The Journal of cardiovascular surgery最新文献

{"title":"A modified turn-up anastomotic technique for total arch replacement: the \"frill-necked lizard\" configuration.","authors":"Takashi Harada, Hironobu Morimoto, Yuki Echie, Saeki Watanabe, Daisuke Futagami, Keijiro Katayama, Shogo Mukai","doi":"10.23736/S0021-9509.26.13551-4","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13551-4","url":null,"abstract":"<p><strong>Background: </strong>Secure distal anastomosis is the critical determinant of success in total arch replacement (TAR). We aimed to examine the outcomes of a turn-up technique for TAR and introduced a modified turn up method with graft like frill-necked lizard for distal anastomosis, which provides secure anastomosis under excellent visualization, regardless of underlying pathology or the use of a frozen elephant trunk (FET).</p><p><strong>Methods: </strong>We retrospectively evaluated 228 consecutive patients who underwent TAR for 119 thoracic aortic aneurysms (TAA) and 109 acute aortic dissections (AAD) between January 2013 and January 2024. We initially used the turn-up method for distal anastomosis. More recently, we have adopted a modified turn-up method with a frill-necked graft. We evaluated overall surgical outcomes of TAR and performed a comparative analysis between patients with TAA and AAD. Circulatory arrest time during distal anastomosis with the modified turn-up technique was compared with that of the conventional turn-up technique.</p><p><strong>Results: </strong>For all patients, the operation, cardiopulmonary bypass, aortic cross-clamp, and lower body circulatory arrest times were 376.2±81.7, 229.3±56.1, 148.6±47.1, and 52.4±16.5 minutes. The circulatory arrest times required for distal anastomosis were 53.1±15.9 and 51.6±17.2 minutes in the TAA and AAD groups. The overall 30-day mortality was 3.1%. The permanent neurological dysfunction rate was 5.7%. Spinal cord complications included three cases of paraparesis; there was no case of paraplegia. Kaplan-Meier survival analysis showed an overall 5-year survival rate of 87.6%. Circulatory arrest time was significantly shorter in the modified turn-up group compared with the conventional turn-up group (34.4 ± 9.4 min vs. 53.9 ± 16.1 min, P<0.01).</p><p><strong>Conclusions: </strong>The turn-up technique provides secure distal anastomosis regardless of the pathology or FET use and the frill-necked graft facilitates distal anastomosis.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-situ fenestrated versus physician-modified endografts in the endovascular treatment of thoracic and complex abdominal aortic pathologies in modern vascular surgery.","authors":"Davide Esposito, Martina Bastianon, Caterina Melani, Fabio Grimaldi, Enrica Bosisio, Andrea Savio, Giovanni Pratesi","doi":"10.23736/S0021-9509.26.13573-3","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13573-3","url":null,"abstract":"<p><strong>Background: </strong>Custom-made endografts are effective for aneurysms involving visceral or supra-aortic vessels but unsuitable in emergencies due to production delays. Off-the-shelf devices expand repair options yet often face anatomical limitations. Recently, alternative approaches - in-situ fenestration (ISF) and physician-modified endografts (PMEG) - have emerged to address complex aortic pathologies when standard devices are impractical. This study aimed to describe the results of ISF and PMEG techniques and compare their outcomes, with a focus on target vessels (TV).</p><p><strong>Methods: </strong>Single-center, retrospective, observational study. Consecutive patients treated with ISF or PMEG for thoracic or complex abdominal aortic pathologies from January 2021 to December 2024 were included.</p><p><strong>Results: </strong>Forty-eight patients were included, with 28 (58.3%) undergoing ISF and 20 (41.7%) PMEG. A total of 69 TVs were treated, which were bridged using ISF in 34 (49.3%) cases and PMEG in 35 (50.7%). The procedure-related technical success was 95.8% (96.4% ISF vs. 95% PMEG, P=0.807). The TV-related technical success was 98.5% (100% ISF vs. 97.1% PMEG, P=0.321). Systemic complications were lower in the ISF group (absolute risk reduction 29.3%, P=0.017). At one-year, estimated freedom from aorta-related mortality was 92.3% for ISF vs. 100% for PMEG (P=0.165), and freedom from reintervention was 80% vs. 83.5% (P=0.662). Competing risk analysis showed similar one-year TV-related reintervention and TV instability incidences.</p><p><strong>Conclusions: </strong>ISF demonstrated lower systemic complication rates compared to PMEG, despite involving a significant period of TV ischemia, and achieved early similar TV-related outcomes despite the lack of fenestration reinforcement.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ad-interim 6- and 12-month results from a prospective multicenter investigation on Renzan Stent in the treatment of patients with femoro-popliteal disease in Tuscany (CURRENT Registry).","authors":"Gianmarco de Donato, Edoardo Pasqui, Raffaella Berchiolli, Nicola Troisi, Giuseppe Galzerano, Sara Speziali, Raffaele Pulli","doi":"10.23736/S0021-9509.26.13513-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13513-7","url":null,"abstract":"<p><strong>Background: </strong>The CURRENT registry is a prospective, multicenter, real-world investigation designed to evaluate the safety and effectiveness of the Renzan^™ stent (Terumo MicroVention Inc., Aliso Viejo, CA, USA) in patients with femoro-popliteal peripheral artery disease (PAD), including complex lesions and chronic limb-threatening ischemia (CLTI). This study reports the interim outcomes at 6 and 12 months.</p><p><strong>Methods: </strong>A total of 89 patients with symptomatic PAD (Rutherford category IV-V 64.1%) were enrolled across three centers in Tuscany, Italy. All patients underwent endovascular treatment with the Renzan^™ dual-layer interwoven nitinol stent. Baseline and follow-up assessments included clinical evaluation and duplex ultrasound imaging. The primary safety endpoint was the composite rate of all-cause death, target lesion revascularization (TLR), and major amputation at 30 days. The primary efficacy endpoint was primary patency at 6 months. Estimated patency and reintervention rates were reported at 12 months using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Technical and procedural success was achieved in 100% of cases. At 30 days, no deaths, TLRs, or major amputations occurred. At 6 months, the composite safety endpoint was met in 94.3% of patients. Primary patency was 100% at 1 and 3 months, 92.0% at 6 months, and declined to 78.7% (95% CI: 55.3-88.1%) at 12 months. Freedom from TLR was 97.2% at 6 months and 78.5% (95% CI: 63.7-88.7%) at 12 months. Exploratory multivariable analysis identified diabetes mellitus, previous peripheral endovascular intervention, and below-the-knee involvement as independent predictors of loss of patency, whereas dual antiplatelet therapy beyond 1 months was associated with a reduced risk of patency loss.</p><p><strong>Conclusions: </strong>The Renzan^™ stent demonstrated excellent early safety and efficacy outcomes in a challenging PAD population, with sustained mid-term patency despite a high proportion of complex lesions. These preliminary results support the use of this new mimetic stent design in real-world clinical settings and warrant further confirmation with longer-term follow-up.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147794032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep vein arterialization for chronic limb-threatening ischemia: from PROMISE to practice.","authors":"Patrick Heindel, Jeremy Darling, Camila R Guetter, Marc Schermerhorn, Lars Stangenberg","doi":"10.23736/S0021-9509.26.13624-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13624-6","url":null,"abstract":"<p><p>A subset of patients with chronic limb-threatening ischemia (CLTI) lack viable options for traditional arterial revascularization - often termed \"no-option\" patients - and have historically faced primary major amputation as the default treatment. Deep venous arterialization (DVA) has emerged as a potential limb salvage strategy for this challenging population, involving the creation of an arteriovenous fistula to deliver oxygenated blood via the venous system to the ischemic foot. The approval of the LimFlow System by the United States Food and Drug Administration (FDA) in 2023, following the PROMISE II trial, has generated considerable interest in this approach. Prospective studies report 6-month amputation-free survival of 66% and limb salvage of 76% after percutaneous DVA. However, real-world Medicare data demonstrate substantially inferior outcomes, with 6-month amputation-free survival of only 42% and 1-year amputation-free survival of 33%. This discrepancy likely reflects differences in patient selection, operator experience, and institutional resources between clinical trials and routine practice. Outcomes are particularly poor in dialysis-dependent patients. Critical evidence gaps remain, including the absence of randomized controlled trials comparing DVA to intensive wound care alone, limited patient-reported outcome data, and undefined cost-effectiveness. Despite an evolving evidence base, DVA represents a promising treatment for carefully selected no-option patients at centers capable of providing comprehensive wound care, close surveillance, and timely reintervention.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis on the incidence and prognosis of sac regression after endovascular aneurysm repair.","authors":"Simona Sica, Mario D'Oria, Marco Bernardi, Andrea Zito, Manav Dimri, Giuseppe Biondi-Zoccai, Fabrizio Minelli, Sandro Lepidi, Carlo Coscarella, Rocco Giudice, Yamume Tshomba, Giovanni Tinelli","doi":"10.23736/S0021-9509.25.13366-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13366-1","url":null,"abstract":"<p><strong>Introduction: </strong>The primary objective of this systematic review and meta-analysis was to assess the incidence and prognosis of sac regression following endovascular aneurysm repair (EVAR), focusing on mortality (all-cause and aneurysm-related), aneurysm rupture, endoleaks, and secondary interventions.</p><p><strong>Evidence acquisition: </strong>A systematic literature search was performed across PubMed, Scopus, Web of Science, and Google Scholar up to December 2024. Randomized trials, cohort studies, and case-control studies involving patients who underwent standard EVAR for abdominal aortic aneurysms (AAA) were included. The studies were included only if they compared patients with sac regression versus those without during follow-up. The Newcastle-Ottawa Scale (NOS) was used for quality assessment. The data were synthesized using a random-effects model to calculate relative risks (RR) for outcomes of interest.</p><p><strong>Evidence synthesis: </strong>A total of 18 observational studies involving 25,984 patients were included. Sac regression was reported in 12,195 patients (46.9% [95% CI: 46.3%, 47.5%]), although with varying definitions of shrinkage through studies. Pooled analyses showed that sac regression was significantly associated with reduced all-cause mortality (RR=0.68 [95% CI: 0.59, 0.78], P<0.001) and aneurysm rupture (RR=0.38 [95% CI: 0.15, 0.97], P=0.044). Sac regression also correlated with lower rates of endoleaks (RR=0.45 [95% CI: 0.33, 0.62], P<0.001) and secondary interventions (RR=0.40 [95% CI: 0.31, 0.52], P<0.001).</p><p><strong>Conclusions: </strong>Aneurysm sac regression is a valuable prognostic marker after EVAR. It is associated with better clinical outcomes, including reduced mortality and complications. Standardizing the definition and assessment of sac regression is essential for more consistent findings. Further prospective studies and randomized trials are needed to confirm these results and better understand the mechanisms behind sac regression.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operative time and outcome after carotid endarterectomy for symptomatic and asymptomatic carotid stenosis: a retrospective multicenter cohort study.","authors":"Radu Tabac, Corneliu Lisii, Mareike Ruckert, Carlotta Linder, Igor Cebotari, Daniel Kleinschmidt, Jessica Nentwig, Marie Schröder, Shervin Taheripour, Eike S Debus, Reinhart T Grundmann","doi":"10.23736/S0021-9509.26.13541-1","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13541-1","url":null,"abstract":"<p><strong>Background: </strong>Carotid endarterectomy (CEA) is the standard treatment for asymptomatic and symptomatic carotid stenosis, but the impact of operative duration on outcomes remains unclear. Previous studies suggested longer procedures increase short-term complications. This multicenter study aimed to evaluate the relationship between operative time and perioperative as well as one-year outcomes, considering indication, surgical technique, and center-specific factors.</p><p><strong>Methods: </strong>We retrospectively analyzed 1966 patients (70.7% male; 62.1% asymptomatic) undergoing CEA between 2015 and 2023. Of these, 1,560 (79.3%) underwent patch angioplasty and 406 (20.7%) eversion endarterectomy (EEA), under local (N.=918) or general anesthesia (N.=1048). All patients were followed for one year.</p><p><strong>Results: </strong>Mean operative time was 99.9±31.8 minutes, longer in men, obese, and symptomatic patients, and varied between centers (69.9-121.6 minutes). EEA was faster than conventional CEA (83.1±26.3 vs. 104.3±31.7 minutes; P<0.001) with similar 30-day major adverse cardiovascular events (MACE) and stroke rates. EEA had lower rates of cranial nerve injury (OR 0.15, 95% CI 0.04-0.52) and early restenosis/occlusion (OR 0.27, 95% CI 0.07-0.97). No differences were observed in long-term MACE, restenosis, or reoperation. Longer operative time correlated with prolonged ICU and hospital stay, and MACE risk increased once operative time exceeded ~200 minutes.</p><p><strong>Conclusions: </strong>Operative time alone is not a reliable quality metric. EEA provides a faster procedure than conventional CEA while maintaining comparable short- and long-term outcomes and lower peri-operative morbidity. It is a safe and efficient alternative in selected patients.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical thrombus removal in acute pulmonary embolism. Where do we stand today?","authors":"Konstantinos C Christodoulou, Stavros V Konstantinides","doi":"10.23736/S0021-9509.26.13607-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13607-6","url":null,"abstract":"<p><p>Acute pulmonary embolism (PE) remains a major cause of cardiovascular morbidity and mortality, with clinical presentations ranging from asymptomatic disease to obstructive shock and sudden death. Although anticoagulation is effective in most hemodynamically stable patients, a substantial proportion present with or progress to right ventricular (RV) failure and require reperfusion therapy. Surgical embolectomy (SE), first introduced in the early 20th century, was historically associated with prohibitive mortality, and largely abandoned following the advent of systemic thrombolysis. However, advances in diagnostic imaging, cardiopulmonary bypass, perioperative management, and multidisciplinary care have led to renewed interest in this approach. Contemporary series demonstrate that, when performed at experienced centers, SE is associated with acceptable operative mortality, favorable long-term survival, preserved RV function, and low rates of recurrent PE or chronic thromboembolic pulmonary hypertension. Outcomes appear to be driven primarily by preoperative clinical status - particularly cardiogenic shock and cardiac arrest - rather than by surgical technique alone, underscoring the importance of careful patient selection and timely referral. Although systemic thrombolysis and catheter-directed therapies remain central to acute PE management, available evidence suggests that SE achieves outcomes comparable to those of non-surgical reperfusion strategies, with a potentially lower risk of intracranial hemorrhage in selected high-risk patients. This narrative review summarizes the historical evolution, contemporary surgical techniques, clinical outcomes, and comparative effectiveness of surgical embolectomy in the treatment of acute pulmonary embolism, with the aim of clarifying its current role within modern multidisciplinary management strategies.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Device dislodgement in ruptured sinus of Valsalva aneurysm: the case for early surgical conversion.","authors":"Hakan Hançer, Mustafa M Özgür, Sabit Sarikaya, M Kaan Kirali","doi":"10.23736/S0021-9509.26.13477-6","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13477-6","url":null,"abstract":"<p><p>Ruptured sinus of Valsalva aneurysm (RSVA) is a rare but potentially life-threatening cardiac anomaly. Although transcatheter closure (TCC) has gained popularity as a less invasive option, anatomical complexity may compromise its success and necessitate urgent surgical conversion. We present the case of a 57-year-old male with a bicuspid aortic valve and ruptured RSVA forming a fistulous connection to the right atrium. Initial management with TCC was attempted based on anatomical feasibility and hemodynamic stability. However, the occluder device became dislodged immediately after deployment, prompting emergent surgical intervention. A successful surgical repair was performed via a median sternotomy with a reverse-U aortotomy (Kırali incision), allowing complete device retrieval and dual-site closure of the fistula. The patient's postoperative course was uneventful, with no residual shunting or aneurysmal recurrence on follow-up. This case underscores the limitations of transcatheter techniques in anatomically complex RSVA and highlights the critical role of early surgical conversion in preventing catastrophic complications. Adequate anatomical assessment and readiness for surgical backup are essential when considering percutaneous options in such scenarios.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk stratification in pulmonary embolism: current evidence and future directions.","authors":"Jihane Jadi, Natalie D Sridharan","doi":"10.23736/S0021-9509.25.13547-7","DOIUrl":"https://doi.org/10.23736/S0021-9509.25.13547-7","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is associated with high cardiovascular morbidity and mortality. Timely diagnosis and accurate prognostication are extremely important for guiding patient management and treatment selection. Risk stratification and clinical scoring systems are crucial for rapid assessment, effective triage, and accurate outcome prediction. Traditional tools have demonstrated strong prognostic value, and the role of dynamic risk assessment is increasingly recognized. Pretest probability scores including the Wells clinical prediction rule and the revised Geneva score, act as first line assessments to determine the need for further diagnostic testing. The Hestia criteria, Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) help to identify patients appropriate for outpatient management. For hospitalized patients, several additional scoring systems, imaging findings, and biomarkers can be used for further risk stratification and treatment planning. The development of multidisciplinary pulmonary embolism response teams (PERTs) and the integration of hybrid predictive models are demonstrating a shift toward a multimodal approach to PE risk stratification. The objective of this review is to summarize current approaches to risk assessment in pulmonary embolism, evaluate existing and emerging prediction models, as well as discuss future directions aimed at improving individualized care in the management and treatment of pulmonary embolism.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive repair of acute type A aortic dissection: early experience in selected population.","authors":"Francesco Cabrucci, Beatrice Bacchi, Massimo Baudo, Serge Sicouri, Dimitrios E Magouliotis, Yoshiyuki Yamashita, Dario Petrone, Giulia Bessi, Basel Ramlawi, Riccardo Codecasa","doi":"10.23736/S0021-9509.26.13501-0","DOIUrl":"https://doi.org/10.23736/S0021-9509.26.13501-0","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to evaluate the feasibility of minimally invasive repair of type A aortic dissection (MIR-TAAD) using mini sternotomy (MS), which improves early outcomes, and to assess its suitability in a highly selected and hemodynamically stable subset of patients.</p><p><strong>Methods: </strong>All consecutive patients with acute TAAD referred to our department were evaluated for MIR-TAAD if hemodynamically stable and without clinical or CT evidence of coronary ostia involvement. Previous cardiac surgery was an exclusion criterion.</p><p><strong>Results: </strong>Between 2022 and 2024, 12 of 103 dissections (9 men, mean age 67.7±1.3) underwent MIR-TAAD. Pre-operative GERAADA score was 10.5±2.3%. Five patients had severe aortic regurgitation, and one had hemiparesis. All underwent hemiarch replacement, with four also receiving an Ascyrus Medical Dissection Stent. Three had aortic valve replacement, eight had valve resuspension, and one had root replacement. Average CPB, cross-clamp, and circulatory arrest times were 130.8±35.0, 81.1±32.7, and 26.2±10.2 minutes (mean temperature 27.8±2.0). None received intraoperative transfusions; two required re-exploration for bleeding. Average intubation time was 22.75 [16.88, 47.00] hours, ICU stays 3.50 [2.75, 7.00] days, hospital LOS 8.50 [7.50, 11.75] days, and transfusion usage 0.50 [0.00, 1.50] units (6 patients received no transfusions). There was no 30-day or in-hospital mortality. At the median follow-up of 15.5 months [12.25, 35.50], only one patient died due to non-cardiac-related reasons.</p><p><strong>Conclusions: </strong>MIR-TAAD can be safely performed by MS in highly selected cases without limiting the range of aortic root or arch procedures. This approach achieved satisfactory short-term outcomes that should be interpreted within this low-risk population context.</p>","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}