Journal Of Cardiothoracic Surgery[JOURNAL]
Sun
200 papers
Multiple leiomyosarcoma of great saphenous vein with lung metastasis.
Zhao S, Shang X, Liu C … +1 more , Ou M
J Cardiothorac Surg · 2026 Jun · PMID 42249481 · Full text
There are very few publications on unplanned excisions of great saphenous vein leiomyosarcomas (GSV-LMS). We describe a 64-year-old female patient with multiple leiomyosarcoma in the great saphenous vein (a total of 13 l...
There are very few publications on unplanned excisions of great saphenous vein leiomyosarcomas (GSV-LMS). We describe a 64-year-old female patient with multiple leiomyosarcoma in the great saphenous vein (a total of 13 lesions) with lung metastasis. The patient was initially misdiagnosed and underwent a repeat surgical intervention. During the follow-up, a pulmonary nodule showed progressive enlargement, and the patient underwent pulmonary surgery. confirmed it to be a metastatic lesion. While some literature has documented this disease, the multidisciplinary treatment has not been emphasized, and the high incidence of lung metastasis has been overlooked. This is crucial importance of early identification and precise evaluation of lung metastasis. Given the paucity of cases, our case contributes valuable insights into the treatment approach necessary for optimal outcomes in GSV-LMS with lung metastasis. Multidisciplinary and aggressive treatment, under the guidance of the thoracic surgeon, remain paramount to improving survival in this rare malignancy with metastasis.
Safety and efficacy of Da Vinci robot-assisted atrial septal defect repair in patients with different body mass index levels: a single-center retrospective analysis.
Wang Q, Dai R, Wang W … +4 more , Li H, Chi X, Sun Z, Yang S
J Cardiothorac Surg · 2026 Jun · PMID 42249473 · Full text
OBJECTIVE: This study aims to investigate the impacts of various body mass index (BMI) classifications on perioperative parameters and short-term outcomes in patients undergoing Da Vinci robot-assisted atrial septal defe...
OBJECTIVE: This study aims to investigate the impacts of various body mass index (BMI) classifications on perioperative parameters and short-term outcomes in patients undergoing Da Vinci robot-assisted atrial septal defect (ASD) repair providing evidence for personalized perioperative management. METHODS: A retrospective analysis was conducted on 100 patients who underwent Da Vinci robot-assisted ASD repair at Qingdao University Affiliated Hospital between November 2014 and December 2025. Based on the Chinese adult BMI classification criteria, the patients were categorized into four groups: underweight group (BMI < 18.5 kg/m², n = 9), normal weight group (18.5 ≤ BMI < 24.9 kg/m², n = 52), overweight group (25.0 ≤ BMI < 29.9 kg/m², n = 26), and obese group (BMI ≥ 30.0 kg/m², n = 13). This study compared baseline characteristics, intraoperative indicators, postoperative recovery, and short-term prognosis across these groups. Furthermore, multivariate logistic regression analyzed the independent associations of BMI classification and age with postoperative surgical site infection and hospital readmission. RESULTS: No significant differences were observed among the four groups concerning baseline echocardiographic parameters, key intraoperative metrics (e.g., operation duration, cardiopulmonary bypass time), or most postoperative recovery measures (e.g., mechanical ventilation duration, length of intensive care unit stay), with all P > 0.05. No sternotomy conversion or early mortality occurred. Univariate analysis showed the obese group had significantly higher rates of surgical site infection (15.4%) and readmission (23.1%) (all P < 0.05), but multivariate regression did not identify BMI classification or age as independent predictors (all P > 0.05). CONCLUSION: Da Vinci robot-assisted ASD repair is safe and effective across different BMI levels, with its minimally invasive nature appearing to mitigate weight-related surgical challenges within this cohort. Although obese patients face higher risks of postoperative infection and readmission, BMI was not found to be an independent influencing factor in this exploratory analysis; however, small subgroup sizes and sparse data limit the statistical reliability of this finding. Individualized enhanced perioperative management for obese populations is recommended, and weight status should not be a contraindication for this procedure.
Protective mechanism of nicorandil on myocardial ischemia-reperfusion injury: a multi-omics study highlighting CYP4F5 as a key node.
Ge Z, Hao J, Zhang H … +2 more , Sun L, Jiang S
J Cardiothorac Surg · 2026 Jun · PMID 42249471 · Full text
BACKGROUND: Nicorandil, a vasodilator, exhibits potential in improving myocardial blood supply, but its protective mechanism against myocardial ischemia-reperfusion (I/R) injury remains unclear. This study aims to explor...
BACKGROUND: Nicorandil, a vasodilator, exhibits potential in improving myocardial blood supply, but its protective mechanism against myocardial ischemia-reperfusion (I/R) injury remains unclear. This study aims to explore the cardioprotective effects of nicorandil on myocardial I/R injury and elucidate its molecular mechanisms, providing a theoretical basis for clinical treatment. METHODS: Myocardial I/R injury models were established using SPF-grade male Sprague-Dawley (SD) rats, randomly divided into control, I/R, and I/R+Nicorandil groups (n = 6 per group). The I/R+Nicorandil group, nicorandil (5 mg/kg) was injected intraperitoneally every day from 3 days before the establishment of myocardial I/R model. Myocardial injury was assessed through TTC staining, hematoxylin-eosin (HE) staining, and multi-omics analyses (transcriptome sequencing, proteomics, and metabolomics) to investigate alterations at genetic, protein, and metabolite levels. RESULTS: Biochemical and histological analyses revealed that nicorandil significantly reduced serum levels of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and creatine kinase (CK), while decreasing myocardial infarction area and pathological damage. Transcriptome sequencing identified differentially expressed genes (DEGs) enriched in TNF and chemokine signaling pathways between control vs. I/R and I/R vs. I/R+Nicorandil groups. Proteomics analysis screened differentially expressed proteins (DEPs) primarily involved in glycolysis and protein glycosylation. Metabolomics detected two key differential metabolites in positive ion mode. Multi-omics integrative analysis identified CYP4F5 as a pivotal protein node, showing significant correlations with multiple metabolites. Western blot results demonstrated that nicorandil modulated the expression of PPAR-α, NF-κB, cGAS, and STING pathway proteins in myocardial I/R injury. CONCLUSION: Nicorandil may alleviate myocardial I/R injury by regulating CYP4F5-associated metabolites and signaling pathways.
A case of primary diffuse large B-cell lymphoma of the heart.
Li Q, Li D, Du Z … +1 more , Wei Y
J Cardiothorac Surg · 2026 Jun · PMID 42249470 · Full text
Primary cardiac diffuse large B-cell lymphoma (DLBCL) is an exceptionally rare entity in the published literature. We have reported here the case of a 73-year-old Chinese man who presented with intermittent chest tightne...
Primary cardiac diffuse large B-cell lymphoma (DLBCL) is an exceptionally rare entity in the published literature. We have reported here the case of a 73-year-old Chinese man who presented with intermittent chest tightness as the chief complaint. Echocardiography identified a pedunculated, moderately echogenic mass (approximately 49 × 36 mm) within the left atrium, attached to the interatrial septum and mobile with the cardiac cycle, initially suggestive of a myxoma. The patient underwent surgical resection of the cardiac mass without any preoperative diagnosis. Histopathological examination confirmed DLBCL. Notably, the patient received neither postoperative radiotherapy nor chemotherapy. At nearly 3 years of follow-up, he remains alive with a favorable prognosis and sustained disease-free survival.
Patient blood management protocol reduces allogeneic transfusion, morbidity, and mortality in coronary artery bypass surgery.
Alceu Dos Santos A, Hossne Junior NA, Gomes WJ … +11 more , Guizilini S, da Silva GS, Castro RM, Bezerra RF, Colosimo FC, Figueiredo MS, Barros MMO, de Cássia Rodrigues R, Lamim RC, Panfilio CE, Céspedes IC
J Cardiothorac Surg · 2026 Jun · PMID 42249468 · Full text
BACKGROUND: Allogeneic blood is a limited and globally scarce resource. Protocols based on the Patient Blood Management (PBM) program, incorporating therapeutic alternatives to reduce the use of red blood cells (RBCs), f...
BACKGROUND: Allogeneic blood is a limited and globally scarce resource. Protocols based on the Patient Blood Management (PBM) program, incorporating therapeutic alternatives to reduce the use of red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates (PCs), have become urgently needed. The aims of this study were: as a primary objective, to evaluate whether the implementation of a Patient Blood Management (PBM) protocol reduces allogeneic transfusion in patients undergoing coronary artery bypass grafting (CABG); and as a secondary objective, to assess the impact of transfusion on clinical outcomes and mortality following CABG surgery. METHODS: The study analyzed patients ≥ 18 years undergoing isolated and elective on-pump coronary artery bypass grafting (CABG), including both arterial and venous grafts. Data were retrospectively collected for two distinct periods, forming two groups: Pre-PBM (2010) and Post-PBM (2012), based on the implementation of a multidisciplinary PBM protocol aimed at optimizing erythropoiesis, hemostasis, and physiological tolerance to anemia. Statistical analyses included between-group comparisons, correlation analyses, and multiple regression to identify independent predictors of increased mortality. Statistical significance was defined as a p-value < 0.05. RESULTS: A total of 3,564 patients undergoing CABG were stratified into the Pre-PBM (n = 2,150) and Post-PBM (n = 1,414) groups. Implementation of a PBM protocol was associated with a significantly reduced allogeneic transfusions-RBC (62.7% to 48.4%), FFP (13.1% to 6.7%), and PC (5.4% to 3.0%) (p < 0.001). Mortality decreased from 4.5% to 3.1% (p = 0.042), with lower deep sternal wound infection rates (p < 0.001). Transfusion was an independent risk factor for increased mortality, with RBC (OR 3.63, 95% CI 2.20-5.99, p < 0.001), FFP (OR 5.69, 95% CI 3.91-8.27, p < 0.001), and PC (OR 6.45, 95% CI 4.07-10.24, p < 0.001) therapy demonstrating a dose-dependent association. Even in low-risk patients (EuroSCORE ≤ 2), allogeneic transfusion was associated with a significantly higher mortality (p < 0.001). CONCLUSIONS: Implementing a PBM protocol was associated with significant reductions in blood transfusions, infection rates, and mortality following CABG. Allogeneic transfusion was a strong predictor of adverse outcomes, including higher mortality, supporting the routine use of PBM strategies in CABG.
Robot-assisted tracheal carina resection and reconstruction for adenoid cystic carcinoma: a case report.
Shi S, Jiao J, Zhao J … +2 more , Zhang G, Li X
J Cardiothorac Surg · 2026 Jun · PMID 42249451 · Full text
BACKGROUND: Carinal reconstruction is the primary surgical intervention for tracheal tumors involving the tracheal carina. However, the complexity of airway management and the challenges associated with invasive carina r...
BACKGROUND: Carinal reconstruction is the primary surgical intervention for tracheal tumors involving the tracheal carina. However, the complexity of airway management and the challenges associated with invasive carina reconstruction significantly increase its operative difficulty. CASE PRESENTATION: A 48-year-old male patient presented with a 6-month history of persistent cough. Cervical and thoracic computed tomography (CT) imaging, along with bronchoscopic biopsy, confirmed a diagnosis of tracheal adenoid cystic carcinoma (TACC), with the tumor extending to the tracheal carina and left main bronchus. The patient subsequently underwent robot-assisted carinal resection and reconstruction using a three-port approach under extracorporeal membrane oxygenation (ECMO) support. Intraoperative oxygen saturation remained stable, and the postoperative course was uneventful. CONCLUSIONS: This case suggests that that the combination of ECMO support and robotic assistance facilitates adequate oxygenation and enables a minimally invasive, safe and efficient approach to carinal resection and reconstruction. Further studies and broader clinical experience across multiple centers are required to validate the safety and practicality of this technique.
Identification MYD88 as a candidate molecule of sodium overload-induced cell death in myocardial ischemia-reperfusion injury.
Wang X, Zou C, He X … +2 more , Liu S, Liu J
J Cardiothorac Surg · 2026 Jun · PMID 42249419 · Full text
BACKGROUND: Myocardial ischemia-reperfusion (I/R) injury disrupts intracellular ion homeostasis, triggering intracellular sodium overload and ultimately leading to cell death. However, the specific molecular mechanisms d...
BACKGROUND: Myocardial ischemia-reperfusion (I/R) injury disrupts intracellular ion homeostasis, triggering intracellular sodium overload and ultimately leading to cell death. However, the specific molecular mechanisms driving this pathological process remain incompletely understood. METHODS: Weighted gene co-expression network analysis (WGCNA) was applied to myocardial I/R injury transcriptomic datasets from the GEO database to identify genes associated with sodium accumulation. Subsequently, three machine learning algorithms (LASSO, Random Forest, and Support Vector Machine) were integrated to further screen for core hub genes. Single-cell RNA sequencing (scRNA-seq) data were utilized to determine the cellular localization of these key genes, followed by in vivo validation using a murine myocardial I/R injury model. RESULTS: WGCNA identified 11 candidate genes highly correlated with sodium accumulation. Further screening via machine learning algorithms pinpointed MYD88 and GPR35 as core genes. Single-cell analysis revealed that MYD88 was specifically upregulated in macrophages, suggesting that sodium overload might exacerbate myocardial I/R injury by mediating inflammatory responses. In vivo experiments confirmed a significant elevation of sodium ion concentration in myocardial tissues following I/R, accompanied by a marked upregulation of MYD88 expression. CONCLUSION: This study confirms that myocardial I/R injury triggers sodium overload and identifies MYD88 as a candidate molecule closely associated with sodium overload-induced cell death (SOICD). These findings provide a novel perspective for further exploring the pathological mechanisms underlying myocardial I/R injury.
Aortic root abscess in a high-risk case requiring modified hemi-UFO procedure with custom-made pericardial conduit - a case report.
Zwaans VIT, Iske J, Pitts L … +5 more , Starck CT, Grubitzsch H, Kempfert J, Falk V, Wert L
J Cardiothorac Surg · 2026 Jun · PMID 42249393 · Full text
BACKGROUND: The UFO procedure is an established surgical technique to treat extensive endocarditis of the aortic or mitral valve with involvement of the intervalvular fibrous body (IVFB). This technique can be used for r...
BACKGROUND: The UFO procedure is an established surgical technique to treat extensive endocarditis of the aortic or mitral valve with involvement of the intervalvular fibrous body (IVFB). This technique can be used for radical resection of the whole infected tissue. Independently of the size of the infected region it is unavoidable to replace both valves. In this high-risk re-do case we performed a modified so-called hemi-UFO procedure with preservation of the mitral valve. We present a 71-year-old male patient initially diagnosed with severe stenosis of the aortic valve. An aortic valve replacement with a 23-mm prosthesis was performed via partial upper mini-sternotomy. Eight weeks after surgery an echocardiogram revealed a large vegetation and severe regurgitation of the aortic valve prosthesis. The risk of death following reintervention heart surgery (EuroSCORE II) was calculated as 50.64%. We performed a re-do with full sternotomy. Intraoperatively it was observed that the aortic prosthesis was partially torn out. The aortic annulus exhibited circular infection with an abscess connecting to the left atrium. The tissue of the left atrial roof was partially destroyed, similar to a phlegmonous infection. We opened the left atrial roof and radically resected the infected tissue up to the IVFB. We prepared a custom-made conduit prosthesis of bovine pericardium with a 25-mm valve prosthesis. We replaced two thirds of the ascending aorta with re-implantation of the coronary arteries using the Bentall-de Bono technique. We were able to stabilise and implant the new aortic valve prosthesis with sutures through the opened left atrial roof. The stitches began close to the anterior mitral leaflet region and ended in the direction of the left ventricle outflow tract. All sutures were pericardium-pledgeted and were passed through a bovine pericardial patch. This patch formed a new mitral annulus and was used for the closure of the left atrial roof. We had to reconstruct the IVFB, the roof of the left atrium and the mitral annulus in the anterior (A1), middle (A2) and posterior (A3) segments. The patient was transferred to the intensive care unit with no inotropes and in sinus rhythm. The 3-year follow-up was uneventful. CONCLUSION: We showed a successful surgical treatment of aortic prosthesis endocarditis with involvement of the IVFB. We were able to perform a radical resection of the infected tissue, reconstruct and replaced all sacrificed tissue with biological tissue and preserved the native mitral valve in a modified hemi-UFO procedure.
Stented vs. stentless in aortic stenosis: a systematic review and meta-analysis.
Saeed A, Gerges KM, Saeed O … +13 more , Alasnag M, Whitlock R, Myers PO, Balacumaraswami L, Alesawy AF, Abraheem A, Elraggal D, Khalleefah DR, Elmesherghi AF, Fahaid A, Aljefairi N, Elhadi M, Mamas M
J Cardiothorac Surg · 2026 Jun · PMID 42249390 · Full text
BACKGROUND: Symptomatic aortic stenosis (AS) is often treated surgically with aortic valve replacement using stented or stentless prostheses. While stentless valves offer potential hemodynamic benefits, a robust synthesi...
BACKGROUND: Symptomatic aortic stenosis (AS) is often treated surgically with aortic valve replacement using stented or stentless prostheses. While stentless valves offer potential hemodynamic benefits, a robust synthesis of the evidence regarding clinical outcomes is needed. This systematic review and meta-analysis assessed the effectiveness and safety of both valve types. METHODS: This study followed the PRISMA guidelines and was prospectively registered in PROSPERO (CRD42025636952). We systematically searched PubMed, Cochrane Library, Scopus, and Web of Science up to December 2024, with a search update in May 2025. We included both randomized and non-randomized studies. The outcomes were early and overall mortality rates, stroke, pacemaker implantation, endocarditis, postoperative atrial fibrillation, total reoperation, severe prosthesis-patient mismatch, hospital stay, cardiopulmonary bypass time, cross-clamp time, and hemodynamic parameters, including postoperative mean aortic valve gradient, left ventricular mass and left ventricular mass index, and left ventricular ejection fraction. A random-effects model with odds ratios (ORs) and mean differences (MDs) was employed. RESULTS: After screening 1,385 records, 20 studies were included, involving 3,940 participants with AS. Studies were first analyzed by design (randomized and non-randomized), and then pooled. There were no significant differences in all-cause mortality rates either early (OR = 1.04, 95% CI: [0.65 to 1.68], p = 0.861) or overall mortality at 1 year (OR = 0.86, 95% CI: [0.28 to 2.63], p = 0.797) and beyond 1 year (OR = 0.95, 95% CI: [0.62 to 1.46], p = 0.820). Postoperative complications showed comparable results between groups, except for pacemaker implantation, which was significantly increased in stentless valves (OR = 1.82, 95% CI: [1.14 to 2.92], p = 0.013). Hemodynamic outcomes showed no significant differences between groups. CONCLUSION: Our study revealed that the rates of early and overall mortality, postoperative complications, and hemodynamic parameters were comparable between stented and stentless valve groups. However, patients receiving stentless valves exhibited a significantly higher incidence of pacemaker implantation.
Natural history of aortic valve disease after rheumatic mitral valve surgery: implications for concomitant aortic intervention.
Khesali H, Shemshadi S, Kanani P … +3 more , Yousefimoghaddam F, Bagheri Y, Salari S
J Cardiothorac Surg · 2026 Jun · PMID 42244012 · Full text
BACKGROUND: Rheumatic heart disease (RHD) frequently affects both mitral and aortic valves. While mitral valve replacement (MVR) is often prioritized, the natural history of coexisting aortic valve disease particularly w...
BACKGROUND: Rheumatic heart disease (RHD) frequently affects both mitral and aortic valves. While mitral valve replacement (MVR) is often prioritized, the natural history of coexisting aortic valve disease particularly when mild or moderate is less well understood. OBJECTIVE: The objective of this study is to assess the progression of aortic stenosis (AS) and aortic insufficiency (AI) in patients undergoing isolated MVR for rheumatic mitral disease. METHODS: We conducted a single-center retrospective cohort study involving 403 adult patients with rheumatic mitral valve disease who underwent isolated MVR at Rajaie Cardiovascular Medical and Research Center between 2010 and 2022. Patients with a history of aortic valve replacement or early postoperative mortality (defined as death within 30 days of surgery) were excluded. Serial transthoracic echocardiography was performed at baseline, 3 months postoperatively, and annually thereafter, with a mean follow-up duration of 78 months. We evaluated baseline and longitudinal changes in the severity of aortic stenosis (AS) and aortic insufficiency (AI), as well as alterations in left ventricular function and pulmonary artery pressures over time. The severity of aortic valve disease was classified according to the American Heart Association (AHA) 2020 and European Society of Cardiology (ESC) 2025 guidelines. RESULTS: At baseline, 9.2% had AS (6.2% mild, 3.0% moderate) and 67% had AI (57.6% mild, 9.4% moderate). During our follow up among patients with mild AS, we observed sever AS is 20% progressing to severe AS, compared with 41.7% progressing to moderate AS. For AI, we observed 3.0% progression to severe AI for patients with mild baseline disease and is 7.8% for patients with moderate baseline disease. Baseline aortic valve lesion severity independently predicted progression (HR 4.2, 95% CI 1.9-9.1, p < 0.001). No other clinical or echocardiographic parameters were significant. Survival analysis showed higher cumulative progression rates among those with baseline lesions (p < 0.001). CONCLUSIONS: Baseline aortic valve involvement predicts subsequent deterioration after MVR. Routine prophylactic AVR is not supported for mild AI, but moderate AS warrants closer follow-up and individualized surgical consideration. Larger, prospective studies are needed to refine risk prediction for concomitant aortic intervention.
Perioperative management of a patient with comorbid immune thrombocytopenia and antiphospholipid syndrome undergoing minimally invasive mitral valve surgery.
Mori K, Sako H, Kizu K … +3 more , Shuto T, Ogata Y, Miyamoto S
J Cardiothorac Surg · 2026 Jun · PMID 42243991 · Full text
BACKGROUND: Although rare, immune thrombocytopenia can coexist with antiphospholipid syndrome, creating a management dilemma between maintaining hemostasis and preventing thromboembolism. Herein, we report our strategic...
BACKGROUND: Although rare, immune thrombocytopenia can coexist with antiphospholipid syndrome, creating a management dilemma between maintaining hemostasis and preventing thromboembolism. Herein, we report our strategic perioperative management of a patient with this complex hematological profile who underwent minimally invasive cardiac surgery. CASE PRESENTATION: A 55-year-old man with chronic atrial fibrillation and severe mitral regurgitation was diagnosed with immune thrombocytopenia and antiphospholipid syndrome. A minimally invasive cardiac surgery approach was chosen to minimize surgical trauma and the risk of perioperative bleeding. The mitral valve exhibited thickened chordae and leaflet retraction accompanied by verrucous excrescences, which are highly suggestive of Libman-Sacks endocarditis. Despite attempts at valve repair using annuloplasty, artificial chordae, and cleft closure, significant mitral regurgitation persisted because of extensive fibrotic changes. Consequently, the procedure was converted to mitral valve replacement with a mechanical prosthesis. Although the patient's platelet count immediately dropped to 12,000/µL postoperatively, prompt treatment with platelet transfusion and high-dose immunoglobulin therapy ensured rapid recovery. The patient was discharged without any complications, even after initiating anticoagulation therapy with warfarin. CONCLUSION: Managing cardiac surgery in patients with comorbid immune thrombocytopenia and antiphospholipid syndrome presents a significant therapeutic challenge. Based on our experience, a minimally invasive approach combined with a strategic perioperative protocol (specifically, postponing immunoglobulin therapy until the immediate postoperative period to facilitate rapid platelet recovery alongside anticoagulation) can achieve successful outcomes while balancing the conflicting risks of thrombosis and hemorrhage.
An old retained sharp intrapulmonary foreign body: a case report and literature review.
Lei Y, Shao S, Jiang T … +1 more , Wang W
J Cardiothorac Surg · 2026 Jun · PMID 42243979 · Full text
OBJECTIVE: To investigate the clinical characteristics, diagnostic challenges, and management strategies of long-term retained sharp intrapulmonary foreign bodies and to improve clinicians' understanding of this rare con...
OBJECTIVE: To investigate the clinical characteristics, diagnostic challenges, and management strategies of long-term retained sharp intrapulmonary foreign bodies and to improve clinicians' understanding of this rare condition. METHODS: We report a case of a 54-year-old male patient presenting with hemoptysis. The diagnosis was established through imaging, multidisciplinary consultation, thoracoscopic surgery, and pathological examination. Additionally, the relevant literature was reviewed to summarize the clinical features of such cases. RESULTS: Chest CT revealed a dense shadow in the left lower lobe. Following multidisciplinary consultation, a diagnosis of "sharp intrapulmonary foreign body complicated by infection" was made. The patient underwent thoracoscopic left lower lobectomy, during which three nail-like foreign bodies, approximately 1.0-2.0 cm in length, were successfully removed. Postoperative pathology confirmed foreign body-induced pulmonary infection. Further history-taking suggested that the foreign bodies were likely the result of an accidental nail gun injury sustained in a workshop approximately 10 years prior. CONCLUSION: Chronic intrapulmonary sharp foreign bodies may remain clinically silent for extended periods, posing diagnostic challenges. A high index of suspicion combined with detailed imaging is essential for diagnosis. Management should be individualized, with surgical intervention considered in symptomatic patients or when complications are likely. For completely asymptomatic patients with a stable foreign body position and no evidence of complications, conservative management with regular imaging follow-up may be a reasonable alternative.
Successful intracardiac repair of unrepaired tetralogy of fallot in a 51-year-old woman: a case report.
Kageyama A, Itatani K, Nakai Y … +1 more , Haibara J
J Cardiothorac Surg · 2026 Jun · PMID 42243973 · Full text
BACKGROUND: Unrepaired tetralogy of Fallot (TOF) diagnosed in adulthood is extremely rare, and preoperative assessment of right and left ventricular functional reserve is essential for determining surgical indications an...
BACKGROUND: Unrepaired tetralogy of Fallot (TOF) diagnosed in adulthood is extremely rare, and preoperative assessment of right and left ventricular functional reserve is essential for determining surgical indications and strategy. CASE PRESENTATION: A 51-year-old woman, who had been followed up a ventricular septal defect (VSD) since childhood, was diagnosed with TOF and with right ventricular failure due to progressive fatigue and peripheral edema. Cardiac imaging revealed overriding aorta, a membranous VSD with a pouch, hypoplastic pulmonary valve annulus, and right ventricular outflow tract (RVOT) obstruction caused by anomalous muscular bundles, suggesting TOF anatomy. 4D flow MRI (Time resolved 3D cine phase contrast MRI) demonstrated accelerated systolic flow across the RVOT with minimal pulmonary regurgitation. Surgical repair consisted of a bioprosthetic pulmonary valve replacement with RVOT reconstruction using a bovine pericardial patch, VSD patch closure, and tricuspid valvuloplasty. The postoperative course was uneventful, and RV pressure was significantly reduced. She was discharged on postoperative day 13 and remained asymptomatic at 4 months. CONCLUSIONS: Even in adults with unrepaired TOF, favorable outcomes can be achieved when surgical indications are carefully evaluated and procedures are tailored to the individual anatomy and hemodynamics.
Early outcomes of emergency coronary artery bypass grafting based on institutional technique selection: a single-center retrospective cohort study.
Özsoy SD
J Cardiothorac Surg · 2026 Jun · PMID 42243961 · Full text
BACKGROUND: Emergency coronary artery bypass grafting (CABG) in high-risk patients remains a major perioperative challenge, and surgical strategy is often determined by clinical and anatomical factors rather than randomi...
BACKGROUND: Emergency coronary artery bypass grafting (CABG) in high-risk patients remains a major perioperative challenge, and surgical strategy is often determined by clinical and anatomical factors rather than randomization. This study aimed to describe early outcomes of emergency CABG within a structured institutional technique selection framework. METHODS: This retrospective cohort study included 59 consecutive patients who underwent emergency isolated CABG between 2004 and 2007. Patients were allocated to on-pump (n = 39) or off-pump (n = 20) CABG according to a predefined institutional algorithm incorporating hemodynamic status, coronary anatomy, and comorbidities. Outcomes are presented descriptively, and between-group comparisons are interpreted in the context of inherent selection bias. RESULTS: Substantial baseline and procedural differences were observed between groups, reflecting structured technique selection rather than random allocation. Patients undergoing on-pump CABG had more complex coronary anatomy and higher clinical acuity, including all four cardiogenic shock cases and 92.6% of triple-vessel grafting procedures. Longer operative time, increased inotropic support, and longer hospital stay were observed in the on-pump group; CK-MB levels at 1 h were lower in the off-pump group. In-hospital mortality was low and comparable (7.7% vs. 5.0%, p = 1.000). Given the marked selection bias and limited sample size, these findings should be considered descriptive rather than comparative. CONCLUSION: In this historical cohort of emergency CABG patients, both on-pump and off-pump techniques were feasible within a structured institutional selection framework. Observed differences in early outcomes likely reflect underlying patient characteristics rather than intrinsic superiority of either technique. These findings highlight the importance of individualized, algorithm-guided decision-making in emergency surgical revascularization.
An unusual omphalocele: a case report of Cantrell syndrome.
Guo J, Lai D, Zhang J … +1 more , Tou J
J Cardiothorac Surg · 2026 Jun · PMID 42243954 · Full text
BACKGROUND: Omphalocele is a central abdominal wall defect that can be readily diagnosed at birth. Cantrell syndrome (CS) is an exceedingly rare disorder characterized by abnormalities involving the abdominal wall, stern...
BACKGROUND: Omphalocele is a central abdominal wall defect that can be readily diagnosed at birth. Cantrell syndrome (CS) is an exceedingly rare disorder characterized by abnormalities involving the abdominal wall, sternum, diaphragm, pericardium, and heart, with a poor prognosis. The processes of diagnosis and treatment may pose challenges due to the variable presentation and severity of the condition. Here, we report our experiences in managing a neonate with Cantrell syndrome. CASE PRESENTATION: A female neonate presented with an abdominal mass, initially diagnosed as an omphalocele accompanied by congenital heart disease based on its appearance, abdominal computed tomography, and echocardiography. The final diagnosis of Cantrell syndrome was confirmed during the omphalocele repair operation, where a pulsatile heart and a diaphragm defect were observed in the hernial sac. During the abdominal reconstruction procedure, an episode of pulseless electrical activity occurred, requiring immediate intracardiac compressions, which successfully restored cardiac activity. She subsequently underwent two cardiovascular surgeries to repair a ventricular septal defect (VSD), an atrial septal defect (ASD), and a patent ductus arteriosus (PDA) a few days later. However, she experienced frequent episodes of supraventricular tachycardia (SVT) postoperatively. During the 20 months of follow-up, the patient exhibited good recovery, although SVT persisted, necessitating long-term administration of antiarrhythmic medication. CONCLUSIONS: Concomitant anomalies should always be considered when diagnosing an omphalocele. Although rare, Cantrell syndrome ought to be suspected in cases exhibiting an epigastric omphalocele. Further detailed examinations and comprehensive assessments are essential for establishing a definitive diagnosis and developing an appropriate treatment plan. The involvement of a multidisciplinary team is imperative.
An interpretable machine learning model for preoperative risk stratification in paediatric congenital heart disease surgery: a retrospective cohort study.
Zhang YZ, Si YY, Ouyang J … +6 more , Wu JL, Zhang M, Nie MS, Liu K, Ma RW, Cheng LM
J Cardiothorac Surg · 2026 Jun · PMID 42243949 · Full text
BACKGROUND: Congenital heart disease (CHD), one of the most common birth defects, poses challenges to preoperative risk stratification due to its anatomical complexity and developmental vulnerability. Existing tools inad...
BACKGROUND: Congenital heart disease (CHD), one of the most common birth defects, poses challenges to preoperative risk stratification due to its anatomical complexity and developmental vulnerability. Existing tools inadequately predict critical outcomes, including mortality and ventilator dependence. We developed a machine learning-based clinical tool to enable precise preoperative risk assessment. METHODS: This retrospective dual-centre cohort study analysed 1,363 CHD surgical cases (1,033 from Kunming Children's Hospital and 330 from Fuwai Yunnan Cardiovascular Hospital), with 78 preoperative variables collected. Feature selection using the Boruta algorithm and LASSO regression identified key predictors. Nine machine learning models, including Random Forest and XGBoost, were constructed to predict a primary composite outcome and four secondary adverse events. Model performance was assessed using AUC and F1-score with threshold optimisation, and external validation was performed using the independent cohort. RESULTS: Eighteen predictors were selected. For the primary outcome, Random Forest achieved the highest AUC (0.861) and F1-score (0.631). Secondary outcomes showed divergent performance: mortality prediction demonstrated excellent discrimination (AUC 0.948), while prolonged hospital stay was predicted moderately (AUC 0.714). SHAP analysis revealed outcome-specific drivers: weight and RACHS-1 category dominated primary outcome risk, whereas mortality was associated with diastolic interventricular septum thickness and the AST/platelet ratio. Mechanical ventilation dependency correlated strongly with the monocyte-lymphocyte ratio. CONCLUSION: Five interpretable Random Forest models were developed and deployed as a web-based tool for preoperative risk stratification in CHD surgery. External validation demonstrated stable predictive performance, and future multicentre prospective studies are planned to further refine model generalisability and clinical utility.
Behavior of mitral regurgitation after isolated tricuspid valve surgery: determinants and hemodynamic correlates.
Savari M, Eftekhari SS, Hosseini S … +3 more , Bakhshandeh H, Khesali H, Kaviani R
J Cardiothorac Surg · 2026 Jun · PMID 42243933 · Full text
BACKGROUND: Isolated tricuspid regurgitation (TR) is increasingly recognized as a clinically important disease associated with adverse outcomes. Surgical repair often improves right-sided hemodynamics, but its effects on...
BACKGROUND: Isolated tricuspid regurgitation (TR) is increasingly recognized as a clinically important disease associated with adverse outcomes. Surgical repair often improves right-sided hemodynamics, but its effects on mitral regurgitation (MR) are unclear. Early observations suggest that MR may worsen postoperatively, yet reliable predictors remain insufficiently defined. OBJECTIVES: To evaluate postoperative MR behavior following isolated surgical TR repair and identify echocardiographic predictors of MR worsening. METHODS: This retrospective cohort study included patients ≥ 14 years who underwent isolated tricuspid valve repair between 2012 and 2023 at a tertiary center. Complete paired pre- and postoperative echocardiograms were analyzed by a blinded cardiologist. MR worsening was defined as an increase of ≥ 1 grade. Paired nonparametric tests compared pre- and postoperative echocardiographic indices, and between-group analyses examined factors associated with MR progression. RESULTS: Nineteen patients (mean age 36.3 years; 63% male) met the inclusion criteria. TR severity improved significantly after surgery (p < 0.001), accompanied by marked right-ventricular reverse remodeling, including significant reductions in RV size (p = 0.001) and RVIDd (4.60 ± 0.58 to 3.89 ± 0.44 cm; p < 0.001). MR severity changed significantly in paired analysis (p = 0.010), and 63% of patients demonstrated postoperative worsening. Left-sided chamber dimensions and systolic function remained stable. Among all parameters assessed, only postoperative E/e' differed significantly between patients with and without MR worsening (9.39 ± 2.32 vs. 7.16 ± 0.65; p = 0.045). CONCLUSIONS: In this small exploratory cohort, postoperative MR worsening occurred in a notable subset of patients, although the clinical relevance of these changes remains uncertain.Among the evaluated parameters, postoperative E/e' was higher in patients with MR worsening, suggesting a possible association between elevated LV filling pressures and postoperative MR behavior. Routine postoperative surveillance may be warranted to detect clinically relevant MR changes.
Combined minimally invasive direct coronary artery bypass with video-assisted thoracoscopic surgery thymectomy via left anterolateral mini-thoracotomy.
Lee LK, Lizwan M, Chua KC … +1 more , Chia CML
J Cardiothorac Surg · 2026 Jun · PMID 42243919 · Full text
Minimally invasive surgery (MIS) has become increasingly prevalent across almost all surgical specialties, including cardiothoracic surgery. However, combined MIS for coronary artery bypass and thymectomy in a single sit...
Minimally invasive surgery (MIS) has become increasingly prevalent across almost all surgical specialties, including cardiothoracic surgery. However, combined MIS for coronary artery bypass and thymectomy in a single sitting has not been previously documented. We report a case of a 61-year-old male with coronary artery disease and anterior mediastinal nodules who underwent both minimally invasive direct coronary artery bypass (MIDCAB) and video-assisted thoracoscopic surgery (VATS) thymectomy via left anterolateral mini-thoracotomy. He was discharged on post-operative day 3. In well-selected patients, performing concomitant MIDCAB and VATS thymectomy through the same incisions is safe and feasible, and significantly reduces hospitalisation duration.
Left-hand-dominant subxiphoid thoracoscopic thymectomy: a case series.
Shi H, Zhang Y
J Cardiothorac Surg · 2026 Jun · PMID 42243897 · Full text
BACKGROUND: Left-handed surgeons face systemic ergonomic challenges in conventional right-oriented surgical environments. This study proposes a standardized left-dominant protocol for subxiphoid thoracoscopic thymectomy,...
BACKGROUND: Left-handed surgeons face systemic ergonomic challenges in conventional right-oriented surgical environments. This study proposes a standardized left-dominant protocol for subxiphoid thoracoscopic thymectomy, integrating dual perspectives as a left-handed surgeon and surgical educator. METHODS: This study describes a case series of 82 consecutive thymic mass resections, performed using the left-dominant subxiphoid thoracoscopic approach at Dalian Medical University. RESULTS: We analyzed 82 patients, comprising 35 males (42.7%) and 47 females (57.3%). The mean age was 53.3 ± 12.8 years, and the mean tumor size was 4.0 ± 2.2 cm. Histopathological analysis identified 48 thymomas, classified according to WHO, Masaoka, and TNM staging systems, as well as 7 thymic carcinomas and other types. All cases achieved R0 resection without conversion to open thoracotomy. The remaining 81 patients (98.8%) experienced smooth recovery. CONCLUSION: Our results suggest that this left-dominant approach is feasible, safe, and reproducible. The methodology introduces a standardized procedural framework for ambidextrous skill development, offering distinct ergonomic advantages for left-handed surgeons while maintaining compatibility with conventional right-handed techniques.
Worldwide research trends on left ventricular assist devices for heart failure: a bibliometric analysis.
Sun G, Xuan F, Tao S … +2 more , Xu J, Zhang L
J Cardiothorac Surg · 2026 Jun · PMID 42243872 · Full text
BACKGROUND: With advancements in medicine, left ventricular assist devices (LVADs) have emerged as a viable treatment option for heart failure (HF). Numerous experts have examined the primary challenges and societal impl...
BACKGROUND: With advancements in medicine, left ventricular assist devices (LVADs) have emerged as a viable treatment option for heart failure (HF). Numerous experts have examined the primary challenges and societal implications associated with the use of LVADs in managing heart failure. This study seeks to analyze the global literature on LVADs for the treatment of heart failure published between 2004 and 2024, aiming to identify key research hotspots and emerging trends within this field. METHODS: This study conducted a bibliometric review of literature on LVADs for the treatment of heart failure from 2004 to 2024. Visual analysis was conducted on a total of 871 publications using CiteSpace (version 5.8) and VOSviewer (version 1.6.15.0). RESULTS: Over the past two decades, research on LVADs has developed continuously, accompanied by a stable annual growth in publications. The United States contributed the largest number of publications (187 articles), followed by other highly active countries and research networks. Columbia University was the most productive institution, while Rogers Joseph G and Farra David J were the most prolific authors. Keyword analysis indicated that "left ventricular assist device" was the core terminology, reflecting the central focus of global research. Further thematic analysis revealed principal research themes including device optimization, clinical outcomes and complication management, patient selection and prognostic evaluation, and long-term quality of life in supported patients. CONCLUSIONS: The field of left ventricular adjuvant therapy for heart failure has undergone steady development for 20 years and has now begun to show results. The results of this bibliometric analysis provide ideas and references for future researchers to further promote the development of this field.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe