Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
The impact of leaflet resection versus leaflet preservation on left ventricular reverse remodelling after mitral valve repair: insights from the UK mini mitral trial.
Rao E, Bayliss CD, Wagnild JM … +3 more , Graham R, Maier R, Akowuah E
J Cardiothorac Surg · 2026 Jun · PMID 42265704 · Full text
OBJECTIVES: Mitral valve repair (MVr) promotes left ventricular (LV) reverse remodelling, and subsequent reduction in LV diameters and volumes. The effectiveness of different MVr techniques, Resect (leaflet resection) an...
OBJECTIVES: Mitral valve repair (MVr) promotes left ventricular (LV) reverse remodelling, and subsequent reduction in LV diameters and volumes. The effectiveness of different MVr techniques, Resect (leaflet resection) and Respect (leaflet preservation) remains debated. This study aimed to investigate the impact of 'Resect' and 'Respect' techniques on LV reverse remodelling, primarily assessed by changes in indexed LV end-systolic diameter (ILVESD) post-MVr. METHODS: Data were drawn from the UK Mini Mitral Trial, which randomised 330 patients to MVr via mini-thoracotomy or median-sternotomy. This subanalysis included patients with isolated posterior leaflet prolapse, who had undergone MVr via Resect or Respect techniques. Transthoracic echocardiography was performed pre-operatively and at 12 and 52 weeks post-operatively, with all studies analysed by a core laboratory. Linear mixed-effects models compared changes in indexed LV measurements between groups. RESULTS: This subanalysis included 175 patients (36 Resect and 139 Respect). Annuloplasty was performed in all but one repair. We found no significant difference between groups in recurrent MR severity at 52 weeks postoperatively (p = 0.31). Both groups had significant improvement in ILVESD by 52 weeks (mean change from baseline - 5.6%, p < 0.001), with no difference between groups (p = 0.24). Both techniques led to significant improvements in indexed end-diastolic LV volumes and diameters, decreasing from baseline to 12 and 52 weeks. However, LV end-systolic volumes and diameters increased at 12 weeks before decreasing by 52 weeks postoperatively. CONCLUSION: No significant differences in LV reverse remodelling between Resect and Respect techniques. Both can be recommended to surgeons. Longer follow-up is needed.
Applying the fear-avoidance model to exercise rehabilitation after coronary artery bypass grafting a nurse-led intervention study.
Xia L, Hua J, Xuan L
J Cardiothorac Surg · 2026 Jun · PMID 42265701 · Full text
OBJECTIVE: To examine whether a nurse-led intervention grounded in the Fear-Avoidance Model (FAM) reduces postoperative kinesiophobia indirectly by improving patients' perceived physical capability. METHOD: We conducted...
OBJECTIVE: To examine whether a nurse-led intervention grounded in the Fear-Avoidance Model (FAM) reduces postoperative kinesiophobia indirectly by improving patients' perceived physical capability. METHOD: We conducted a single-center, parallel-group randomized controlled trial. A total of 122 patients who underwent coronary artery bypass grafting (CABG) were randomized 1:1 to an intervention group or a usual-care control group (n = 61 each). The intervention included graded activity, functional feedback, goal setting, structured education, and post-discharge follow-up. Perceived physical capability and kinesiophobia were assessed 30 days after discharge. Mediation analysis was used to test whether perceived physical capability mediated the effect of the intervention on kinesiophobia. RESULTS: The intervention was associated with higher perceived physical capability (a = 2.43, p = 0.031). Perceived physical capability was inversely associated with kinesiophobia (b = - 0.775, p < 0.001). The indirect effect of the intervention on kinesiophobia through perceived physical capability was significant (ab = - 1.879; bootstrapped 95% CI [- 3.702, - 0.288]). In contrast, the total effect (c = - 1.557, p = 0.433) and the direct effect (c'=0.322, p = 0.860) were not statistically significant. CONCLUSIONS: These findings suggest a rehabilitation-relevant pathway in which strengthening perceived capability may help reduce avoidance-oriented responses after CABG. A nurse-led approach that combines graded mobilization, performance feedback, and goal-based progression may support engagement in early recovery activities and may offer a practical framework for transitional rehabilitation support.
Successful management of acute type A aortic dissection in late pregnancy: a case report.
Luyang H, Li Y, Yan S … +1 more , Zongzhao H
J Cardiothorac Surg · 2026 Jun · PMID 42265563 · Full text
BACKGROUND: Stanford Type A aortic dissection (TAAD) complicating pregnancy is exceedingly rare yet catastrophic, representing a leading cause of maternal cardiovascular mortality. Management requires balancing maternal...
BACKGROUND: Stanford Type A aortic dissection (TAAD) complicating pregnancy is exceedingly rare yet catastrophic, representing a leading cause of maternal cardiovascular mortality. Management requires balancing maternal hemodynamic stability and fetal viability. CASE PRESENTATION: A 31-year-old woman (G2P0) at 38 weeks gestation presented with acute tearing chest pain. Computed tomography angiography confirmed TAAD extending from ascending aorta to proximal arch, and the right coronary artery was affected. Transthoracic echocardiography confirmed TAAD with aortic sinus dilation (40 mm) and moderate aortic regurgitation. Multidisciplinary management included emergency cesarean section delivering a healthy female infant (Apgar 9/9/10), followed by prophylactic uterine artery embolization to mitigate hemorrhage risk during subsequent cardiac surgery. The patient underwent Bentall procedure combined with coronary artery bypass grafting. The patient recovered uneventfully, discharged on postoperative day 14. Two-month follow-up demonstrated adequate aortic remodeling with regional residual distal dissection. CONCLUSION: This case demonstrates that a sequential surgical approach with multidisciplinary collaboration can optimize outcomes in late pregnancy complicated by TAAD.
Effects of mindfulness-based intervention combined with aerobic training on Kinesiophobia and heart rate variability after percutaneous coronary intervention: a randomized controlled trial.
Mi Q, Jiang L, Leng M … +1 more , Fan H
J Cardiothorac Surg · 2026 Jun · PMID 42260638 · Full text
OBJECTIVE: To evaluate the effectiveness of mindfulness-based intervention (MBI) combined with aerobic training on treatment adherence, kinesiophobia (an excessive fear of movement), heart rate variability (HRV), exercis...
OBJECTIVE: To evaluate the effectiveness of mindfulness-based intervention (MBI) combined with aerobic training on treatment adherence, kinesiophobia (an excessive fear of movement), heart rate variability (HRV), exercise tolerance, and psychological stress response in patients with coronary heart disease (CHD) post-percutaneous coronary intervention (PCI). METHODS: Post-PCI patients (n = 150) were randomly assigned to an intervention group (receiving combined MBI and aerobic training) and a control group (receiving aerobic training only). Treatment adherence, the Tampa Scale for Kinesiophobia-Heart (TSK-SV Heart), HRV parameters, exercise tolerance, and psychological stress responses were assessed before and after the intervention. Psychological assessments included the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Repeated-measures mixed analysis of variance was used to evaluate changes in outcomes between groups and across time points. RESULTS: A total of 150 post-PCI patients were enrolled, including 97 males and 53 females, with a mean age of 50.79 ± 6.83 years. Baseline demographic and clinical characteristics were comparable between the two groups (P > 0.05). After the intervention, the intervention group showed significantly greater improvements than the control group in treatment adherence, HRV indices (standard deviation of all normal-to-normal RR intervals, standard deviation of the average normal-to-normal RR intervals in all 5-minute segments, and percentage of successive normal-to-normal RR intervals that differ by more than 50 milliseconds), exercise tolerance (6-minute walk test, peak oxygen uptake, and anaerobic threshold oxygen uptake), as well as reductions in kinesiophobia scores, anxiety and depression scores (SAS, SDS) (p < 0.001). CONCLUSION: An adapted MBI combined with aerobic training can significantly improve treatment adherence and exercise tolerance, while reducing kinesiophobia and psychological stress in post-PCI patients. This combined rehabilitation strategy may provide additional benefits beyond conventional aerobic rehabilitation alone.
The effect of hemoadsorption to patients with Stanford Type A Aortic Dissection.
Liu B, Liu H, Zhang S … +2 more , Wei X, Ge S
J Cardiothorac Surg · 2026 Jun · PMID 42260569 · Full text
OBJECTIVE: To observe the effect of hemoadsorption, an emerging therapy potentially valuable in blood purification, inflammation inhibition and toxic removal, to patients with Stanford Type A Aortic Dissection. METHODS:...
OBJECTIVE: To observe the effect of hemoadsorption, an emerging therapy potentially valuable in blood purification, inflammation inhibition and toxic removal, to patients with Stanford Type A Aortic Dissection. METHODS: The clinical data of 100 patients with TAAD from January 2021 to June 2023 were retrospectively analyzed. Patients were divided into HA group and CON group, depending on the usage of hemoadsorption during the cardiopulmonary bypass, with 50 patients in each group. The comparison between two groups was performed including cardiopulmonary time, surgery time, aortic cross-clamp time, deep hypothermia cardiac arrest time, ultrafiltration volume, urine output as well as blood transfusion and clinical laboratory tests such as white cell count, aspartate aminotransferase, alanine transaminase, creatinine as well as blood urea nitrogen. All these variables were measured at 24 h and 48 h after surgery. RESULTS: There was no significant difference for both baseline characteristics and surgery-related variables between two groups (P > 0.05). The number of patients with ICU stay ≤ 6 d in HA group was higher significantly than that in CON group (P = 0.038), while, other remaining endpoints were not significant in two groups (P > 0.05). Postoperative 24 h and 48 h, lower aspartate aminotransferase and alanine transaminase are associated with intraoperative hemoadsorption (P = 0.006, 0.006, 0.001 and 0.001, respectively). CONCLUSION: Hemoadsorption is correlated with early positive and favorable changes of laboratory tests.
Development efficiency and mortality after coronary artery bypass grafting: a national causal inference analysis.
Martins GK, Botelho AD, Consoli L … +4 more , Grillo IT, Passos FS, Treml RE, Caldonazo T
J Cardiothorac Surg · 2026 Jun · PMID 42260539 · Full text
BACKGROUND: We evaluated whether development efficiency, the component of the Human Development Index independent of GDP per capita and income inequality, is associated with in-hospital mortality after coronary artery by...
BACKGROUND: We evaluated whether development efficiency, the component of the Human Development Index independent of GDP per capita and income inequality, is associated with in-hospital mortality after coronary artery bypass grafting (CABG) in Brazil, and whether this association is mediated by access to elective surgery. METHODS: We conducted a retrospective ecological panel study using administrative data on CABG hospitalizations within the Brazilian Unified Health System from 2008 to 2024. State-year observations were linked to socioeconomic indicators. Development efficiency was defined as the residual of HDI after regression on GDP per capita and the Gini coefficient. Associations with in-hospital mortality were examined using volume-weighted multilevel models. Absolute causal effects and mediation through urgency status were estimated using g-computation and parametric causal mediation analysis. RESULTS: The final analytic panel included 379 state-year observations. A 1-standard deviation increase in development efficiency was associated with a reduction in predicted in-hospital mortality from 6.8% to 5.7% (absolute risk reduction - 1.1% points; p < 0.001). At the population level, this corresponds to approximately one fewer observed death per 91 procedures in states with higher versus lower development efficiency. Mediation analysis indicated that 95.5% of the total effect was attributable to the natural direct effect, while only 4.5% was mediated through urgency status, with no significant indirect effect. CONCLUSIONS: Development efficiency is an independent and clinically meaningful determinant of survival after CABG in Brazil. Higher income-independent HDI performance is associated with substantial absolute mortality reductions, driven predominantly by direct system-level pathways rather than changes in urgency profile. Strengthening health-system efficiency and perioperative capacity may therefore yield meaningful gains in cardiac surgical outcomes.
Uni-portal thoracoscopic lymph node dissection under the left prominence: pause ventilation technique.
Yang Y, Mei J, Luo J … +5 more , Xie L, Ma C, Li J, Wang Y, Xie X
J Cardiothorac Surg · 2026 Jun · PMID 42260519 · Full text
TECHNIQUE: Uni-portal video-assisted thoracoscopic lobectomy (UVATS) has become a well-established technique; however, performing a complete lymphadenectomy, particularly the removal of lymph nodes located below the left...
TECHNIQUE: Uni-portal video-assisted thoracoscopic lobectomy (UVATS) has become a well-established technique; however, performing a complete lymphadenectomy, particularly the removal of lymph nodes located below the left hemithorax (LHLN), remains a challenging procedure. To our knowledge, there are limited reports addressing the use of pause ventilation during UVATS for LHLN dissection. In this study, we propose the application of pause ventilation for facilitating LHLN dissection under UVATS. Through transnasal humidified rapid-insufflation ventilatory exchange (THRIVE), we innovatively implemented an intermittent apnea technique during surgery, enabling UVATS dissection of the LHLN. This study details the surgical procedure and includes an accompanying operative video. RESULTS: The application of pause ventilation can promote LHLN dissection under UVATS. CONCLUSIONS: The use of pause ventilation for LHLN dissection in UVATS appears safe and feasible, providing clear exposure of key surrounding tissues and organs.
Factors associated with postoperative acute kidney injury in stanford type a aortic dissection in china: a systematic review and meta-analysis.
Ning L, Chen M, Luo H … +3 more , Xie P, Li Z, Liao Q
J Cardiothorac Surg · 2026 Jun · PMID 42260504 · Full text
OBJECTIVE: This study aimed to explore the factors associated with postoperative acute kidney injury in Chinese Stanford type A aortic dissection patients through a systematic review and meta-analysis. METHODS: CNKI, Wan...
OBJECTIVE: This study aimed to explore the factors associated with postoperative acute kidney injury in Chinese Stanford type A aortic dissection patients through a systematic review and meta-analysis. METHODS: CNKI, WanFang Database, VIP, SinoMed, PubMed, Web of Science, Embase and Cochrane Library were comprehensively searched from inception until September 2025. Two reviewers independently conducted study selection, data extraction, and quality assessment. Meta-analysis was performed using Stata 15.1 and R 4.5.0 software. The certainty of evidence was evaluated using the GRADE tool. RESULTS: A total of 47 eligible studies comprising 9077 patients were included. Based on these observational studies, which predominantly had low to very low certainty of evidence (GRADE), the following factors were found to be associated with postoperative AKI in Chinese Stanford type A aortic dissection patients: age[adjusted odds ratio (OR) = 1.10, 95% confidence interval (CI): 1.03-1.19, p < 0.05], BMI[OR = 1.20, 95%CI: 1.17-1.24, p < 0.001], hypertension history[OR = 2.74, 95%CI: 2.34-3.21, p < 0.001], renal artery involvement[OR = 4.40, 95%CI: 2.81-6.91, p < 0.001], preoperative cardiac tamponade[OR = 3.47, 95%CI: 1.93-6.26, p < 0.001], preoperative serum creatinine[OR = 1.16, 95%CI: 1.09-1.23, p < 0.001], preoperative platelet[OR = 0.96, 95%CI: 0.92-1.00, p < 0.05], preoperative serum myoglobin[OR = 1.69, 95%CI: 1.44-1.98, p < 0.001], preoperative serum cystatin C[OR = 6.59, 95%CI: 3.77-11.50, p < 0.001], cardiopulmonary bypass time[adjusted OR = 1.01, 95%CI: 1.00-1.02, p < 0.05], CPB > 180 min[OR = 3.48, 95%CI: 1.65-7.30, p < 0.01], operative time[OR = 1.69, 95%CI: 1.33-2.14, p < 0.05], deep hypothermic circulatory arrest time[OR = 1.16, 95%CI: 1.10-1.22, p < 0.001], aortic cross-clamp time[OR = 1.11, 95%CI: 1.01-1.21, p < 0.05], intraoperative RBCs transfusion volume[adjusted OR = 1.17, 95%CI: 1.02-1.35, p < 0.05], intraoperative urine output[OR = 0.75, 95%CI: 0.64-0.88, p < 0.001], mechanical ventilation time[OR = 1.01, 95%CI: 1.01-1.02, p < 0.001] and postoperative procalcitonin[OR = 1.03, 95%CI: 1.01-1.06, p < 0.05]. CONCLUSION: This study demonstrates that factors associated with postoperative acute kidney injury in Chinese Stanford type A aortic dissection patients are closely related to the perioperative period. These findings may help clinicians identify risk factors early and facilitate the development of preventive strategies to improve patient outcomes. REGISTRATION: The research is registered on the PROSPERO website with the registration number CRD420250651792.
A comparative content and quality analysis of patent ductus arteriosus-related health information on Bilibili and TikTok.
Zhang X, Li Q, Aximu Y … +1 more , Zhang P
J Cardiothorac Surg · 2026 Jun · PMID 42251427 · Full text
BACKGROUND: The rapid expansion of short-form educational video platforms has substantially increased public access to health information; however, the characteristics and quality of videos concerning patent ductus arter...
BACKGROUND: The rapid expansion of short-form educational video platforms has substantially increased public access to health information; however, the characteristics and quality of videos concerning patent ductus arteriosus (PDA) have not been systematically evaluated. This study aimed to evaluate the quality and reliability of short-form videos related to PDA posted on TikTok and Bilibili. METHODS: The Chinese keyword "patent ductus arteriosus" was used to retrieve relevant videos from TikTok and Bilibili, yielding 140 videos for the final analysis. Uploaders were classified according to publicly available account information. Professional uploaders were defined as accounts identifying the uploader as a healthcare professional and displaying official platform verification and/or an explicit affiliation with a recognized medical institution. Credentials were verified using publicly visible profile elements, including verification badges, profile descriptions, professional titles, and stated institutional affiliations. All included videos were independently evaluated by two reviewers. Because paired reviewer-level ratings were available for the Global Quality Score (GQS), inter-rater reliability for GQS was assessed before consensus adjudication using the intraclass correlation coefficient (ICC) and quadratic weighted Cohen's kappa. Video quality and reliability were assessed using five established instruments: the Global Quality Score (GQS), Video Information and Quality Index (VIQI), Patient Education Materials Assessment Tool (PEMAT), the JAMA benchmark criteria, and modified DISCERN (mDISCERN). Only the first 100 algorithm-ranked videos from each platform were screened, in order to reflect the content most likely to be encountered by typical users, although this approach may preferentially capture videos favored by platform recommendation systems. No independent clinical subject-matter expert (such as a neonatologist or cardiologist) was separately involved in the formal scoring process; instead, the evaluation focused on quality, reliability, transparency, and understandability using established assessment instruments. Clinical accuracy was not independently assessed or adjudicated in this study. RESULTS: A total of 140 short videos related to patent ductus arteriosus (PDA) were included in the analysis, with 57 from Bilibili and 83 from TikTok. TikTok videos demonstrated significantly higher audience engagement than those on Bilibili, with markedly greater numbers of likes, favorites, shares, and comments. Bilibili videos were slightly longer in duration, and there was no significant difference in posting time between the two platforms. Videos on TikTok also achieved significantly higher scores across all five quality assessment tools-mDISCERN, GQS, VIQI, PEMAT, and the JAMA benchmark-and most high-quality videos were uploaded by professional individuals. In the present study, these professional individuals were defined on the basis of publicly visible healthcare-related identity information and platform verification status. When stratified by uploader type, videos created by professionals consistently outperformed those from non-professional individuals and institutions in both quality scores and engagement metrics. Professional videos were predominantly found on TikTok. Correlation analyses indicated weak to moderate positive associations between most quality indicators and likes, favorites, and shares on both platforms, although the correlation coefficients remained low. Notably, the average JAMA benchmark score was approximately half of the maximum possible score on both platforms. Inter-rater reliability for GQS was acceptable, with a single-measure ICC of 0.632, an average-measure ICC of 0.774, and a quadratic weighted Cohen's kappa of 0.630. CONCLUSIONS: The overall quality of PDA-related health information on major Chinese short-video platforms appears to be moderate. TikTok and professional uploaders demonstrated clear advantages in reliability, comprehensibility, and communication effectiveness. Platform attributes and uploader background exert significant influence on video quality and dissemination performance. Future efforts should focus on strengthening platform oversight, encouraging greater involvement of qualified healthcare professionals, and standardizing the disclosure of information sources and conflicts of interest. Such measures are essential for improving the accuracy, quality, and trustworthiness of online cardiovascular health information and for better supporting parents of children with PDA and the general public. These findings should be interpreted as reflecting informational quality, structure, transparency, and understandability rather than independently verified clinical accuracy.
Advanced cystic lung cancer complicated with pulmonary lymphangitic carcinomatosis: a case report.
Tang H, Zhou J, Tian T … +3 more , Guan H, Ye L, Ye L
J Cardiothorac Surg · 2026 Jun · PMID 42251426 · Full text
Pulmonary lymphangitic carcinomatosis(PLC) is a life-threatening complication of intrathoracic malignant tumors and is characterized by tumor cell spread via the pulmonary lymphatic system.The lymphatic vessel dilation,...
Pulmonary lymphangitic carcinomatosis(PLC) is a life-threatening complication of intrathoracic malignant tumors and is characterized by tumor cell spread via the pulmonary lymphatic system.The lymphatic vessel dilation, interstitial thickening and edema caused by the tumor can lead to progressive breathing difficulties, which is a typical clinical feature of this condition.Pleuritic pain may occur if subpleural lymphatics are obstructed, but clinical manifestations are often non-specific.Most patients are diagnosed at an advanced stage with respiratory failure, and there is no definitive therapy; thus, the overall prognosis remains poor with short survival.Herein, we report a case of advanced cavitary lung adenocarcinoma complicated with PLC, with pericardial effusion and mediastinal or pericardial metastases.The patient underwent palliative surgery followed by sequential chemotherapy and immunotherapy and had survived for 41 months as of the last follow-up.
Preoperative IV iron and postoperative blood transfusion reduction in non-anaemic patients undergoing cardiac surgery: a systematic review and meta-analysis of RCTs.
Murad ZA, Lahcen AA, Alkhawam M … +6 more , Elbasosy MY, Abdelhamid MO, El Hilali A, Abdallatif LA, Abdelrahman H, Agnaou Y
J Cardiothorac Surg · 2026 Jun · PMID 42251415 · Full text
BACKGROUND: Preoperative intravenous iron has become increasingly popular as a strategy to optimize hemoglobin before major surgery. However, its potential benefit in non-anaemic patients undergoing cardiac surgery remai...
BACKGROUND: Preoperative intravenous iron has become increasingly popular as a strategy to optimize hemoglobin before major surgery. However, its potential benefit in non-anaemic patients undergoing cardiac surgery remains unclear. To address this uncertainty, we conducted a systematic review and meta-analysis to investigate whether preoperative IV iron reduces red blood cell transfusion requirements and improves hematologic and clinical outcomes in adults with normal baseline hemoglobin undergoing cardiac surgery. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched PubMed, Embase, Scopus, Web of Science, and the Cochrane Library until October 2025 for randomized controlled trials. Eligible studies compared preoperative IV iron to a control (placebo, saline, or standard care) in non-anaemic (per WHO definition) adult patients (≥ 18 years) undergoing cardiac surgery. The primary outcomes were the incidence of postoperative RBC transfusion and the number of units transfused. Secondary outcomes included postoperative hemoglobin level, Postoperative iron indices, length of ICU stay, length of hospital stay (LOS), overall postoperative infection, All-cause mortality, and adverse events possibly related to IV iron (hypersensitivity, anaphylaxis). We used the Cochrane ROB 2 tool for bias assessment and for evidence certainty. Pooled Risk ratios, odds ratios, mean difference, and standardized mean difference with 95% confidence intervals were calculated using random-effects models, with the fixed-effects model applied when heterogeneity was absent or low (I² < 10%). RESULTS: From 529 initial records, 3 RCTs met the inclusion criteria, encompassing 338 patients. The overall risk of bias was low to moderate. Preoperative IV iron significantly reduced the incidence of postoperative RBC transfusion compared to the control group (Risk Ratio [RR] = 0.62; 95% CI 0.43-0.88; p = 0.008; I² = 0%), representing a 38% relative risk reduction. Furthermore, IV iron significantly decreased the mean number of RBC units transfused (Mean Difference [MD] = - 1.08 units; 95% CI - 1.61 to - 0.54; I² = 0%). While no significant difference was observed in hemoglobin levels at 48 h or one week postoperatively, the IV iron group showed significantly higher hemoglobin at 4-6 weeks (MD = 0.84 g/dL; 95% CI 0.41-1.26; p = 0.0001). IV iron also significantly increased postoperative serum ferritin and transferrin saturation. There were no statistically significant differences in overall postoperative infection rates (RR = 1.16; 95% CI 0.64-2.08) or all-cause mortality (Risk Difference = - 0.00; 95% CI - 0.03 to 0.03). The GRADE certainty of evidence for the primary outcome was moderate. CONCLUSION: In non-anaemic adult patients undergoing cardiac surgery, preoperative IV iron administration significantly reduces the incidence of postoperative RBC transfusion and the total volume of blood transfused. This intervention also improves hemoglobin levels during the 4-6 week recovery period without an increased risk of infection or mortality. The moderate-certainty evidence suggests this is a beneficial strategy, though further adequately powered RCTs are warranted to strengthen these findings. PROSPERO REGISTRY REFERENCE: CRD420251161421.
Cardiopulmonary bypass elevates the neutrophil-to-lymphocyte ratio and reduces lymphocyte counts: a comparison of on-pump versus off-pump CABG.
Xia XF, Zhu YC, Zhang L … +6 more , Bao R, Li D, Deng XM, Bian JJ, Li BL, Wang JF
J Cardiothorac Surg · 2026 Jun · PMID 42251413 · Full text
OBJECTIVE: To evaluate the effects of cardiopulmonary bypass (CPB) on peripheral white blood cell counts, neutrophil surface marker expression, and neutrophil function by comparing patients undergoing on-pump CABG (ONCAB...
OBJECTIVE: To evaluate the effects of cardiopulmonary bypass (CPB) on peripheral white blood cell counts, neutrophil surface marker expression, and neutrophil function by comparing patients undergoing on-pump CABG (ONCAB) versus off-pump CABG (OPCAB), and to identify CPB-related immunological and inflammatory alterations. METHODS: Patients undergoing on-pump CABG (ONCAB) or off-pump CABG (OPCAB) were recruited. Blood samples were collected preoperatively and at 24 h postoperatively. The primary outcome was the neutrophil-to-lymphocyte ratio (NLR) measured at 24 h after surgery. Secondary outcomes included monocyte Human leukocyte antigen-DR (HLA-DR) expression, lymphocyte programmed cell death protein-1 (PD-1) expression, and neutrophil surface markers (CD11b, CD18, CXCR2, CD35, CD63, CD66b, CD88, and programmed cell death-ligand 1). Neutrophil apoptosis, reactive oxygen species (ROS) production, and plasma inflammatory mediators (interleukin-6, tumor necrosis factor-alpha, interleukin-10) were also measured. Postoperative clinical outcomes and laboratory parameters were recorded. RESULTS: Data from 36 ONCAB patients and 18 OPCAB patients were analyzed. Postoperative NLR was significantly higher in the ONCAB group than in the OPCAB group (16.6 ± 6.1 vs. 13.1 ± 3.9; p = 0.015). This difference was attributable to lower lymphocyte counts in the ONCAB group (0.7 ± 0.2 vs. 0.8 ± 0.2 × 10/L; p = 0.002), whereas neutrophil counts did not differ significantly between groups. In both groups, monocyte HLA‑DR expression decreased and lymphocyte PD-1 expression increased after surgery. CPB did not result in significant alterations in neutrophil adhesion, chemotaxis, degranulation markers, ROS production, or apoptosis. ONCAB patients had higher postoperative levels of aspartate aminotransferase (AST), cardiac troponin I (cTnI), and procalcitonin (PCT), as well as longer durations of mechanical ventilation and intensive care unit stay. CONCLUSIONS: CPB elevates the NLR after CABG primarily, accompanied by reduced level of lymphocyte count, but not neutrophil count or molecular markers of neutrophil functional. These results might reflect a higher risk of short-term complications after on-pump CABG.
Ten-year follow-up of the first left ventricular assist device implantation program in Chile: a case series.
Pedemonte Villablanca O, Berthelon Vega P, Espinoza Reed P … +7 more , Merello Norero L, Aranda Gutierrez F, Ibarra Castillo J, Novajas Balboa M, Meza Concha N, Aranguiz Santander E, Vera Peralta A
J Cardiothorac Surg · 2026 Jun · PMID 42251323 · Full text
Heart failure (HF) affects over 64 million people worldwide, with prevalence projected to reach 3% by 2030. In advanced stages, when medical therapy fails and transplantation is limited by organ shortages, left ventricul...
Heart failure (HF) affects over 64 million people worldwide, with prevalence projected to reach 3% by 2030. In advanced stages, when medical therapy fails and transplantation is limited by organ shortages, left ventricular assist devices (LVADs) represent a viable alternative. This retrospective, single-center study reports 10-year outcomes from the first Chilean LVAD program using the HeartWare (HVAD) device. Between 2013 and 2015, nine patients with advanced HF received HVAD implants. The mean age was 42.2 ± 15.8 years, with a left ventricular ejection fraction of 22% ± 4.1%. One-year survival was 77.8%, and 10-year survival for those using LVAD as destination therapy was 62.2%. All patients experienced at least one infection, with driveline infections being most common (55.5%). Bleeding events affected 77.7%, including gastrointestinal bleeding and severe epistaxis (both 22.2%). Neurological complications occurred in 33.3% of patients. Despite these events, four patients remained on LVAD support after 10 years, with no mechanical device failures requiring replacement. This case series highlights the feasibility, durability, and clinical relevance of long-term LVAD support in low-donation settings. Findings support LVADs as a destination therapy in selected patients and emphasize the importance of multidisciplinary care and structured follow-up.
An intermittent ascending aorta clamping strategy to rescue an emergency management of unexpected massive hemorrhage in mediastinal tumor surgery: a case report.
Zhu Y, Teng W, Xiang Y … +1 more , Zheng Y
J Cardiothorac Surg · 2026 Jun · PMID 42249501 · Full text
BACKGROUND: Mediastinal tumors pose significant surgical and anesthetic challenges. CASE PRESENTATION: In this paper, we discuss the management of a large mediastinal tumor complicated by sudden aortic injury. With the s...
BACKGROUND: Mediastinal tumors pose significant surgical and anesthetic challenges. CASE PRESENTATION: In this paper, we discuss the management of a large mediastinal tumor complicated by sudden aortic injury. With the strategic application of an intermittent ascending aorta clamping technique combined with timely extracorporeal support, the aortic injury could be successfully managed. Additionally, complete tumor resection was possible without any deterioration of vital organ functions, which resulted in a successful outcome. CONCLUSIONS: Our experience with this case offers valuable insights for managing similar challenging surgical scenarios.
Comparative efficacy and safety of transcatheter edge-to-edge repair versus tricuspid valve replacement versus optimal medical therapy in moderate-to-severe tricuspid regurgitation: a network meta-analysis of randomized controlled trials.
Veettil INK, Jamandlamudi A, Khader NA … +11 more , Shehu T, Lacej D, Jha S, Mayowa O, Zumba J, Ismailov T, Almaganbetova Z, Gabriela B, Hajjar L, Safi SU, Khawar M
J Cardiothorac Surg · 2026 Jun · PMID 42249500 · Full text
BACKGROUND: Severe tricuspid regurgitation (TR) is associated with substantial morbidity and increased mortality. Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged...
BACKGROUND: Severe tricuspid regurgitation (TR) is associated with substantial morbidity and increased mortality. Transcatheter edge-to-edge repair (TEER) and transcatheter tricuspid valve replacement (TTVR) have emerged as less-invasive options for patients remaining symptomatic despite optimal medical therapy (OMT). We conducted a network meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of TEER and TTVR versus OMT. METHODS: Three RCTs were included after systematic search of PubMed, Embase, and ScienceDirect (inception to December 2025). A frequentist network meta-analysis (random-effects) was performed in R. A Bayesian NMA with vague priors was conducted in parallel to obtain posterior rank probabilities and SUCRA values. Relative effects were translated into absolute risk differences and number-needed-to-treat (NNT) / number-needed-to-harm (NNH) using pooled OMT baseline event rates, with 95% CIs via parametric bootstrap. RESULTS: The network comprised 1,050 patients (star-shaped, OMT common comparator; no direct TEER-TTVR comparison). Neither TEER (RR 0.99, 95% CI 0.56-1.76) nor TTVR (RR 0.85, 95% CI 0.51-1.41) significantly reduced all-cause mortality. Both interventions improved NYHA class ≥ 1 class (TEER RR 1.46, 95% CI 1.30-1.64, NNT 8; TTVR RR 3.28, 95% CI 2.41-4.47, NNT 2), KCCQ-OS (TEER MD + 11.00, 95% CI 7.46-14.54; TTVR MD + 17.80, 95% CI 12.78-22.82; both exceeding the 5-point MCID with ≥ 95% confidence), and 6MWD (TEER MD + 17.53 m; TTVR MD + 30.90 m; neither clearly exceeding the 30-m MCID). Both increased major bleeding (TEER NNH 29; TTVR NNH 21) and new pacemaker implantation (TEER NNH 91; TTVR NNH 10). Bayesian posterior probability that TTVR was best was 100% for NYHA improvement, 99% for KCCQ-OS, and 82% for 6MWD, but only 1% for avoidance of pacemaker implantation. CONCLUSION: In patients with symptomatic moderate-to-severe TR, both TEER and TTVR plus OMT provide consistent and clinically meaningful improvements in functional status and quality of life. Longer-term trials with direct head-to-head comparisons are warranted. CLINICAL TRIAL REGISTRATION: Not applicable. This study is a systematic review and meta-analysis of previously published randomized controlled trials.
Association between enteral nutrition timing and postoperative anion gap trajectory in cardiac surgery ICU patients: a retrospective study based on the MIMIC-IV database.
Chen SJ, Lu JW, Yao YN … +1 more , Liu CQ
J Cardiothorac Surg · 2026 Jun · PMID 42249494 · Full text
OBJECTIVE: To investigate the association between enteral nutrition (EN) timing and postoperative anion gap (AG) trajectory in ICU patients undergoing cardiac surgery. METHODS: Data were extracted from the MIMIC-IV datab...
OBJECTIVE: To investigate the association between enteral nutrition (EN) timing and postoperative anion gap (AG) trajectory in ICU patients undergoing cardiac surgery. METHODS: Data were extracted from the MIMIC-IV database. Cardiac surgery patients receiving EN were classified into preoperative and postoperative groups according to whether EN was first recorded before or after surgery. Baseline comparability was assessed. AG levels at admission, within 24 h after surgery, and at discharge were compared, and multivariable linear regression and subgroup analyses were performed as exploratory analyses. RESULTS: Among 195 cardiac surgery patients, 83 had preoperative EN and 112 had postoperative EN records. Baseline illness severity was broadly similar between groups, although age, sex, alcohol use history, and diabetes prevalence differed. No significant between-group difference in admission AG was observed, whereas the preoperative EN group had lower AG at postoperative 24 h (15 [12, 17] vs. 17 [14, 19], P = 0.035) and at discharge (15 [13, 17] vs. 17 [13, 21], P = 0.027). EN timing remained associated with postoperative 24-hour and discharge AG in multivariable models. EN timing was not clearly associated with postoperative delirium, in-hospital mortality, or length of hospital stay. It was discharge-AG that positively correlated with in-hospital mortality. CONCLUSIONS: Preoperative EN was associated with lower postoperative and discharge AG levels in this retrospective cohort. However, this metabolic signal did not translate into clear clinical outcome benefit, and the findings should be interpreted as hypothesis-generating because residual confounding by indication remains possible.
Anesthetic management of a patient with malignant right ventricular tumor and pulmonary tumor embolism secondary to cervical cancer: a case report.
Lin Y, Shuang P, Tao D … +5 more , Lu L, Bao L, Zhang G, Hou H, Chen S
J Cardiothorac Surg · 2026 Jun · PMID 42249489 · Full text
BACKGROUND: Cardiac metastasis involving the right ventricle and pulmonary artery is extremely rare and poses significant anesthetic challenges due to the high risk of tumor embolization and hemodynamic instability. We r...
BACKGROUND: Cardiac metastasis involving the right ventricle and pulmonary artery is extremely rare and poses significant anesthetic challenges due to the high risk of tumor embolization and hemodynamic instability. We report the anesthetic management of a patient with metastatic right ventricular tumor secondary to cervical cancer who underwent surgical resection. CASE PRESENTATION: A 63-year-old woman with a history of cervical cancer presented with respiratory symptoms and was found to have a mobile mass involving the right ventricle and main pulmonary artery on imaging. Given the risk of sudden pulmonary embolism, surgical resection under cardiopulmonary bypass was undertaken. Anesthetic management emphasized careful induction, advanced monitoring including cerebral oximetry, and intraoperative transesophageal echocardiography to guide hemodynamic management and reduce embolic risk. The procedure was completed successfully, and the patient recovered without major complications. Histopathology confirmed metastatic squamous cell carcinoma. At eight-month follow-up, the patient was alive and receiving adjuvant chemotherapy. CONCLUSION: Intracardiac metastatic tumors with pulmonary artery involvement present substantial anesthetic risk. This case highlights the importance of individualized anesthetic planning, vigilant hemodynamic control, and echocardiographic guidance in achieving safe perioperative outcomes.
Comparative study of the tumor-infiltrating lymphocytes before and after neoadjuvant chemoimmunotherapy in esophageal squamous cell carcinoma.
Xu Y, Wang H, Wang N … +7 more , Cui S, Guo J, Huang C, Wang M, Su P, Qi J, Tian Z
J Cardiothorac Surg · 2026 Jun · PMID 42249487 · Full text
BACKGROUND: OBJECTIVE: To explore changes of tumor-infiltrating lymphocytes and the relationship with therapeutic effect before and after neoadjuvant chemoimmunotherapy in patients with esophageal squamous cell carcinoma...
BACKGROUND: OBJECTIVE: To explore changes of tumor-infiltrating lymphocytes and the relationship with therapeutic effect before and after neoadjuvant chemoimmunotherapy in patients with esophageal squamous cell carcinoma(ESCC). METHOD: This study collected clinical data from 25 ESCC patients with neoadjuvant chemoimmunotherapy from November 2019 to June 2022 in our hospital. After the completion of the neoadjuvant treatment, Mckeown MIE surgery was performed. The pathological specimen before therapy and after surgery was collected. Immunohistochemical analysis was performed to obtain the tumor-infiltrating lymphocytes (TILs) infiltration of the tumor before and after treatment. RESULT: Seven (28%) patients achieved pathology complete response (pCR group) and 18 (72%) patients did not achieve pCR (non-pCR group). Compared with non-pCR group, the after treatment proportion of CD4 + TILs (P = 0.012) and the proportion of CD8 + TILs (P = 0.018) were significantly increased in pCR group; There was no significant change in the proportion of CD20 + TILs (Z = -1.933, P = 0.053). In pCR group, the proportion of CD4 + TILs (P = 0.047) and the proportion of CD8 + TILs (P = 0.036) were significantly increased after treatment; The proportion of CD20 + TILs (P = 0.111) did not change significantly. In non-pCR group, no significant changes were observed in proportions of CD4 + TILs (P = 0.729), CD8 + TILs (P = 0.712), and CD20 + TILs (P = 0.811) between before and after treatment. CONCLUSION: For ESCC patients who received neoadjuvant chemoimmunotherapy, patients with pCR had a more active immune response independent of pre-treatment PD-L1 expression levels, and the pre-treatment CD4 + TILs ratio may be one of the predictors of their survival.
Intraoperative tension pneumothorax during laparoscopic cholecystectomy as a presentation of delayed traumatic diaphragmatic hernia: a case report.
Yun J, Ryu S, Yoon C
J Cardiothorac Surg · 2026 Jun · PMID 42249484 · Full text
BACKGROUND: Traumatic diaphragmatic hernia (TDH) may present months to years after blunt injury and can mimic biliary or pulmonary disease. Right-sided TDH is particularly prone to delayed recognition because partial hep...
BACKGROUND: Traumatic diaphragmatic hernia (TDH) may present months to years after blunt injury and can mimic biliary or pulmonary disease. Right-sided TDH is particularly prone to delayed recognition because partial hepatic herniation may be overlooked unless the diaphragm is specifically reviewed. CASE PRESENTATION: A 45-year-old woman with a remote motor-vehicle collision developed right-sided tension pneumothorax with hemodynamic collapse at the start of laparoscopic cholecystectomy at another hospital; a chest tube and cardiopulmonary resuscitation were required and the operation was aborted. Fourteen months later, she presented to our institution with recurrent right-upper-quadrant pain. A targeted re-review of serial prior CT images demonstrated a hepatic collar sign along the right hemidiaphragm, consistent with hepatic herniation through a traumatic diaphragmatic defect. Cholecystectomy was deferred and urgent thoracoscopic repair was performed the same day. The patient recovered uneventfully and remained asymptomatic at 7-year follow-up. CONCLUSIONS: Unexplained tension pneumothorax during laparoscopy may be a sentinel event of delayed TDH. Targeted CT re-review with attention to diaphragm-specific signs may help avoid inappropriate abdominal surgery and enable timely definitive repair.
Temporal epidemiological characteristics of acute aortic dissection incidence patterns in east China: a retrospective analysis of 1,038 patients.
Sun F, Wang H, Cai T … +3 more , Gan L, Cheng Y, Meng F
J Cardiothorac Surg · 2026 Jun · PMID 42249482 · Full text
BACKGROUND: This study aims to investigate the temporal biological distribution characteristics of acute aortic dissection (AAD) onset in East China, analyze differences in onset patterns between patients with different...
BACKGROUND: This study aims to investigate the temporal biological distribution characteristics of acute aortic dissection (AAD) onset in East China, analyze differences in onset patterns between patients with different types (Stanford Type A and Type B) and genders, and provide regional epidemiological evidence to inform our understanding of the temporal distribution of AAD in East China. METHOD: Clinical data were retrospectively collected from 1,038 patients with confirmed AAD diagnosed between January 2009 and September 2025. SPSS 27.0 software was employed to analyze temporal distribution patterns of onset, including seasonal, monthly, weekly, and daily rhythmic characteristics, whilst investigating the influence of gender and disease subtype on temporal biological features. RESULT: A total of 1,038 patients with AAD were included, comprising 571 cases (55.0%) of Stanford Type A AAD and 467 cases (45.0%) of Stanford Type B AAD; 767 were male (73.9%), with a mean age of 55.7 ± 13.5 years. Circadian patterns showed that 17:00-20:00 was the peak period for onset (21.4%), whilst 01:00-04:00 was the trough (12.5%); females exhibited more pronounced fluctuations across certain time scales. Regarding weekly distribution, Stanford Type B cases had the lowest proportion on Saturdays (11.8%); the weekly distribution of female patients showed a certain degree of variation. At the monthly and seasonal levels, cases were concentrated in January, February, March, November and December; the incidence was highest in winter (32.6%), followed by autumn (25.4%), spring (24.6%) and summer (17.4%). Seasonal differences were statistically significant (P < 0.0001), and the seasonal fluctuations in Stanford Type A AAD were greater than those in Stanford Type B AAD. Furthermore, significant differences were observed between patients of different subtypes in terms of gender distribution, history of smoking and alcohol consumption, and the prevalence of comorbidities (P < 0.05). CONCLUSION: The incidence of AAD in East China exhibits distinct circadian patterns, with potential variations across different subtypes and gender groups at certain temporal scales. These findings provide an epidemiological basis for understanding the temporal distribution of AAD incidence in East China and for the preparation of clinical resources.
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