Journal of Cardiothoracic Surgery最新文献

{"title":"Case report of penetrating coronary artery ulcer of the right coronary artery in a middle-aged man presenting with recurrent chest pain.","authors":"Olurotimi J Badero, Bamikole T Osibowale, Pelumi V Ajayi, Sandra Bakare","doi":"10.1186/s13019-026-04559-y","DOIUrl":"10.1186/s13019-026-04559-y","url":null,"abstract":"<p><strong>Background: </strong>Penetrating Coronary artery ulcers (PCAU) are rarely reported disruption of vascular wall integrity believed to arise from plaque rupture. Its clinical presentation often mimics other acute coronary syndromes, making timely recognition challenging. Despite their potential association with adverse cardiovascular events, they are poorly understood and no consensus guideline for their management exists. 64-year-old man with complex medical history including a prior coronary artery disease with stent implantation, who presented with recurrent chest pain. Cardiac catheterization identified a grade II penetrating ulcer of the proximal right coronary artery with no obstructive lesions, and he was subsequently managed conservatively with good outcome.</p><p><strong>Discussion: </strong>Penetrating coronary artery ulcers are rare clinical findings with no specific treatment guidelines. Given the limited evidence base and the potential for progression to dissection, thrombosis, or myocardial ischemia, detailed reporting of PCAU presentations is essential to guide clinical practice. Further research is crucial to develop evidence-based treatment guidelines, especially with the advancements in intravascular imaging.</p><p><strong>Conclusion: </strong>Penetrating coronary artery ulcer remains a rare but clinically important condition. Early recognition with multimodality imaging and individualized management strategies are key to preventing adverse outcomes. This report expands the existing evidence base and provides valuable reference material for clinicians facing similar scenarios.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549059","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":"Mechanistic exploration of Wenyang Zhenshuai granules in doxorubicin-induced cardiotoxicity: integrating network pharmacology and experimental validation.","authors":"Xu Deng, Xiaoping Li, Jialuo Cai, Zelin Xu, Xinyu Chen, Kunpeng Yao, Yuntao Luo","doi":"10.1186/s13019-026-04631-7","DOIUrl":"https://doi.org/10.1186/s13019-026-04631-7","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the cardioprotective effects of Wenyang Zhenshuai granules (WYZSG) against doxorubicin (DOX)-induced cardiotoxicity and elucidate the underlying molecular mechanisms.</p><p><strong>Methods: </strong>Network pharmacology was performed to identify the potential therapeutic targets of WYZSG against doxorubicin (DOX)-induced cardiac injury. Protein-protein interaction (PPI) network construction, hub gene analysis, and molecular docking were conducted to identify key targets and validate the interactions between the major active compounds and core targets. In vivo, a rat model of DOX-induced cardiac injury was established to evaluate the effects of WYZSG on cardiac injury, histopathological changes, apoptosis, and serpin family E member 1 (SERPINE1) expression. The role of SERPINE1 in the protective effects of WYZSG was further validated through SERPINE1 overexpression experiments.</p><p><strong>Results: </strong>A total of 65 bioactive compounds and 1,057 putative targets were identified, with 49 overlapping targets associated with cardiac injury. Network analysis highlighted genistein, L-phenylalanine, daidzein, nobiletin, and isoliquiritigenin as the major active constituents, while SERPINE1 emerged as a central hub gene. Molecular docking confirmed strong binding affinities between these core compounds and SERPINE1. In vivo, WYZSG attenuated DOX-induced cardiac injury, reduced serum creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) levels, alleviated myocardial histopathological damage, inhibited cardiomyocyte apoptosis, and dose-dependently downregulated SERPINE1 expression in DOX-treated rats. Notably, SERPINE1 overexpression partially abolished the cardioprotective effects of WYZSG against DOX-induced cardiac injury.</p><p><strong>Conclusion: </strong>WYZSG protects against DOX-induced cardiac injury by suppressing SERPINE1 expression, providing mechanistic insight into its cardioprotective effects and supporting its potential therapeutic application in DOX-induced cardiac injury.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549037","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":"Type B aortic dissection following personalized external aortic root support (PEARS): a report of two cases.","authors":"Alejandro González-Caldevilla Fernandez, Shivan Edmond Saith, Farhin Holia, Ana Lopez-Marco, Aung Ye Oo","doi":"10.1186/s13019-026-04120-x","DOIUrl":"10.1186/s13019-026-04120-x","url":null,"abstract":"<p><strong>Background: </strong>Personalized external aortic root support (PEARS) is a prophylactic surgical technique designed to stabilize the aortic root in patients with heritable thoracic aortic disease (HTAD), including Marfan and Loeys-Dietz syndromes. Although early outcomes have been encouraging, distal aortic complications after PEARS remain poorly characterized. Type B aortic dissection (TBAD) following PEARS implantation has rarely been reported.</p><p><strong>Case presentation: </strong>We report two patients with HTAD who developed complicated TBAD several years after PEARS implantation. The first patient, a woman with Loeys-Dietz syndrome, presented with acute TBAD complicated by visceral malperfusion and underwent emergency total arch replacement using the frozen elephant trunk (FET) technique, followed by extensive abdominal surgery for bowel ischemia. The second patient, a man with Marfan syndrome, presented with TBAD and progressive descending thoracic aortic dilatation. He initially underwent open descending thoracic aortic replacement and subsequently required staged arch replacement with FET after retrograde extension of the dissection into the proximal aorta. Both patients survived the acute events and remain under radiological surveillance.</p><p><strong>Conclusions: </strong>Distal aortic dissection may still occur in patients with HTAD who have previously undergone PEARS implantation. Although causality cannot be inferred from isolated observations, these cases emphasize the importance of continued imaging surveillance of the entire aorta after PEARS.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549057","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":"Endovascular repair of type B aortic dissection associated with coarctation: a case report.","authors":"Zhen Liang, Haiyang Chang, Guimei Shao","doi":"10.1186/s13019-026-04496-w","DOIUrl":"10.1186/s13019-026-04496-w","url":null,"abstract":"<p><strong>Background: </strong>Type B aortic dissection associated with aortic coarctation is an extremely rare condition. We present a case that was treated successfully by endovascular repair.</p><p><strong>Case presentation: </strong>A 46-year-old man was admitted to our hospital for severe chest pain radiating to his back. Contrast-enhanced computed tomography angiography revealed type B aortic dissection associated with coarctation at the distal end of the aortic arch. Combined treatment with angioplasty and endovascular stent-graft deployment was performed successfully. Three years later, contrast-enhanced computed tomography angiography showed that the coarctation had disappeared, with the residual dissection remaining asymptomatic.</p><p><strong>Conclusion: </strong>For type B aortic dissection associated with aortic coarctation, endovascular repair seems to be an alternative to open surgery, especially for highly selected patients.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549018","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 power of the pen: effectiveness of hand-drawn schematic diagrams In congenital heart disease ultrasound education for resident physicians : a randomized controlled trial.","authors":"Liqing Lin, Xiaoqiong Chen, Qun Huang, Qiulin Zheng, Zhue Wu, Guorong Lyu, Ming Chen","doi":"10.1186/s13019-026-04507-w","DOIUrl":"10.1186/s13019-026-04507-w","url":null,"abstract":"<p><strong>Background: </strong>Educating resident physicians to master the complex. Educating resident physicians to master the complex echocardiographic diagnosis of congenital heart disease (CHD) represents a substantial pedagogical challenge. The central difficulty lies in translating dynamic two-dimensional ultrasound images into a robust three-dimensional spatial understanding. While high-technology teaching aids have emerged, their significant cost and limited accessibility impede widespread adoption. This study was designed to rigorously evaluate the effectiveness of a low-cost, high-cognitive-engagement instructional method-instructor-led, real-time hand-drawn schematic diagrams-in augmenting the CHD ultrasound diagnostic capabilities of resident physicians.</p><p><strong>Methods: </strong>A single-center, prospective randomized controlled trial was conducted. Forty residents rotating through the Department of Ultrasound at Zhangzhou Affiliated Hospital of Fujian Medical University from September 2024 to August 2025 were enrolled. Participants were randomly assigned to either an intervention group (n=20) or a control group (n=20). The control group received conventional PowerPoint-based instruction. The intervention group received the same conventional instruction supplemented with instructor-led dynamic hand-drawn schematic diagrams. The primary outcomes were objective assessment scores in ultrasonic theoretical knowledge, practical skill operation, and clinical reasoning abilities. Secondary outcomes encompassed subjective learning satisfaction and self- perceived understanding.</p><p><strong>Results: </strong>All 40 participants successfully completed the study protocol. Theintervention group demonstrated significantly superior performance compared with the control group in theoretical knowledge (88.20 ± 3.96 vs. 82.95 ± 2.37, p < 0.001) and clinical reasoning abilities (90.50 ± 2.76 vs. 82.75 ± 3.60, p < 0.001). However, no statistically significant difference was observed in practical skills scores (89.40 ± 3.24 vs. 87.20 ± 4.99, p = 0.106). Subjective questionnaire surveys revealed that the intervention group provided significantly higher ratings across all assessed dimensions of learning and overall teaching satisfaction (all p < 0.05).</p><p><strong>Conclusions: </strong>In the context of CHD ultrasound education for residents, theintegration of instructor-led hand-drawn schematic diagrams markedly enhances learners', theoretical knowledge and clinical reasoning. The limited direct impact on practical skills highlights the distinct developmental pathways for cognitive versus psychomotor competencies. These findings validate hand-drawn diagrams as an effective, economical, and readily implementable pedagogical tool, particularly well- suited for constructing the complex conceptual and spatial frameworks essential for mastering echocardiography.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549073","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":"Amino acids for the prevention of acute kidney injury after cardiac surgery: a narrative review of trials and meta-analyses.","authors":"Rolf Svedjeholm, Jonas Holm, Farkas Vanky","doi":"10.1186/s13019-026-04540-9","DOIUrl":"10.1186/s13019-026-04540-9","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is one of the most common serious complications after cardiac surgery. Although many causes and risk factors have been identified, effective measures to prevent AKI after cardiac surgery are still lacking. Recent randomized trials and meta-analyses suggest a potential role for amino acids in preventing AKI after cardiac surgery. The growing interest in this topic is reflected in the number of recently published meta-analyses, which approaches that of adequately designed clinical trials addressing this subject. However, close examination of these meta-analyses reveals substantial heterogeneity among the included trials, particularly with respect to the selection of amino acids, dosages used, and proposed mechanisms of action. In this review, we describe the putative mechanisms of action, detail the major sources of heterogeneity and identify key gaps that need to be addressed to clarify the role of amino acids in preventing AKI following cardiac surgery.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549028","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":"Imbalance between oxygen delivery and consumption during cooling and rewarming phases of cardiopulmonary bypass and association with hyperlactatemia in total aortic arch replacement: a prospective observational study.","authors":"Ling Peng, Wei Wei, Lei Du, Jiyue Xiong","doi":"10.1186/s13019-026-04532-9","DOIUrl":"10.1186/s13019-026-04532-9","url":null,"abstract":"<p><strong>Background: </strong>Inadequate oxygen perfusion during cardiac surgery increases risk of postoperative complications. In order to optimize perfusion strategies, the aim of this exploratory study was to investigate oxygen delivery, consumption and extraction during hypothermic circulatory arrest and their association with postoperative hyperlactatemia.</p><p><strong>Method: </strong>A consecutive sample of 44 adult patients scheduled for total aortic arch replacement under cardiopulmonary bypass and hypothermic circulatory arrest were prospectively enrolled during the study period. Oxygen delivery index, oxygen consumption index and oxygen extraction rate were measured during cooling from 36 to 24 ℃ and rewarming from 24 to 36 ℃. The primary outcome was the association between intraoperative oxygen metabolism parameter and postoperative hyperlactatemia. Hyperlactatemia was defined as peak lactate ≥ 4 mmol/L within 24 h after surgery.</p><p><strong>Results: </strong>A total of 41 patients were enrolled in the final analysis. Serum lactate rose slightly from 1.5 (1.3-2.2) mmol/L at baseline to 2.0 (1.5-2.6) mmol/L before hypothermic circulatory arrest and again to 4.0 (3.6-5.1) mmol/L after 29.17 ± 5.87 min of arrest, finally peaking at 5.0 (2.9-7.1) mmol/L within 24 h after surgery. The three oxygen parameters decreased progressively during cooling and increased gradually during rewarming. All three parameters at a given temperature were obviously higher during rewarming than cooling. Oxygen extraction rate at 24 ℃ during cooling correlated positively with peak lactate concentration within 24 h after surgery (Spearman's ρ = 0.67, p = 0.001). Hyperlactatemia occurred in 24 patients (58.54%), whose oxygen extraction rate and oxygen consumption index at 24 ℃ during cooling were significantly higher than in those who did not suffer hyperlactatemia. In fact, these two parameters discriminated hyperlactatemia with respective areas under the receiver operating characteristic (AUC) curves of 0.83 and 0.80.</p><p><strong>Conclusion: </strong>In this exploratory study, a relatively higher oxygen extraction rate at 24 °C during cooling appeared to be associated with postoperative hyperlactatemia (AUC 0.83, cut-off > 0.102). This preliminary finding warrants validation in larger prospective studies.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536012","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":"Causal relationship between cardiac arrhythmias and sepsis: a two-sample bidirectional mendelian randomization study.","authors":"Xinglei Li, Yadong Yang, Xunqi Zhang, Tianyi Lu, Lingling Liu, Zhengjun Kong, Tao Cui","doi":"10.1186/s13019-026-04539-2","DOIUrl":"10.1186/s13019-026-04539-2","url":null,"abstract":"<p><strong>Objective: </strong>This study used a bidirectional two-sample Mendelian randomization (MR) framework to investigate whether genetic liability to cardiac arrhythmias increases the risk of sepsis and whether genetic liability to sepsis increases the risk of cardiac arrhythmias.</p><p><strong>Methods: </strong>Summary statistics were obtained from publicly available genome-wide association studies in individuals of European ancestry. Cardiac arrhythmia data were derived from FinnGen (32,416 cases and 139,739 controls; IEU ID: finn-b-CARDIAC_ARRHYTM), and sepsis data were derived from UK Biobank (11,643 cases and 474,841 controls; IEU ID: ieu-b-4980). Independent single-nucleotide polymorphisms (SNPs) associated with each exposure at P < 5 × 10^-6 were selected, clumped at r^2 < 0.001 within a 10,000-kb window, harmonized, and filtered to retain instruments with F-statistics > 10. The primary analysis used random-effects inverse-variance weighting (IVW), with weighted median, MR-Egger, simple mode, and weighted mode analyses as complementary methods. Horizontal pleiotropy and outliers were assessed using MR-PRESSO and the MR-Egger intercept. Heterogeneity was evaluated with Cochran's Q test. Because the two causal directions were prespecified, false-positive control was strengthened by combining concordant directional evidence across methods with Benjamini-Hochberg false-discovery-rate assessment for the two primary IVW tests.</p><p><strong>Results: </strong>Genetic liability to cardiac arrhythmias was associated with a higher risk of sepsis (IVW OR = 1.066, 95% CI: 1.007-1.128, P = 0.0268). Genetic liability to sepsis was also associated with a higher risk of cardiac arrhythmias (IVW OR = 1.078, 95% CI: 1.005-1.156, P = 0.0347), although the reverse-direction analysis was based on only three SNPs and should be interpreted cautiously. Effect directions were concordant across complementary MR models, Cochran's Q test did not indicate substantial heterogeneity, MR-Egger intercepts did not support directional pleiotropy, and the two primary IVW tests showed an FDR-adjusted q value of 0.0536.</p><p><strong>Conclusion: </strong>The present bidirectional MR analysis supports a robust association from cardiac arrhythmia liability to sepsis risk and suggests a possible reverse association from sepsis liability to cardiac arrhythmias. These findings support closer rhythm and infection surveillance in high-risk patients while highlighting the need for larger and biologically resolved validation studies.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535923","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":"Emergency thoracoscopic management of early ablation-tract bronchopleural fistula after low-power lung microwave ablation: a case report.","authors":"Weike Lv, Jiewen Deng, Dongjie Feng","doi":"10.1186/s13019-026-04526-7","DOIUrl":"10.1186/s13019-026-04526-7","url":null,"abstract":"<p><strong>Background: </strong>Microwave ablation (MWA) is an established local therapy for selected pulmonary nodules in patients who are poor candidates for surgery. Bronchopleural fistula (BPF) is a rare but serious complication after lung ablation.</p><p><strong>Case presentation: </strong>A 74-year-old woman with prior bilateral thoracic interventions and impaired pulmonary reserve underwent CT-guided percutaneous MWA (30 W for 4 min) for a right upper lobe ground-glass nodule on post-ablation day (PAD) 0. On PAD2, chest radiography showed a large right pneumothorax with more than 50% right lung compression, and right chest tube drainage was promptly performed with symptomatic improvement. On PAD5, she developed worsening chest tightness and rapidly increasing fever; in the context of recurrent pneumothorax and poor lung re-expansion despite chest drainage, urgent CT showed findings highly suggestive of BPF with pleural infection/empyema, including an air-fluid cavity along the ablation tract. Emergency VATS was performed on the same day. Intraoperatively, a thick-walled purulent necrotic cavity was identified along the ablation tract and communicated with a distal branch of the anterior segmental bronchus. Thoracoscopic adhesiolysis, decortication, debridement, partial pulmonary resection of the fistula-bearing lung tissue, pleural irrigation, and chest tube drainage were performed. The pneumothorax resolved, lung re-expansion was satisfactory, and the patient recovered and was discharged. At 3 months, no clinical evidence of recurrent fistula or need for reintervention was observed, and 1-month CT showed no definite radiologic evidence of recurrent BPF, empyema, or local progression.</p><p><strong>Conclusions: </strong>This case highlights that BPF may occur early even after low-power lung MWA. In a post-MWA pneumothorax patient, new fever, poor lung re-expansion despite chest drainage, and a CT air-fluid cavity along the ablation tract should raise suspicion for MWA-tract-related BPF. In selected severe cases with pleural infection/empyema and a non-expanding lung, prompt thoracoscopic source control may be considered, but a single case cannot define a universal management algorithm.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535982","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":"Association of preoperative monocyte level with postoperative delirium in patients receiving cardiac surgery under propofol-based anesthesia: a retrospective study.","authors":"Xuebin Wen, Jianbo Shan, Shuyu Deng, Gengfan Ye, Zhihao Pan","doi":"10.1186/s13019-026-04642-4","DOIUrl":"10.1186/s13019-026-04642-4","url":null,"abstract":"<p><strong>Background: </strong>Postoperative delirium is a common complication after cardiac surgery, and perioperative inflammation may contribute to its development. However, the association between preoperative blood indicators and postoperative delirium in patients receiving propofol-based anesthesia remains unclear.</p><p><strong>Objective: </strong>To identify preoperative blood indicators associated with postoperative delirium risk in patients undergoing cardiac surgery under propofol-based anesthesia.</p><p><strong>Methods: </strong>Related data of 694 patients were from MIMIC-IV database. Importance ranking using 2 machine learning algorithms was performed, followed by LASSO regression, multivariable logistic regression, and trend regression analyses to identify the important factors associated with postoperative delirium risk. Receiver operating characteristic curve and decision curve analysis were used to assess their clinical value for predicting delirium.</p><p><strong>Results: </strong>Among all patients, 44 patients experienced postoperative delirium (identified via ICD diagnostic coding during hospitalization). Machine learning algorithms initially implied the importance of monocyte in postoperative delirium risk as monocyte ranked first both in 2 algorithms. LASSO regression identified 7 variables, and 4 variables (red cell distribution width, red blood cell, monocyte, sepsis) showed independent association with delirium risk (all P < 0.05). Further, we found that the risk of delirium was increased with the increase of monocyte level (P for trend = 0.042), particularly when monocyte level exceeded 5.4% (P = 0.037). These results suggested monocyte as a key indicator independently associated with delirium risk and showing the most favorable discriminative performance among the evaluated markers, although its predictive utility requires prospective validation.</p><p><strong>Conclusions: </strong>Preoperative monocyte level was independently associated with coded postoperative delirium in this cohort, but prospective validation is still required before any predictive application.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535816","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}