Journal of Cardiothoracic Surgery最新文献

{"title":"Purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex oncologic and cardiac history.","authors":"Cameron Rattray, Mohamad Moughnyeh, Jibran Fateh, Michael Lee","doi":"10.1186/s13019-025-03411-z","DOIUrl":"10.1186/s13019-025-03411-z","url":null,"abstract":"<p><strong>Background: </strong>Hepatic-pericardial fistulas are extremely rare complications typically arising from hepatic abscesses, trauma, or invasive procedures. These fistulas can lead to clinical manifestations such as pericarditis, cardiac tamponade, and septic shock. We report a case of purulent pericarditis and septic shock secondary to a hepatic-pericardial fistula in a patient with complex cardiac and oncologic history.</p><p><strong>Case presentation: </strong>A 76-year-old man with a history of pancreatic, renal cell and prostate cancer presented with acute chest pain and dyspnea. Initial investigations revealed a moderate pericardial effusion and a suspicious hepatic lesion. The patient developed cardiac tamponade and underwent emergency pericardiocentesis, draining 750 ml of purulent fluid. A CT-guided biopsy confirmed a hepatic abscess with fistulization to the pericardium. Despite antibiotic therapy and drainage procedures, the patient's condition deteriorated, resulting in septic shock and death.</p><p><strong>Discussion: </strong>This case highlights the challenges in managing hepatic-pericardial fistulas, particularly in patients with significant comorbidities. Bacteroides fragilis was identified as the causative pathogen, which underscores the importance of timely identification and management of these rare infections. Early surgical intervention and targeted antibiotic therapy are critical, although prognosis remains poor in patients with compromised cardiovascular and respiratory status.</p><p><strong>Conclusion: </strong>Hepatic-pericardial fistulas, though rare, should be considered in patients with unexplained pericarditis or septic shock, particularly in the presence of hepatic abscesses. Early recognition, multidisciplinary management, and individualized treatment are essential to improve outcomes.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"274"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total thyroidectomy performed under general anesthesia with venovenous extracorporeal membrane oxygenation during a thyroid storm: a case report.","authors":"Hyung Gon Lee, Joon-Suk Bom, Leyeoin Lee, Joungmin Kim","doi":"10.1186/s13019-025-03491-x","DOIUrl":"10.1186/s13019-025-03491-x","url":null,"abstract":"<p><strong>Background: </strong>Thyroid storm (TS) is an endocrine emergency requiring aggressive medical management. In severe cases, hemodynamic instability may necessitate extracorporeal membrane oxygenation (ECMO) support as a bridge to definitive surgical treatment. ECMO is categorized into two types: venoarterial (V-A) ECMO, which provides both cardiac and pulmonary support, and venovenous (V-V) ECMO, which supports only pulmonary function. Surgery is generally not recommended for patients with unstable TS due to the high risk of complications, even when ECMO support is in place. Here, we present a case of a 44-year-old man initially improved with V-A ECMO for TS with cardiogenic shock, but later developed refractory hypoxemia due to pulmonary thromboembolism (PTE). He subsequently underwent emergency thyroidectomy with continuous support from V-V ECMO.</p><p><strong>Case presentation: </strong>A 44-year-old man presented to our hospital with complaints of palpitations. He had a recent history of coronavirus disease of 2019 (COVID-19) infection, which may have exacerbated undiagnosed hyperthyroidism, leading to thyroid storm and cardiogenic shock (left ventricular ejection fraction [LVEF], 13%). Heart failure improved with immediate medical management and V-A ECMO for 4 days, resulting in LVEF, 30%. V-A ECMO provide both respiratory and cardiac support, allowing myocardial recovery. Although the patient's cardiac output improved, uncontrolled tachycardia persisted. Medical treatment for hyperthyroidism-associated tachycardia was continued after V-A ECMO weaning but failed to achieve adequate rate control. Ten days after weaning V-A ECMO, the patient suddenly developed pulmonary thromboembolism and hypoxia despite ongoing heparinization. To manage refractory hypoxia, V-V ECMO was initiated, as it exclusively provides respiratory support. Given that persistent TS was the underlying cause of the patient's instability, we proceeded with thyroidectomy under general anesthesia with V-V ECMO support, despite the associated risks. On postoperative day 4, the patient was successfully weaned off V-V ECMO. By postoperative day 18, he was discharged without complications, with an improved LVEF of 52.5%.</p><p><strong>Conclusions: </strong>This is the first reported case of total thyroidectomy performed while on V-V ECMO support for TS complicated by PTE. Although V-V ECMO is more susceptible to hemodynamic instability than V-A ECMO, this case demonstrates that thyroidectomy can be successfully performed with appropriate anesthesia management. Additionally, careful selection of the ECMO modality based on the patient's condition is crucial for optimal management.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"273"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12188653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of hemadsorption combining with cardiopulmonary bypass used in patients with acute type A aortic dissection.","authors":"Shichao Guo, Zhiyuan Wang, Youwei Zhao, Yingying Guo, Huijun Zhang, Jia Liu","doi":"10.1186/s13019-025-03497-5","DOIUrl":"10.1186/s13019-025-03497-5","url":null,"abstract":"<p><strong>Background: </strong>It is hypothesized that combining HA380 with cardiopulmonary bypass (CPB) in acute type A aortic dissection (ATAAD) surgery could reduce the inflammatory response induced by CPB and subsequently improve prognosis.? Therefore, we aimed to assess the short-term effectiveness of combining HA380 with CPB in treating ATAAD.</p><p><strong>Methods: </strong>This study exclusively included individuals diagnosed with ATAAD at our institution from January 2021 to April 2023. After propensity score matching (PSM), patients were allocated into two groups: the hemadsorption (HA) group (n = 45) and the control group (n = 45). The outcome measures included commonly used clinical inflammatory markers, coagulation function, liver and kidney function, ventilator time, and time of ICU stay duration.</p><p><strong>Results: </strong>Patients in the HA group exhibited elevated postoperative levels of procalcitonin and systemic coagulation-inflammation index (SCI), along with lower white blood cell counts and blood urea nitrogen levels compared to the control group. The HA group had a significantly higher 60-day postoperative survival rate compared to the control group. While the HA group experienced reduced in-hospital mortality and stroke incidence, only the reduction in stroke incidence showed a significant association with the intervention after adjusting for confounders.</p><p><strong>Conclusion: </strong>The application of HA380 does not significantly reduce all postoperative inflammatory indicators in ATAAD surgery. The reduction in inflammatory response was also not obvious. However, it was associated with a significantly lower stroke incidence and improved 60-day survival, suggesting potential clinical benefits in specific outcomes. The specific mechanisms underlying the lower rates of stroke and mortality require further investigation.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"269"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of miR-637 for the occurrence of myocardial hypertrophy in patients with hypertension.","authors":"Shenglan Zou, Xiaomin Li, Xueya Liu, Fei Sun","doi":"10.1186/s13019-025-03517-4","DOIUrl":"10.1186/s13019-025-03517-4","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is one of the cardiovascular diseases that seriously endangers human life and health, and myocardial hypertrophy is the most common secondary condition of hypertension. Hypertensive with myocardial hypertrophy patients have very high rates of disability and mortality. Previous studies have shown that miR-637 is downregulated in hypertension. Here, our objective was to investigate the correlation and diagnostic potential of serum miR-637 levels in hypertensive patients with myocardial hypertrophy, and to develop new biomarkers for clinical applications.</p><p><strong>Methods: </strong>The content of serum miR-637 was detected by RT-qPCR. ROC curve was used to analyze the diagnostic accuracy of serum miR-637 in hypertension with myocardial hypertrophy. Logistic analysis was used to evaluate the risk factors associated with hypertension with myocardial hypertrophy. The effect of miR-637 on the viability of H9c2 cells was verified by transfection in vitro. The model of myocardial hypertrophy was established by treating H9c2 cells with Ang II.</p><p><strong>Results: </strong>Compared with healthy controls, miR-637 expression was attenuated in hypertensive patients and weakest in hypertension patients with myocardial hypertrophy. ROC curve showed high sensitivity (78.8%) and specificity (85.0%) of miR-637 in predicting the occurrence of hypertension with myocardial hypertrophy. miR-637 was a risk factor for predicting the development of hypertension with myocardial hypertrophy and showed a negative correlation with LVMI. Overexpression of miR-637 enhanced H9c2 cell viability and decreased apoptosis rate. Ang II treatment decreased miR-637 expression, inhibited cell proliferation, promoted apoptosis, and increased myocardial hypertrophy markers levels, whereas transfection with miR-637 mimic reversed this trend.</p><p><strong>Conclusion: </strong>miR-637 is poorly expressed in hypertension patients with myocardial hypertrophy and may be an indicator of clinical diagnosis. In addition, miR-637 may serve as a biomarker for diagnosing whether hypertensive patients have myocardial hypertrophy.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"270"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic annulus reconstruction with bovine pericardium during aortic valve replacement for severe calcific aortic stenosis.","authors":"Jiaao Li, Tao Yang, Nan Wu, Yan Qin, Jianing Gao, Zhenhao Liu, Lingbo Yang, Xuening Wang","doi":"10.1186/s13019-025-03505-8","DOIUrl":"10.1186/s13019-025-03505-8","url":null,"abstract":"<p><strong>Objective: </strong>To explore the application and effect of aortic annulus reconstruction (AAR) with bovine pericardium during surgical aortic valve replacement (SAVR) for severe calcific aortic stenosis (AS).</p><p><strong>Methods: </strong>We retrospectively reviewed 12 patients with severe calcified AS who underwent bovine pericardium aortic annulus reconstruction between January 2021 to December 2023. The average age of the patients was 58 ± 8.8 years. All patients were diagnosed with severe AS, along with aortic valve and annulus calcification, through chest computed tomography (CT) and transthoracic echocardiography (TTE) prior to surgery. After the resection of severely calcified aortic annulus tissue, all patients were given a bovine pericardial patch to repair the annular defect, and five of these patients underwent Y-incision aortic annular enlargement (AAE). The patients were followed up for a duration of 0.5 to 2 years.</p><p><strong>Results: </strong>A total of 12 patients undergoing SAVR were enrolled, and all received bovine pericardial patches to repair the annular defects, with a mean preoperative indexed effective orifice area (iEOA) of 0.58 ± 0.098 cm²/m². The average extracorporeal circulation time during the operation was 150.83 ± 34.5 min, and the average cross-clamp time was 95.42 ± 17.46 min. Postoperative evaluations indicated that the structural integrity of the valve annulus remained intact, demonstrating hemodynamic stabilization without any recorded fatalities among participants. Compared to preoperative levels, the aortic valve mean gradient (4.67 ± 1.15 vs. 59.67 ± 17.94 mmHg, P < 0.001), peak gradient (13 [10-15.75] vs. 92 [82.25-110.25] mmHg, P < 0.001), mean aortic jet velocity (99.67 ± 15.44 vs. 367.17 ± 58.13 cm/s, P < 0.001), and peak aortic jet velocity (182.25 ± 23.40 vs. 495.67 ± 61.74 cm/s, P < 0.001) significantly decreased after 0.5 years of follow-up. There were no complications such as hemolysis, perivalvular leakage, thrombosis or endocarditis during follow-up.</p><p><strong>Conclusion: </strong>In patients with severe calcified AS, the AAR technique using bovine pericardium during SAVR is safe and effective, with stable hemodynamic performance and satisfactory clinical outcomes.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"272"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of 3-dimensional reconstruction via modified pulmonary artery computed tomography angiography in anatomic pulmonary segmentectomy.","authors":"Weiwei Min, Jianbin Zhang, Yilv Zhu, Lili Jin","doi":"10.1186/s13019-025-03515-6","DOIUrl":"10.1186/s13019-025-03515-6","url":null,"abstract":"<p><strong>Background: </strong>This retrospective study aimed to summarize the application of 3-dimensional(3D) reconstruction via modified pulmonary artery computed tomography angiography(CTA), as well as to compare the surgical outcomes of 3D versus high resolution CT(HRCT) in anatomic pulmonary segmentectomy(APS).</p><p><strong>Methods: </strong>A total of 93 patients who underwent thoracoscopic APS were enrolled in the study. They were divided into 3D group (n = 30) and HRCT group (n = 63), and than matched at 1:1 ratio using the propensity score matching (PSM) method. Clinical characteristics, surgical status, and postoperative recovery were compared between two groups, additionally, variations of segmental structures were summarized.</p><p><strong>Results: </strong>60 cases were matched by PSM with 30 cases in each group. There were no significant differences between two groups in clinical characteristics, intraoperative blood loss and postoperative recovery (including total chest drainage, length of postoperative hospital stay)(P > 0.05 for all). 8(26.7%) patients in 3D group manifesting unique variations of segmental structures underwent anatomical segmentectomy accurately. Despite the 3D group exhibited higher anatomic variations compared to the HRCT group, it demonstrated shorter operation times and lower incidence of pulmonary infection. (P < 0.05 for all).</p><p><strong>Conclusion: </strong>Preoperative 3D reconstruction has advantages in APS, particularly for patients with complex anatomic variations. Reconstruction via modified pulmonary artery CTA is also feasible for preoperative planning and intraoperative navigation in thoracoscopic APS.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"271"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlations of serum histone deacetylase 3 and thrombospondin-1 levels with cardiac function grades, ventricular remodeling, and prognosis in patients with chronic heart failure.","authors":"Jiange Cheng, Tao Cheng","doi":"10.1186/s13019-025-03467-x","DOIUrl":"10.1186/s13019-025-03467-x","url":null,"abstract":"<p><strong>Background: </strong>This study aims to analyze the relations of serum Histone Deacetylase 3 (HDAC3) and Thrombospondin-1 (TSP-1) levels to cardiac function grades, ventricular remodeling, and prognosis of patients with chronic heart failure (CHF).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 128 enrolled CHF patients, with 102 healthy individuals as controls. Baseline data and two-year follow-up records were collected to assess prognosis. Serum levels of HDAC3 and TSP-1 were measured using ELISA, and their correlations with ventricular remodeling indicators such as LVEF, LVEDD, LVFS, BNP, NT-proBNP, and cTnI were analyzed using Pearson's correlation coefficient.</p><p><strong>Results: </strong>No significant differences were observed among participants in terms of age, gender, BMI, comorbidities, smoking history, and drinking history. CHF patients exhibited significantly reduced LVEF and LVFS, while LVEDD, BNP, NT-proBNP, cTnI levels, and serum levels of HDAC3 and TSP-1 were markedly elevated. It was found that serum levels of HDAC3 and TSP-1 increased with worsening cardiac function. Both of them correlated significantly with ventricular remodeling indicators, and their elevation was an independent risk factor for poor prognosis in CHF patients.</p><p><strong>Conclusion: </strong>Serum levels of HDAC3 and TSP-1 are elevated in CHF patients, exhibiting significant correlations with ventricular remodeling indicators. Combined detection of these two markers may assist in predicting poor prognosis in CHF patients.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"268"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"En bloc versus branched graft technique for supra-aortic vessel reimplantation in total arch replacement: a systematic review and meta-analysis.","authors":"Kristine Santos, Kensei Oya, Tulio Caldonazo, Tomasz Płonek","doi":"10.1186/s13019-025-03468-w","DOIUrl":"10.1186/s13019-025-03468-w","url":null,"abstract":"<p><strong>Objectives: </strong>Total arch replacement (TAR) necessitates reimplantation of supra-aortic vessels to preserve blood flow to the brain and upper body. En bloc (EB) or branched graft (BG) techniques are commonly performed for this, however, their comparative superiority remains under debate. Our meta-analysis aims to compare the outcomes associated with these two approaches.</p><p><strong>Methods: </strong>A comprehensive literature search was performed across MEDLINE, Cochrane, and Scopus databases, focusing on studies that compared EB and BG for TAR. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using RevMan 8.13.0.</p><p><strong>Results: </strong>The final analysis included six observational studies comprising a total of 2,028 patients, with 50.2% of supra-aortic vessel reimplantations for TAR conducted using the EB technique. The pooled results revealed a statistically significant reduction in aortic cross-clamp (ACC) time favouring the EB group [MD -13.2 min; 95% CI -22.7 to -3.7; p < 0.05]. Intraoperative and 30-day mortality as well as other postoperative complications such as permanent and transient neurological deficits, acute kidney injury, myocardial infarction, reoperation for bleeding, and aortic reintervention were comparable between the two approaches.</p><p><strong>Conclusion: </strong>The available evidence suggests that the EB technique is associated with a significantly shorter ACC time compared to the BG technique, with comparable rates of mortality and postoperative complications. However, these findings are limited by the observational nature of the included studies, therefore, higher-quality prospective research is needed to confirm our results.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"267"},"PeriodicalIF":1.5,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12186343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of radial access versus femoral access for rotational atherectomy: an updated systematic review and meta-analysis.","authors":"Muhammad Ahmed, Muzna Murtaza, Muhammad Muzammil, Syeda Zuha Sami, Ariba Nazir, Muhammad Ahmed, Afsana Ansari Shaik, Muhammad Sohaib Asghar","doi":"10.1186/s13019-025-03512-9","DOIUrl":"10.1186/s13019-025-03512-9","url":null,"abstract":"<p><strong>Background: </strong>Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.</p><p><strong>Methods: </strong>PubMed, Google Scholar, and Cochrane Library were searched until May 2024 for studies comparing the radial and femoral approaches in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, and hospital stay. Generic inverse variance (GIV) was used to pool the risk ratio for dichotomous outcomes and mean difference (MD) for the continuous outcomes, with corresponding 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Twelve studies including 15,700 patients with a mean age of 77.77 years in the radial group and 74.04 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was a significantly lower risk (RR: 0.23; 95% CI [0.12, 0.41]; p < 0.00001) in the radial group as compared to the femoral group. From the secondary outcomes, radial access was found to have significantly lower MACE (RR:0.80; 95% CI [0.68, 0.93]; p = 0.004), shorter procedural time (MD: -6.95; 95% CI [-11.52, -2.38], p = 0.003) and hospital stay (MD: -2.8; 95% CI [-5.56, -0.04], p = 0.05) as compared to femoral group. In contrast, all the other secondary outcomes were found to be insignificant.</p><p><strong>Conclusion: </strong>Rotational atherectomy using the radial approach has a significantly lower rate of major vascular site bleeding and MACE and is associated with significantly shorter procedural time and hospital stay.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"266"},"PeriodicalIF":1.5,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diameter of sinotubular junction to body surface area is independently associated with incident acute type a aortic dissection.","authors":"Wuwei Wang, Yiming Liu, Xiaodi Wang, Hong Ran, Fuhua Huang, Jifang Zhou, Xin Chen, Cunhua Su","doi":"10.1186/s13019-025-03502-x","DOIUrl":"10.1186/s13019-025-03502-x","url":null,"abstract":"<p><strong>Objective: </strong>The main aim of this study is to measure and calculate the ratio of sinotubular junction diameter to body surface area (RDA) in patients with acute type A aortic dissection (ATAAD) and normal subjects, and to analyze the relationship between RDA and ATAAD to provide guidance for primary prevention of ATAAD.</p><p><strong>Methods: </strong>This retrospective observational study totally admitted consecutive 320 patients with acute type A aortic dissection diagnosed in Nanjing First Hospital from March 2017 to March 2021. Meanwhile, 608 healthy subjects who took echocardiography examination in outpatient was selected as controls. The diameter of sinotubular junction (D.STJ) was measured using echocardiography and direct vision (in some ATAAD patients). The differences in body surface area (BSA), D.STJ and RDA index in both groups were assessed. The association between D.STJ and demographic characteristics were established. RDA index was used to distinguish the ATAAD and healthy subjects.</p><p><strong>Results: </strong>The diameter of STJ (24.41 ± 2.16 mm versus 26.66 ± 2.60 mm) and RDA index (13.16 ± 1.67 versus 15.40 ± 1.59) were significantly different between dissection group and control group. The D.STJ were found a positive, linear correlation to BSA in the healthy subjects. Multivariate logistic regression showed that RDA index was one of the independent risk factors to associated with ATAAD as a continuous variable (odds ratio (OR), 0.403, 95% confidence interval (CI): 0.352-0.457, P < 0.001) or a categorical variable (RDA cut-off: 13.88 mm/m², OR, 0.070, 95%CI: 0.050-0.098, P < 0.001).</p><p><strong>Conclusions: </strong>RDA index is an independent and key risk factor for ATAAD occurrence. Timely identification of high-risk patients using RDA index has the potential to become an optional guidance for primary prevention of ATAAD.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"263"},"PeriodicalIF":1.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12177952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}