full thickness esophageal perforation has not previously been described. We report the first documented case of Boerhaave's syndrome associated with GLP-1 RA use, highlighting the potential for rare but life threatening complications following abrupt reinitiation at high doses. CASE PRESENTATION: A previously healthy woman in her 50s presented with vasopressor dependent shock and respiratory failure requiring intubation following severe nausea, emesis, and acute chest pain. She had restarted semaglutide at the maximum 2.4 mg weekly dose the day prior to symptom onset, after several months off therapy and without dose titration. Imaging revealed pneumomediastinum and bilateral pleural effusions. Esophagram confirmed a contained esophageal perforation. She was managed with endoscopic stent placement, nasojejunal feeding, and chest tube drainage, followed by clinical improvement and discharge. Two months later, she was readmitted with necrotizing pneumonia. Imaging and endoscopy revealed an esophagopleural fistula, abscess, and migrated stent. She underwent left thoracotomy, abscess drainage, decortication, and wedge resection of necrotic lung. The perforation site was reinforced with an intercostal muscle flap, and a PEG tube was placed. Postoperatively, at 10-month follow up she was on a regular diet, PEG tube removed, and esophagus was healed on EGD. She was advised to permanently discontinue GLP-1 RAs. CONCLUSIONS: This case underscores a previously unreported but serious complication of GLP-1 RA therapy, transmural esophageal rupture, likely precipitated by drug induced gastroparesis and forceful emesis. Restarting semaglutide at a high dose without titration after a prolonged interruption likely increased vulnerability to injury. Clinicians should maintain a high index of suspicion for esophageal complications in patients presenting with chest pain and vomiting during GLP-1 RA initiation or reinitiation. Early multidisciplinary management is crucial to optimizing outcomes in this rare but life-threatening scenario.
Management of tetralogy of fallot in developing countries: opportunities and challenges for surgeons.
Ambarsari YA, Kurnia Y, Aribowo H … +2 more , Amal I, Susantya DP
J Cardiothorac Surg · 2026 Jun · PMID 42277928 · Full text
BACKGROUND: This study evaluates outcomes of Tetralogy of Fallot (TOF) correction, focusing on survival, complications, and management insights in a developing country setting. METHODS: This cohort retrospective study an...
BACKGROUND: This study evaluates outcomes of Tetralogy of Fallot (TOF) correction, focusing on survival, complications, and management insights in a developing country setting. METHODS: This cohort retrospective study analyzed medical records of patients with TOF undergoing total correction (April 2024-April 2025). Variables included demographics, McGoon ratio, Cardiopulmonary Bypass (CPB), Aortic Cross Clamp (AOX), Length of Stay (LOS), morbidity, and mortality. Data were analyzed with chi-square and Mann-Whitney tests (p < 0.05). RESULTS: Among 43 patients with TOF undergoing late total correction, mortality was 11.6%, higher than reported rates in low- and middle-income countries. Most cases presented late (mean age 9.19 years), underweight (65.1%), and hypoxemic (SpO₂ <90% in 79.1%). Predominant subvalvar stenosis led to prolonged CPB and AOX times. Deaths occurred only in children < 2 years. Limited Intensive Care Unit resources and delayed referral likely worsened outcomes, underscoring the need for early surgery, nutrition support, and infection control. CONCLUSION: Delayed referral and limited early detection within the community should not preclude surgical correction in patients older than one year. With appropriate perioperative management, favorable outcomes remain achievable despite late presentation. PRACTICAL IMPLICATIONS: Enhancing preoperative optimization, perioperative management, and postoperative care could improve late-repair outcomes and align results with global standards.
Perioperative thrombocytopenia after transcatheter versus surgical bioprosthetic aortic valve replacement: a single-center retrospective study.
Karaca Ö, Tüysüz ME, Elbir F … +2 more , Kınay V, Göçer K
J Cardiothorac Surg · 2026 Jun · PMID 42277924 · Full text
BACKGROUND: Postoperative thrombocytopenia is frequently observed after both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). However, contemporary real-world data directly com...
BACKGROUND: Postoperative thrombocytopenia is frequently observed after both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). However, contemporary real-world data directly comparing the magnitude and temporal pattern of platelet decline between these two interventions remains limited. METHODS: Consecutive patients with severe aortic stenosis who underwent SAVR with a bioprosthesis or TAVI at a single tertiary center between 2017 and 2023 were retrospectively analyzed. Demographic, clinical, echocardiographic, and laboratory data were collected. Platelet counts were recorded at baseline, intraoperatively, and on postoperative days (PODs) 1 and 2. In the SAVR group, the intraoperative platelet count was defined as the measurement obtained immediately after separation from cardiopulmonary bypass and reversal of heparin with protamine. In the TAVI group, the intraoperative value corresponded to the platelet count measured immediately after valve deployment and completion of the procedure. The primary endpoint was perioperative platelet count dynamics across predefined time points. RESULTS: A total of 248 patients were included (SAVR, n = 132; TAVI, n = 116). Patients undergoing TAVI were significantly older and had higher surgical risk scores, whereas baseline platelet counts were comparable between groups. Baseline platelet counts were comparable between groups. In the SAVR cohort, platelet counts declined sharply intraoperatively and continued to decrease on POD1 and POD2. In contrast, patients treated with TAVI showed a more gradual, moderate platelet reduction. Intergroup differences were significant during the intraoperative and postoperative periods. Although the decline from POD1 to POD2 was less pronounced, it remained statistically significant. CONCLUSIONS: Thrombocytopenia occurs almost universally following aortic valve intervention. SAVR is associated with a more abrupt and sustained decrease in platelet counts, whereas TAVI results in milder reductions, despite being performed in older, higher-risk patients. Close monitoring of platelet dynamics in the early postoperative period may provide clinically relevant insights; however, further studies are required to establish a direct relationship with patient outcomes.
Repeated in-stent occlusion of RCA: a case report.
Guo W, Wang Y, Wang X … +1 more , Pella S
J Cardiothorac Surg · 2026 Jun · PMID 42277902 · Full text
BACKGROUND: There are few reports of cases with more than 3 in-stent coronary occlusion on the basis of conventional dual antiplatelet therapy. The possible mechanism of repeated in-stent occlusion is a question worthy o...
BACKGROUND: There are few reports of cases with more than 3 in-stent coronary occlusion on the basis of conventional dual antiplatelet therapy. The possible mechanism of repeated in-stent occlusion is a question worthy of consideration. The selection of treatment strategies for recurrent in-stent occlusion is more challenging than that for the initial percutaneous coronary intervention. CASE PRESENTATION: A 74-year-old woman with a long history of rheumatoid arthritis underwent percutaneous coronary intervention (implantation of three stents in series) of the right coronary artery due to ST-segment elevation myocardial infarction and received long-term dual antiplatelet therapy. Within the subsequent 9.5 months, in-stent occlusion was detected three times, and she underwent percutaneous coronary intervention each time. After adding colchicine to the treatment, during a six-month follow-up, no adverse cardiovascular events occurred in the patient. CONCLUSIONS: Long stents with tandem configurations are more prone to thrombus formation at coronary turning point of right coronary artery, and re-stenting at this site fails to prevent recurrent stent thromboembolism, which might be related to the pockets under expanded and mal apposed stent segments. For the patients with autoimmune diseases, it remains to be further clarified whether combining low-dose colchicine with dual antiplatelet therapy and statins may offer adjunctive benefit. Guided by intracavitary imaging examinations, interventional treatment for diffuse lesions of the right coronary artery should prioritize avoiding tandem stacking of stents and minimizing stent placement at the vascular turning points.
Minimally invasive pulmonary valve replacement via left anterior mini-thoracotomy after Tetralogy of Fallot repair: a five-patient case series.
Teshnizi MA, Alizadeh B, Samadieh F … +2 more , Zayat R, Lotfi S
J Cardiothorac Surg · 2026 Jun · PMID 42277866 · Full text
BACKGROUND: Pulmonary regurgitation is a common long-term consequence after Tetralogy of Fallot (TOF) repair and often leads to right ventricular dilatation requiring pulmonary valve replacement (PVR). Redo sternotomy ca...
BACKGROUND: Pulmonary regurgitation is a common long-term consequence after Tetralogy of Fallot (TOF) repair and often leads to right ventricular dilatation requiring pulmonary valve replacement (PVR). Redo sternotomy carries risks including cardiac injury and bleeding. Minimally invasive alternatives aim to reduce surgical trauma while maintaining procedural safety. CASE PRESENTATION: We report five consecutive patients (aged 9-44 years) with severe pulmonary regurgitation and right ventricular dilatation who underwent minimally invasive PVR via a left anterior mini-thoracotomy (LAMT). All procedures were performed on a beating heart using femorofemoral cardiopulmonary bypass and stented bioprosthetic valves. Mean cardiopulmonary bypass time was 37.8 min. No conversions to sternotomy, major complications, or mortality occurred. Patients were extubated after a mean of 9.6 h, and mean hospital stay was 6.8 days. At two-month follow-up, all patients demonstrated excellent prosthetic valve function and significant reduction in right ventricular size. CONCLUSIONS: LAMT-PVR is a feasible and safe alternative to redo sternotomy for selected post-TOF patients. This approach provides direct access to the pulmonary artery with reduced surgical trauma and favorable early outcomes.
Fatal early graft failure in a heart transplant recipient with occult multivessel coronary artery disease in a young donor: implications for donor evaluation.
Navarro-Zambrano G, Martínez-Hernández H, Soulé-Egea M … +6 more , Aranda-Fraustro A, de Los Monteros-Duche RE, Latorre-Dávila C, Echevarría-Frutos I, León-Sosa A, Pérez-Reyes J
J Cardiothorac Surg · 2026 Jun · PMID 42277834 · Full text
BACKGROUND: Primary graft dysfunction (PGD) represents the leading cause of early mortality following heart transplantation. Among the associated factors, donor characteristics-particularly the presence of undiagnosed co...
BACKGROUND: Primary graft dysfunction (PGD) represents the leading cause of early mortality following heart transplantation. Among the associated factors, donor characteristics-particularly the presence of undiagnosed coronary artery disease-may play a relevant role. Donor evaluation is typically based on clinical assessment and echocardiographic findings, which may be insufficient to detect subclinical coronary disease, especially in young donors. CASE PRESENTATION: We report the case of a 52-year-old patient with advanced dilated cardiomyopathy who underwent orthotopic heart transplantation. The donor was a 27-year-old male with no known medical history, evaluated at a secondary-level hospital using electrocardiography and transthoracic echocardiography, both without pathological findings. Following transplantation, the recipient developed severe hemodynamic instability progressing to primary graft dysfunction. Initially, hyperacute rejection was considered in the differential diagnosis given the early and severe graft dysfunction. A postoperative electrocardiogram reportedly showed no ischemic changes; however, a marked elevation in troponin I (80 ng/mL) was documented, suggesting significant myocardial injury. A transesophageal echocardiogram demonstrated global biventricular systolic dysfunction. Mechanical circulatory support with venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump was required. Despite intensive management, the patient developed multiorgan failure and died within the first 24 h postoperatively. Postmortem histopathological examination of the graft revealed severe multivessel atherosclerotic coronary artery disease that had not been previously diagnosed. CONCLUSION: This case suggests a possible association between undiagnosed donor coronary artery disease and early graft failure, while highlighting the limitations of conventional donor evaluation, particularly in detecting non-calcified coronary lesions. These findings underscore the need for cautious interpretation of donor assessment, especially in resource-limited settings.
Endovascular embolization for systemic artery to pulmonary artery fistulas supplied by 4 distinct vessels: a case report.
Qiu Z, Qirong Z, Qian W … +2 more , Xin M, Xiaodong W
J Cardiothorac Surg · 2026 Jun · PMID 42277820 · Full text
BACKGROUND: Systemic artery to pulmonary artery fistula (SAPAF) is a rare vascular anomaly that often presents with hemoptysis and can be classified as congenital or acquired. CASE PRESENTATION: A 34-year-old female, pre...
BACKGROUND: Systemic artery to pulmonary artery fistula (SAPAF) is a rare vascular anomaly that often presents with hemoptysis and can be classified as congenital or acquired. CASE PRESENTATION: A 34-year-old female, presenting with recurrent hemoptysis, was diagnosed with multiple SAPAFs originating from four distinct arterial sources. Imaging using CT angiography and catheter angiography revealed complex systemic-to-pulmonary vascular connections, and the symptoms were successfully managed through transarterial embolization. CONCLUSION: Endovascular embolization successfully treated a rare case of SAPAF, and the patient was discharged in stable condition without complications.
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