Journal of Cardiothoracic Surgery最新文献

{"title":"Ultra-fast-track extubation is associated with reduced EEG abnormalities and improved early outcomes after pediatric cardiac surgery: a propensity score-matched cohort study.","authors":"Xiaowei Li, Rouyi Lin, Na Du, Jinqing Feng, Na Zhou, Shuyao Ning, Xinxin Chen, Li Ma, Mingjie Zhang, Huaizhen Wang, Jia Li","doi":"10.1186/s13019-026-04153-2","DOIUrl":"https://doi.org/10.1186/s13019-026-04153-2","url":null,"abstract":"<p><p>Ultra-fast-track extubation (UF) improves postoperative recovery in cardiac surgery, but its cerebral effects remain unclear. This study compared UF and conventional extubation (CE) in children with congenital heart disease (CHD) after cardiopulmonary bypass (CPB), focusing on electroencephalographic (EEG) abnormalities during the initial 48 postoperative hours. Of 352 CHD patients undergoing CPB, 57 UF and 295 CE cases were propensity score-matched (PSM) (1:2), yielding 55 PSM-UF and 89 PSM-CE subjects. Intra/postoperative EEGs were analyzed for background abnormalities (sleep-wake cycle) and epileptiform discharges (seizures, spikes/sharp waves). Clinical parameters including STS-EACTS mortality risk and CPB duration were balanced. The PSM-UF group demonstrated milder background abnormalities (P = 0.02) and lower incidence of unresolved abnormalities at 48 h (7% vs. 24%, P = 0.009). Epileptiform activity was significantly reduced (0% vs. 11% seizures, P = 0.007; P = 0.008 for spikes/sharp waves). UF patients showed superior cerebral oxygen saturation (ScO₂, P < 0.0001), reduced vasopressor requirements (P < 0.0001), and shorter hospital stays (2.0 ± 1.4 vs. 6.0 ± 5.6 days, P < 0.0001) with comparable CICU stay reductions (9.6 ± 4.1 vs. 13.3 ± 8.5 days, P = 0.002). UF following pediatric cardiac surgery correlates with attenuated EEG abnormalities and enhanced early recovery, supporting its neuroprotective benefits in CHD patients.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial protection during surgery for infective endocarditis: retrospective, single center, risk-adjusted study.","authors":"Murat Mukharyamov, Tulio Caldonazo, Philine Fleckenstein, Sebastian Freiburger, Hristo Kirov, Mathias Pletz, Stefan Hagel, Jürgen Bogoviku, Sandesh Dinesh, Stefan Glöckner, Micha Banz, Mahmoud Diab, Torsten Doenst","doi":"10.1186/s13019-026-04246-y","DOIUrl":"10.1186/s13019-026-04246-y","url":null,"abstract":"<p><strong>Objectives: </strong>Current evidence does not support superiority of one cardioplegia type over another, but stems from low-risk populations. Therefore, we compared outcomes of multimorbid, high-risk infective endocarditis (IE) patients receiving Custodiol^®crystalloid or Calafiore blood cardioplegia during cardiac surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed 553 patients (mean EuroScore II 22.7 ± 21.1) who underwent surgery for IE between 2009 and 2023 and received either cold crystalloid (Custodiol^®, n = 335) or warm blood (Calafiore, n = 218) cardioplegia. The primary endpoint was 1-year mortality. Secondary endpoints included 30-day mortality, postoperative stroke, and new-onset dialysis. Propensity score matching (1:1, 14 covariates) resulted in 175 matched pairs. Statistical analysis included nonparametric and exact tests.</p><p><strong>Results: </strong>In the overall cohort, patients receiving Custodiol^® were higher risk and had higher mortality and morbidity. After matching, there was no significant difference in 1-year mortality between patients receiving Custodiol^® and Calafiore (37.1% vs. 28.6%, p = 0.09). 30-day mortality trended to be lower in the Calafiore group without reaching statistical significance (22.9% vs. 14.9%, p = 0.057). However, stroke was less frequent (4.6% vs. 10.9%, p = 0.029), ICU stay was shorter (3[1-8] vs. 6[3-12.5] days, p < 0.001) and postoperative dialysis was numerically less common (13.7 vs. 20.6%, p = 0.091). These differences were most evident in procedures with shorter cross-clamp times, such as isolated mitral or aortic valve surgery, where mortality and recovery parameters consistently favored Calafiore.</p><p><strong>Conclusions: </strong>In high-risk endocarditis patients warm blood cardioplegia may be superior to cold crystalloid, although differences did not reach statistical significance. However, propensity matching may not have accounted for all differences, which warrants further discussion and investigation.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13151226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838294","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":"Myectomy with secondary chordal resection in hypertrophic obstructive cardiomyopathy: the mid-term outcomes.","authors":"Zhuheng Wu, Zedong He, Lin Xie, Songbo Zhang, Hong Qian, Yajiao Li, Yanlin Yang, Changping Gan, Ke Lin","doi":"10.1186/s13019-026-04205-7","DOIUrl":"https://doi.org/10.1186/s13019-026-04205-7","url":null,"abstract":"<p><strong>Background: </strong>It is not clear whether septal myectomy with secondary chordal resection (SM-SCR) can achieve similar postoperative outcomes among hypertrophic obstructive cardiomyopathy (HOCM) patients exhibiting different severity of septal hypertrophy.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study with a nested case-control study. HOCM patients received SM-SCR between 2014 and 2023 were retrospectively included and were grouped based on their septal thickness. The main outcome was the relief of the left ventricular outflow tract (LVOT) obstruction. Besides, predictors for recurrent mitral regurgitation (MR) were also explored.</p><p><strong>Results: </strong>A total of 88 patients were included, with 63 in the significant hypertrophy group (SH group) and 25 in the mild hypertrophy group (MH group). The overall median follow-up time was 54.0 (33.0-79.0) months. Before adjusting the covariates, The LVOT gradients at the last follow-up were similar between groups [SH group vs. MH group: 10.0 (6.0-14.0) mmHg vs. 8.0 (6.0-11.5) mmHg, P = 0.556], while the interventricular septum (IVS) was thicker for the SH group [15.0 (12.0-17.0) mm vs. 13.0 (11.0-14.0) mm, P = 0.016]. In the fully adjusted model, both the LVOT gradients and the IVS thickness were comparable (P = 0.606 and 0.520 respectively). The risk of recurrent MR was similar between groups (7.9% vs. 8.0%, log-rank P = 0.879), while no predictors for recurrent MR were identified.</p><p><strong>Conclusion: </strong>According to our single-center data, the mid-term outcomes after SM-SCR were comparable for HOCM patients with different severity of septal hypertrophy. However, further investigations with larger sample sizes and longer follow-up durations are needed.</p><p><strong>Trial registration: </strong>The study was approved by the Institutional Review Board [2023(2408)], and patients' consents were waived due to the retrospective nature of the study.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative direct coronary angiography clarifying a misleading coronary stenosis caused by an ascending aortic floating thrombus: a case report.","authors":"Mei Li, Xiangfeng Gong, Zhi Fang","doi":"10.1186/s13019-026-04211-9","DOIUrl":"https://doi.org/10.1186/s13019-026-04211-9","url":null,"abstract":"<p><strong>Background: </strong>Ascending aortic thrombus is an uncommon entity that may mimic primary aortic tumors. When aortic masses coexist with suspected coronary stenosis, conventional coronary angiography may increase the risk of thrombus embolization. We describe a case in which an ascending aortic thrombus produced imaging features suggestive of both aortic tumor and coronary disease, and demonstrate the diagnostic value of intraoperative direct coronary angiography.</p><p><strong>Case presentation: </strong>A 60-year-old man presented with a two-year history of chronic dry cough. Transthoracic echocardiography revealed a mildly mobile 1.5 × 2.5 cm weakly echogenic mass on the anterior ascending aorta. Transesophageal echocardiography confirmed a 1.6 × 2.8 cm homogeneous, smooth-surfaced mass with a broad attachment to the aortic intima and no intimal tear or vascularity. Coronary computed tomography angiography showed a severe mid-left anterior descending artery stenosis, though the mass was distant from coronary ostia. Preoperative coronary angiography was avoided because of the high risk of thrombus embolization during angiography. During surgery, intraoperative direct coronary angiography via a cardiopulmonary perfusion needle excluded significant coronary artery disease. The mass was excised intact; pathology revealed an organized thrombus with myxoid degeneration. Recovery was uneventful, and the patient remained asymptomatic at follow-up.</p><p><strong>Conclusions: </strong>Diagnosis of an ascending aortic mass relies on careful multimodality imaging, and surgical excision can be performed safely. When conventional coronary angiography is not feasible, intraoperative direct angiography provides a reliable alternative for assessing coronary anatomy.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and quality of life outcomes after CABG in a South Asian country: a prospective study.","authors":"Asma Altaf Hussain Merchant, Mohammad Umair Khan, Ebadullah Shahood Ahmed, Areesha Ahmer, Mustafa Ali Khan, Malik Muhammad Hamza Khan, Mohammad Bin Pervez, Shahid Sami, Syed Shahabuddin, Ashar Khan, Saulat Hasnain Fatimi","doi":"10.1186/s13019-026-04116-7","DOIUrl":"https://doi.org/10.1186/s13019-026-04116-7","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) is a proven life-saving intervention for ischemic heart disease (IHD). However, literature on its post-surgical quality of life (QoL) and mental health is limited in resource-constrained settings, where IHD burden remains high. This study determined changes in depression, anxiety, and QoL pre-operatively to 1- and 6-month post-CABG in a South Asian low- and middle-income country (LMIC).</p><p><strong>Methods: </strong>This prospective study was conducted at a large private hospital in Pakistan (February 2022-March 2023). Data were collected pre-operatively, 1-month, and 6-month post-CABG. Beck Depression Inventory II (BDI-II), Beck Anxiety Inventory (BAI), and 36-Item Short Form Health Survey (SF-36) were used to assess depression, anxiety, and QoL, respectively. Pre-operative scores were compared with 1-month and 6-month post-operative scores using paired t-tests, with p-value < 0.05 considered significant.</p><p><strong>Results: </strong>The mean age of 82 patients with complete pre-operative data was 58.48 ± 10.07 years. 1- and 6-month follow-up rates were 63% and 53.7%, respectively. No significant differences were noted for depression, but mean anxiety scores reduced preoperatively to 6-month postoperatively (7.48 ± 8.44 to 4.39 ± 7.25, p-value:0.0216). 6-month postoperative results demonstrated significant improvements from preoperative scores in physical functioning (57.39 to 81.36), role limitations due to physical health (32.39 to 69.89), role limitations due to emotional problems (58.33 to 84.09), and general health perceptions (71.36 to 81.36).</p><p><strong>Conclusion: </strong>This study showed improvement in anxiety and QoL 6 months after CABG. However, depression scores remained unchanged. Interventions like pre-operative counselling, post-operative cardiac rehabilitation, and long-term psychiatric evaluation are critical to support sustained recovery post-CABG.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and financial comparison of percutaneous debulking versus surgical management of tricuspid endocarditis.","authors":"Sanjhai L Ramdeen, Sahaj S Shah, Clement J Rajakumar, Jordan G Law, Kent A Strohecker, Stephanie A Buczkowski, Damian D Mason, Michael E Friscia, Michael A Bresticker, Shikhar Agarwal, Carlo R Bartoli","doi":"10.1186/s13019-026-04061-5","DOIUrl":"https://doi.org/10.1186/s13019-026-04061-5","url":null,"abstract":"<p><strong>Background: </strong>Intravenous drug abuse (IVDA) has increased the incidence of infective endocarditis. Standard management includes traditional open surgery and more recently described percutaneous tricuspid valve debulking. Study goals were to compare clinical outcomes and identify financial differences between percutaneous tricuspid debulking and tricuspid surgery for isolated tricuspid valve endocarditis.</p><p><strong>Methods: </strong>A single-center, retrospective cohort patient study of isolated tricuspid valve endocarditis was performed. Patients underwent either percutaneous debulking with the AngioVac system (n=14, 83% IVDA) or tricuspid valve surgery (n=23, 76% IVDA). Length of stay, readmission rates, mortality, echocardiographic parameters, hematologic markers, transfusion rates, and total charges for index hospitalization were evaluated between groups.</p><p><strong>Results: </strong>In patients who underwent either percutaneous debulking or open surgery, length of stay (17±17 vs 20±13 days, p=0.48), 30-day readmission (29% vs 26%, p=0.87), in-hospital mortality (7% vs 0%, p=0.20), and 30-day mortality (7% vs 0%, p=0.20) were not statistically different. One-year mortality (21% vs 4%, p=0.11) trended toward but did not reach significance. Postoperative tricuspid valve regurgitation (2.5±1.1 vs 1.0±0.3, p<0.0001) and transfusion rates (2±3 vs 6±6 units, p=0.02) were significantly different between therapies. Total charges for hospitalization were not statistically different ($557,066±457,520 vs $571,615±324,254, p=0.91).</p><p><strong>Conclusions: </strong>Tricuspid debulking is a potential alternative to surgery for patients with infective tricuspid endocarditis. Similar outcomes, costs, and avoidance of prosthetic material in patients with active IVDA are potential benefits.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe mitral regurgitation after aortic annular enlargement with Y-incision: a case report.","authors":"Safa Özçelik, Farid Gojayev","doi":"10.1186/s13019-026-04047-3","DOIUrl":"https://doi.org/10.1186/s13019-026-04047-3","url":null,"abstract":"<p><strong>Background: </strong>The Y-incision technique enables implantation of larger prosthetic valves by facilitating effective aortic annular enlargement. Although this approach improves hemodynamic outcomes, rare and clinically significant complications may occur and remain insufficiently described.</p><p><strong>Case presentation: </strong>A patient undergoing surgical aortic valve replacement with concomitant Y-incision annular enlargement developed early postoperative severe central mitral regurgitation. Standard transthoracic and transesophageal echocardiography demonstrated abnormal aorto-mitral geometry and annular distortion. Reoperation revealed deformation of the mitral annulus adjacent to the patch implantation site. Based on intraoperative findings, imaging data, and schematic analysis, we hypothesized that turbulent flow within the pouch-like neo-aortomitral curtain combined with patch sutures placed near the mitral annulus contributed to annular distortion and subsequent mitral valve incompetence.</p><p><strong>Conclusion: </strong>Severe mitral regurgitation represents a rare but clinically important complication of the Y-incision technique. Patient-specific aorto-mitral anatomy, including annular distance and aorto-mitral angle, may play a critical role in this mechanism. Careful preoperative anatomical assessment and meticulous intraoperative patch positioning are essential to minimize this risk and improve procedural safety.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visualization analysis of research hotspots and trends in Type B Aortic Dissection based on bibliometrics.","authors":"Yinghong Li, Yierpani Aierken, Zhian Liang, Yuqi Wang, Yuanhao Sun, Zongwei Liu, Jiayin Guo, Jiaxin Wang, Jiaxue Bi, Xiangchen Dai","doi":"10.1186/s13019-026-04217-3","DOIUrl":"https://doi.org/10.1186/s13019-026-04217-3","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to systematically map and analyze the knowledge structure, research hotspots, and evolutionary trends in the field of Type B Aortic Dissection (TBAD) using bibliometric methods.</p><p><strong>Patients and methods: </strong>CiteSpace and VOSviewer were employed to conduct quantitative and visual analyses across multiple dimensions, including publication trends, collaboration networks among countries/institutions/authors, keyword co-occurrence and evolution, as well as co-citation analysis and reference burst detection.</p><p><strong>Results: </strong>The number of publications in this field has shown an overall upward trend, with a significant increase since 2013, reflecting the growing clinical and scientific attention to this life-threatening vascular emergency. The United States (USA) and China form a dual-core global collaboration structure, with the USA leading in international cooperation depth and citation impact, and China emerging as a major contributor with rapid growth in research output - an evolution that mirrors the global redistribution of cardiovascular research capacity. Keyword analysis reveals a paradigm shift from technical application to precision intervention and individualized management, while current research focusing on Thoracic Endovascular Aortic Repair (TEVAR), complication prediction, computational fluid dynamics (CFD), and artificial intelligence (AI)-assisted diagnosis and treatment. Co-citation analysis confirms TEVAR as the gold-standard minimally invasive treatment for TBAD, with its widespread acceptance driving the standardization of clinical practice. Burst analysis of keywords indicates that \"prediction model\" and \"deep learning\" have become emerging research hotspots, marking the entry of TBAD research into an intelligent, data-driven era.</p><p><strong>Conclusion: </strong>Research on TBAD has developed a sophisticated knowledge system over the past two decades, shifting from traditional surgical exploration to an intelligent, data-driven research paradigm. This bibliometric analysis identifies a USA-China dual-core global collaboration pattern in the field and a three-stage evolution of research focus from pathophysiological exploration to evidence-based TEVAR standardization, and further to the integration of CFD and AI. Critical research gaps are also highlighted, including under-investigation of high-risk populations, insufficient long-term evidence for TEVAR, and inadequate cross-disciplinary integration of CFD, AI and genomics. Future TBAD research should prioritize multicenter prospective trials to upgrade clinical evidence, advance interdisciplinary precision medicine models, and build globally standardized big data platforms for the development and validation of AI-based diagnostic and therapeutic tools, thereby achieving more scientific and personalized management of TBAD.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship of neutrophil to high-density lipoprotein cholesterol ratio with all-cause mortality in patients undergoing cardiac surgery: a retrospective cohort study.","authors":"Zehan Guo, Tianshuo Li, Peipei Zhang, Ke Zheng, Gefei Li, Longhai He, Xiangyang Li, Meng Lv, Qian Zhang","doi":"10.1186/s13019-026-04195-6","DOIUrl":"https://doi.org/10.1186/s13019-026-04195-6","url":null,"abstract":"<p><strong>Background: </strong>The mortality following cardiac surgery remains high. The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is a marker that reflects both inflammation and metabolic status, and it has shown promise in predicting outcomes across various diseases. However, the association of NHR with the outcomes in cardiac sur gery patients has not been fully validated.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed data from the MIMIC-Ⅳ database, including 2784 patients who underwent cardiac surgery. Patients were categorized into three groups (Q1, Q2, Q3) based on the NHR value. The primary outcome was 90-day all-cause mortality. The secondary outcomes included 180-day and 360-day all-cause mortality. Kaplan-Meier survival analysis, Cox proportional hazards regression, and restricted cubic spline (RCS) analysis were employed to assess the relationship between NHR and all-cause mortality.</p><p><strong>Results: </strong>A total of 2784 patients (73.10% male) were enrolled. Higher NHR index levels were associated with an increased risk of 90-day,180-day, and 360-day all-cause mortality as shown by Kaplan-Meier curves. Cox proportional hazards analysis showed that the elevated NHR index was significantly related to all-cause death. Additionally, restricted cubic spline (RCS) analysis confirmed a linear positive relationship between NHR and all-cause mortality.</p><p><strong>Conclusion: </strong>NHR is significantly associated with all-cause mortality in patients undergoing cardiac surgery. As a simple and cost-effective measure, NHR can support clinicians in the early identification of high-risk patients and guide personalized postoperative management strategies. To confirm its clinical utility and improve postoperative risk assessment and patient care, further large-scale, multicenter retrospective cohort studies are needed.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual-chamber epicardial pacing in preterm and low birth weight infants with congenital complete atrioventricular block: a staged approach.","authors":"Ahmet Kuddusi İrdem, Yiğit Kılıç, Hasan Balık, Onur Doyurgan","doi":"10.1186/s13019-026-04192-9","DOIUrl":"https://doi.org/10.1186/s13019-026-04192-9","url":null,"abstract":"<p><strong>Background: </strong>Congenital complete atrioventricular block (CCAVB) in preterm low birth weight neonates poses significant technical challenges for permanent pacemaker implantation. Epicardial pacing is generally preferred in this population; however, definitive implantation in infants weighing < 2500 g may be technically demanding. We evaluated the feasibility and safety of dual-chamber epicardial pacing in preterm low birth weight neonates with autoimmune-associated CCAVB.</p><p><strong>Methods: </strong>Eight preterm neonates weighing < 2500 g underwent epicardial pacing between April 2021 and May 2022. All patients initially received temporary epicardial pacing via a subxiphoid approach for rhythm stabilization. Permanent dual-chamber epicardial pacemaker implantation was subsequently performed following clinical optimization and weight gain. Procedural outcomes, pacing performance, ventricular function, and device-related complications were analyzed descriptively.</p><p><strong>Results: </strong>Temporary pacing was successfully established in all patients at a median postnatal age of 3 days (range, 0-12 days) and a median body weight of 2290 g (range, 1890-2440 g), without major complications. Permanent dual-chamber implantation was achieved in all cases at a median age of 18 days and a mean body weight of 2725 g. Electrical parameters, including sensing amplitudes and capture thresholds, remained stable throughout follow-up. One patient required ventricular lead repositioning due to persistent ventricular dysfunction, with subsequent functional improvement, while ventricular function remained stable or improved in the remaining patients. No device-related complications were observed during the follow-up period. The median follow-up duration was 24 months.</p><p><strong>Conclusions: </strong>This study indicates that dual-chamber epicardial pacing is feasible and safe in selected preterm low birth weight neonates with CCAVB. When immediate permanent implantation is technically challenging, a staged approach may facilitate stabilization and subsequent definitive implantation with favorable early to short-term outcomes.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}