Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Transcatheter mitral valve replacement or repair for mitral regurgitation: a narrative review.","authors":"Michail Penteris, Anastasia Kalogirou, Konstantinos Lampropoulos","doi":"10.1007/s12055-025-02032-4","DOIUrl":"https://doi.org/10.1007/s12055-025-02032-4","url":null,"abstract":"<p><strong>Objectives: </strong>The burden of mitral regurgitation (MR) is increasing globally. Transcatheter mitral valve repair (TMVr) is the preferred option for high-risk patients, while transcatheter mitral valve replacement (TMVR) is emerging as an alternative. The objective of this narrative review is to synthesize the available comparative evidence on these two approaches for MR. Specifically, we focus on procedural outcomes, clinical effectiveness, and patient selection criteria.</p><p><strong>Methods: </strong>This review investigates through PubMed and the Cochrane Library for studies comparing TMVR and TMVr in patients with MR until February 28, 2025.</p><p><strong>Results: </strong>We identified three observational studies, including a total of 4322 patients with MR. TMVR was associated with a higher risk of short-term mortality and peri-procedural complications but greater MR reduction and symptomatic improvement at follow-up compared to TMVr. Furthermore, there was no difference in long-term mortality between TMVR and TMVr.</p><p><strong>Conclusions: </strong>All in all, TMVr is currently preferred due to the lower procedural risks, while TMVR may provide more durable MR reduction and symptomatic improvement. Patient selection is critical, and future trials are needed to refine patient selection, and establish its role in clinical practice. Given that only three studies were eligible, this narrative review serves to describe preliminary evidence and highlight the need for more robust comparative data.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1450-1459"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey.","authors":"Lokeswara Rao Sajja, Gopichand Mannam, Prashanthi Beri, Balakrishna Nagalla","doi":"10.1007/s12055-025-02038-y","DOIUrl":"https://doi.org/10.1007/s12055-025-02038-y","url":null,"abstract":"<p><strong>Purpose: </strong>The management of acute type A aortic dissection (ATAAD) remains a challenge in cardiac surgery, with significant variability in practices influenced by surgeon experience, institutional resources, and patient demographics. This survey aims to evaluate the current trends in ATAAD management among Indian cardiac surgeons.</p><p><strong>Methods: </strong>A nationwide survey was conducted among Indian cardiac surgeons, collecting data on preoperative, intraoperative, and postoperative practices, as well as surgeon demographics and institutional case volumes. The survey questionnaire was distributed to 380 active Indian cardiac surgeons. Key trends and factors influencing decision-making were analyzed.</p><p><strong>Results: </strong>Two hundred surgeons responded to the survey questionnaire. In patients over 80 years of age, the management was conservative, with 73.49% of surgeons avoiding surgery. Timing of surgery within 24 h was prioritized by 68.37%. Axillary artery cannulation (55.81%) and antegrade cerebral perfusion (77.67%) were the most favored techniques. Deep hypothermia (18-20 °C) was used by 26.51% of surgeons, and moderate hypothermia (25-28 °C) was increasingly used by 32.09% of surgeons during circulatory arrest. Postoperative surveillance relied mainly on computed tomography angiography (CTA) (88.37%), while magnetic resonance angiography (MRA) was underutilized (19.53%). High-volume surgeons and centers were more likely to adopt advanced techniques. Barriers included limited access to resources, specialized training, and regional disparities in healthcare infrastructure.</p><p><strong>Conclusion: </strong>This study highlights significant variability in ATAAD management practices in India, underscoring the need for standardized guidelines tailored to the local context. Investments in training, infrastructure, and regional referral systems are essential to harmonize care and improve outcomes. India has the potential to optimize ATAAD management and enhance patient survival.</p><p><strong>Graphical abstract: </strong>Sajja, L.R., Mannam, G., Beri, P., Nagalla B. Indian Journal of Thoracic and Cardiovascular Surgery. Central picture: Practice variations in the management of acute type A aortic dissection among Indian cardiac surgeons: a national survey.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02038-y.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1408-1416"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New packaging, old ingredients: what the RHEIA Trial really tells us about TAVI in women?","authors":"Pradeep Narayan","doi":"10.1007/s12055-025-02067-7","DOIUrl":"https://doi.org/10.1007/s12055-025-02067-7","url":null,"abstract":"<p><p>The Randomized researcH in womEn all comers wIth Aortic stenosis (RHEIA) trial is the first randomized study to compare transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) exclusively in low-risk women with severe aortic stenosis. While results showed statistical superiority of TAVI for the composite endpoint of death, stroke, or rehospitalization at 1 year, this was driven primarily by reduced readmission rates. Mortality and stroke outcomes were similar between groups. Significant procedural imbalances and reliance on as-treated analysis raise concerns about interpretation. RHEIA not only fills a critical evidence gap in sex-specific valve therapy but also highlights persistent methodological challenges in evaluating treatment efficacy in this population.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1513-1515"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative C-reactive protein for differentiating tuberculous and malignant pleural effusion: A cross-sectional study.","authors":"Narayan Prakash Sharma, Ranjan Sapkota, Prajjwol Luitel, Roshan Shrestha","doi":"10.1007/s12055-025-01978-9","DOIUrl":"https://doi.org/10.1007/s12055-025-01978-9","url":null,"abstract":"<p><strong>Purpose: </strong>Pulmonary or pleural tuberculosis and malignancy are the most common causes of lymphocyte-rich pleural effusion. In resource-limited settings, establishing a definitive diagnosis for patients with pleural effusion (PEs) may be challenging, emphasizing the need for a simple diagnostic test. This study aimed to investigate the diagnostic value of quantitative C-reactive protein (qCRP) for differentiating between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE).</p><p><strong>Methods: </strong>A cross-sectional study was performed on 81 patients admitted for lymphocyte-rich exudative pleural effusion at a tertiary care center. Comprehensive biochemical analyses, including qCRP levels in the pleural fluid and pathological examinations of blood, pleural fluid, and/or tissue, were performed. The t-test was used for continuous variables, and the chi-square test was used for categorical variables. To assess the independent associations between variables, multivariate logistic regression analysis was performed. The diagnostic performance of pleural fluid qCRP levels was evaluated using a receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>Forty-four (54.3%) patients were diagnosed with TPE and 34 (42.0%) with MPE. The qCRP levels in the pleural fluid were significantly greater in the TPE group than in the MPE group (55.5 ± 45.9 mg/L vs. 18.6 ± 19.1 mg/L, <i>P</i> < 0.001). The cutoff value for pleural fluid CRP levels (≥ 24.1 mg/L) yielded a sensitivity of 65.9% and a specificity of 73.5% in predicting TPE.</p><p><strong>Conclusions: </strong>Pleural fluid qCRP is a simple, rapid, cost-effective diagnostic tool for differentiating tuberculous from malignant etiology in patients with lymphocyte-rich exudative pleural effusion.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01978-9.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1425-1431"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes following totally endoscopic mitral valve replacement versus mitral valve replacement through right thoracotomy: a prospective randomized controlled study.","authors":"Sandip Sardar, Monalisa Datta","doi":"10.1007/s12055-025-01981-0","DOIUrl":"https://doi.org/10.1007/s12055-025-01981-0","url":null,"abstract":"<p><p>Total endoscopic video-assisted mitral valve replacement represents a comparatively new advancement in cardiac surgery. It is associated with cosmetic benefits, minimal pain, and shorter hospital stay than right anterolateral thoracotomy approach of minimally invasive mitral valve replacement. Our study aims to delineate the advantages and disadvantages of these two minimally invasive techniques along with the relative improvement of quality of life. In this prospective randomized study, 40 patients undergoing isolated mitral valve replacement via right anterolateral thoracotomy approach (group A) and 40 patients undergoing the same procedure using the totally endoscopic method (group B) were randomly selected. Immediate postoperative outcomes, including duration of intensive care unit and hospital stay, were analyzed. Additionally, outcomes were assessed at 1 and 6 weeks, 6 months, and 1 year. Group B exhibited significantly lower pain scores (<i>p</i> - 0.012) and superior postoperative pulmonary function (<i>p <0.001</i>). Cosmesis, return to normal activities, and work were significantly higher in group B (<i>p</i> = 0.029 and <i>p</i> = 0.030 respectively). Left ventricular (LV) function, incidence of valve thrombosis, paravalvular leakage, and mortality rates were similar. A totally endoscopic mitral valve replacement technique provides better quality of life and patient satisfaction, with comparable cardiac function and complication rates to the right anterolateral thoracotomy approach.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1443-1449"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical presentation and rapid deterioration in a patient with pulmonary artery sarcoma: a case report.","authors":"Ramin Khameneh-Bagheri, Hakime Ghadiri Hakim, Alireza Tavassoli, Ahmad Nemati, Mahdi Radfar","doi":"10.1007/s12055-025-02003-9","DOIUrl":"https://doi.org/10.1007/s12055-025-02003-9","url":null,"abstract":"<p><p>Pulmonary artery sarcoma (PAS) is a rare disorder and can be challenging in terms of both diagnosis and treatment for cardiologists and cardiac surgeons. This case report describes a 63-year-old male who presented with acute dyspnea, exertional chest pain, and transient syncope, diagnosed with a massive saddle pulmonary embolism, without any significant risk factor. This impression was confirmed by echocardiography and computed tomography pulmonary angiography. Thrombolytic therapy was not effective, and the patient's conditions deteriorated. Therefore, the patient was scheduled for an embolectomy. Surprisingly, during the surgery, a large mass was detected at the bifurcation of the main pulmonary artery and mostly filling its lumen. This tumor was removed and diagnosed as PAS. Unfortunately, the patient's condition worsened over the next day, culminating in cardiopulmonary arrest and death. This case emphasizes the importance of considering differential diagnoses of pulmonary embolism in patients with atypical presentations and highlights the potential for rapid clinical decline despite aggressive management.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1469-1475"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of cardiac surgical outcomes across different healthcare funding modalities: a comprehensive cohort study.","authors":"Sufina Shales, Paramita Auddya Ghorai, Bharath Sundar, Anit Kumar, Kunal Patel, Sukanta Kumar Behera, Atanu Saha, Pradeep Narayan","doi":"10.1007/s12055-025-01987-8","DOIUrl":"https://doi.org/10.1007/s12055-025-01987-8","url":null,"abstract":"<p><strong>Aim: </strong>To critically examine patient outcomes across different funding categories in cardiac surgical interventions.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted on patients undergoing cardiac surgery between April 2017 and August 2023 at a single institution. Patients were stratified into six distinct funding categories: Cash Payment, Insurance, Government Schemes, Fund/Trust, Public Sector Unit, and the state-specific Swasthya Sathi patients. We examined three major surgical procedures: isolated coronary artery bypass grafting (CABG), aortic valve replacement, and mitral valve replacement. The primary outcome was mortality rates across various funding schemes and specific surgical procedures.</p><p><strong>Results: </strong>The overall mortality rate was 2.40%, with no statistically significant differences observed across funding categories (<i>p</i> = 0.74). Mortality rates for individual procedures were also comparable across funding sources: aortic valve replacement (<i>p</i> = 0.70), mitral valve replacement (<i>p</i> = 0.11), and isolated CABG (<i>p</i> = 0.68). Specifically, when comparing government scheme patients to cash-paying patients, no significant differences were found for aortic valve replacement (<i>p</i> = 0.65), mitral valve replacement (<i>p</i> = 0.53), or isolated CABG (<i>p</i> = 0.45). Among patients covered under West Bengal's state-sponsored Swasthya Sathi scheme, the mortality rate was 2.2%, compared to 2.7% in non-Swasthya Sathi patients (<i>p</i> = 0.47).</p><p><strong>Conclusion: </strong>Our study provides preliminary evidence that challenges the widespread perception of inferior care for government-funded patients. The study suggests that the funding mechanism does not significantly impact surgical outcomes in this cardiac surgery cohort, highlighting the potential effectiveness of diverse healthcare financing models in delivering equitable medical care.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01987-8.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1417-1424"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coil embolization for pulmonary sequestration may serve as an alternative to surgical treatment: under which circumstances?","authors":"İlteriş Türk, Mustafa Özdemir, Mehmet Çetin, Pınar Bıçakçıoğlu","doi":"10.1007/s12055-025-01997-6","DOIUrl":"https://doi.org/10.1007/s12055-025-01997-6","url":null,"abstract":"<p><p>Although surgical intervention for pulmonary sequestration (PS) has traditionally been the primary treatment for adults, recent case reports have shown successful outcomes with coil embolization. However, information regarding the application of surgical versus coil embolization options in different patient groups remains limited. We report on two cases: both asymptomatic and without significant parenchymal damage, who underwent successful coil embolization for intralobar PS. After coil embolization, the first patient has been followed up for 4 years and the second patient for 1 year without symptoms. In asymptomatic adult PS patients without significant parenchymal damage, coil embolization may be utilized as part of the management of potential complications during observation, as well as a safe alternative to surgical treatment. These patients should be monitored at regular intervals post-procedure, and surgery should be considered if complications develop.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1464-1468"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinal nocardiosis causing dysphagia/odynophagia: a case report.","authors":"Mathew Vadukoot Lazar, George Sarin Zacharia, Ismail Siyad","doi":"10.1007/s12055-025-02020-8","DOIUrl":"https://doi.org/10.1007/s12055-025-02020-8","url":null,"abstract":"<p><p>Nocardiosis is an uncommon but potentially life-threatening infection. It predominantly affects immunocompromised individuals or those with chronic lung diseases. The lungs are the most frequent focus of infection, followed by the skin and brain. Mediastinal nocardiosis remains exceedingly rare, with only a few cases reported in published medical literature. We report a case of a middle-aged man on chronic corticosteroids for autoimmune hemolytic anemia, who presented with dysphagia and odynophagia, with an apparently normal esophagogastroduodenoscopy, but with a mass/abscess abutting the esophagus on cross-sectional imaging, ultimately diagnosed with endoscopic ultrasound-guided aspiration yielding Gram-positive, acid-fast, branching filamentous rods, and culture confirmed <i>Nocardia</i> species. He was treated with intravenous imipenem and high-dose oral cotrimoxazole for 4 weeks, followed by prolonged oral cotrimoxazole therapy for 6 months, with an excellent clinical and radiological response. To our knowledge, this is the first reported case of mediastinal nocardiosis presenting with dysphagia/odynophagia, expanding the clinical spectrum of this rare infection and, highlighting the need for high clinical suspicion in immunocompromised patients with esophageal symptoms. With the rapid evolution of immunosuppressive therapies in the setting of neoplasia and organ transplantation, clinicians likely come across a myriad of manifestations of opportunistic infections, including nocardiosis. Multimodal imaging and advanced endoscopic techniques for tissue harvesting or aspiration facilitate the early recognition of these rare diseases and subsequent appropriate antimicrobial therapy, early enough for favorable outcomes.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02020-8.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1498-1502"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on \"The Effect of the Extent of the Stent Graft Coverage of the Aorta on the Remodeling of the Distal False Lumen after Thoracic Endovascular Aortic Repair for Non-traumatic Type IIIB Dissections\".","authors":"Aashir Zahid, Syed Mudassir Ahmed Jillani, Maliha Khan","doi":"10.1007/s12055-025-02018-2","DOIUrl":"https://doi.org/10.1007/s12055-025-02018-2","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1519-1520"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}