Journal of Cardiothoracic Surgery最新文献

{"title":"Case report: decommissioning of a left ventricular assist device following reverse remodeling in non-ischemic cardiomyopathy patient.","authors":"Sabina Ugovšek, Gregor Zemljič, Andraž Cerar, Sabina Frljak, Renata Okrajšek, Miran Šebeštjen, Ivan Kneževič, Zvezdana Dolenc Stražar, Gregor Poglajen","doi":"10.1186/s13019-026-04609-5","DOIUrl":"10.1186/s13019-026-04609-5","url":null,"abstract":"<p><strong>Background: </strong>Left ventricular assist devices (LVAD) improves clinical outcomes in patients with advanced heart failure (HF) and may induce myocardial recovery. LVAD explantation remains underutilized due to challenges in identifying patients with true recovery potential. We describe a case of a patient with advanced HF due to myocarditis, who underwent LVAD implantation and after reverse structural remodelling facilitated by a structural recovery protocol, LVAD weaning was possible.</p><p><strong>Case presentation: </strong>A patient presented with an advanced HF due to myocarditis. Despite receiving guideline-directed medical therapy (GDMT) and levosimendan, left ventricular function failed to improve and the patient remained inotrope dependent. The patient was approved and listed for heart transplant. Due to progressive worsening despite inotropic support, the patient underwent LVAD HeartMate II implantation. Through optimized mechanical unloading, GDMT, and structured follow-up, echocardiography demonstrated progressive cardiac reverse remodelling and LVAD decommissioning was feasible.</p><p><strong>Conclusion: </strong>Despite low explantation and decommissioning rates in registries, dedicated recovery programs demonstrate that through combining mechanical unloading and GDMT optimization, sustained recovery and LVAD weaning are possible. This strategy offers a valuable alternative to transplantation and highlights the importance of standardized protocols in identifying and managing recovery candidates.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470888","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":"Clinical and radiological presentations of pulmonary hydatid cysts in Yemen: a retrospective cross-sectional study at a tertiary center.","authors":"Mohammed M Al-Shehari, Yasser Abdurabo Obadiel, Mugahed Esmail Nahshal, Haitham Mohammed Jowah","doi":"10.1186/s13019-026-04584-x","DOIUrl":"10.1186/s13019-026-04584-x","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hydatid cysts caused by Echinococcus granulosus represent a significant health burden in endemic regions such as Yemen. Limited contemporary data are available on the clinical and radiological characteristics of this disease in the Yemeni population. This study aimed to evaluate the clinical presentation, radiological features, surgical management, and early outcomes of pulmonary hydatid cysts at a tertiary center in Sana'a, Yemen.</p><p><strong>Methods: </strong>This retrospective cross-sectional study was conducted at Al-Thawra Modern General Hospital between January 2019 and March 2023. The medical records of 114 patients with surgically confirmed pulmonary hydatid cysts were analyzed. Demographic data, clinical presentation, radiological findings, surgical procedures, and early postoperative complications were collected using structured questionnaires. Statistical analyses were performed using SPSS v. 28.0, and 95% confidence intervals were calculated for all the proportions.</p><p><strong>Results: </strong>Of the 114 patients, 82 (71.9%; 95% CI: 63.1%-79.4%) were male, with a predominant age group of 19-30 years (43.0%; 95% CI: 34.3%-52.2%). Most patients were from urban areas (75.4%; 95% CI: 66.8%-82.4%) and worked as laborers (35.1%) or students (33.3%). Khat chewing was reported by 50.0% (95% CI: 41.0%-59.0%) of the patients. Five patients (4.4%; 95% CI: 1.9%-9.8%) were asymptomatic. The most common symptoms were cough (89.5%; 95% CI: 82.5%-93.9%), dyspnea (76.3%; 95% CI: 67.7%-83.2%), chest pain (64.9%; 95% CI: 55.8%-73.1%), and sputum production (71.1%; 95% CI: 62.2%-78.6%). Radiologically, 97 patients (85.1%; 95% CI: 77.4%-90.5%) had solitary cysts, predominantly in the right lung (67.0%). Most cysts were intact (76.3%; 95% CI: 66.9%-83.6%). Among the 17 patients with multiple cysts, 36 individual cysts were identified (range: 2-4 per patient). Twelve patients (10.5%; 95% CI: 6.0%-17.4%) had concurrent liver hydatid cysts documented on preoperative imaging. Among solitary cysts, peri-cyst changes, including mass effect (39.2%), empyema (5.2%), and pleural effusion (2.1%), were documented. Preoperative albendazole was administered to 8.8% of patients, and 95.6% underwent elective surgery. Capitonnage was performed in 91.2% (95% CI: 84.6%-95.2%) of the cases. Postoperative complications occurred in 7.9% (95% CI: 4.2%-14.3%), with no mortality reported. Hospital stay was less than 1 week for 75.4% (95% CI: 66.8%-82.4%) of patients.</p><p><strong>Conclusions: </strong>Pulmonary hydatid cysts in Yemen predominantly affect young urban males and present with respiratory symptoms. Solitary, intact cysts are the most common, and surgical management with capitonnage is safe and effective, with low morbidity rates when performed in specialized centers.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470861","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":"Improving outcomes in myasthenia gravis: uni-portal video-assisted thoracoscopic (UVATS) thymectomy in a single-centre retrospective cohort.","authors":"A Rahim, I Samsudin, M Menon, J X Hoo, T Jayaselan, J Y Ooi, Z S Nicolas Ong, C D Sudarshan, S Krishnasamy","doi":"10.1186/s13019-026-04633-5","DOIUrl":"10.1186/s13019-026-04633-5","url":null,"abstract":"<p><strong>Background: </strong>Thymectomy is a well-established treatment for myasthenia gravis (MG), with minimally invasive approaches increasingly preferred due to reduced morbidity. This study evaluates the safety and clinical outcomes of uni-portal video-assisted thoracoscopic surgery (UVATS) thymectomy in MG patients at a Malaysian tertiary centre.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 30 patients who underwent UVATS thymectomy for MG at Universiti Malaya Medical Centre between August 2016 and July 2025. Of these, 24 patients with complete perioperative and follow-up data were included. Outcomes assessed included postoperative complications, length of stay, disease severity by Modified Osserman classification, medication requirements, and symptomatic improvement.</p><p><strong>Results: </strong>The cohort (58% female, mean age 42.5 ± 18.2 years) had 50% thymoma. Postoperatively, 88% demonstrated clinical improvement. Osserman Class I proportion increased from 8% preoperatively to 75% postoperatively (p < 0.001). Corticosteroid dependency decreased from 75% to 33% (p = 0.003), pyridostigmine from 67% to 29%. Mean hospital stay was 3.4 ± 1.2 days. Complication rate was 8% (all minor), with no perioperative mortality.</p><p><strong>Conclusions: </strong>\"UVATS thymectomy is safe and demonstrates favorable short-term clinical outcomes in appropriately selected MG patients as the result has demonstrated significant clinical improvement, reduced medication requirements, and low morbidity. These findings support UVATS as the preferred minimally invasive approach in suitable candidates.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470824","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":"Intrathoracic fetus in fetu cases found in paediatric population: a systematic review.","authors":"Ali Samady-Khanghah, Anahita Abdolzadeh, Mahdi Parvizi-Mashhadi, Khashayar Atqiaee","doi":"10.1186/s13019-026-04632-6","DOIUrl":"10.1186/s13019-026-04632-6","url":null,"abstract":"<p><strong>Objectives: </strong>The fetu in fetu (FIF) expression refers to an extremely rare congenital phenomenon characterized by a second fetus growing into the body of the healthy twin. This study aimed to review the few cases located in the thoracic cavity.</p><p><strong>Method: </strong>Using the central medical databases PubMed/Medline, Web of Science, Scopus, ScienceDirect, and Google Scholar, as well as the references of the articles, we collected only 9 cases of FIF in pediatric patients' thorax. The inclusion criteria were full-text literature and participants aged 19 years or younger. Intra-abdominal or extra-thoracic cases and the presence of malignant components were our exclusion criteria.</p><p><strong>Results: </strong>Only one case was diagnosed in adolescence. The remaining participants were younger than 10 months at the time of the intervention. There were 4 male, 3 female, and 2 non-declared sex cases. The entire mass was found in the mediastinum, but one was located intrapulmonary. All cases had undergone the thoracotomy. The minimum survival reported in the literature was 5 months. Adipose tissue was the most frequently reported tissue among the resected masses, with 8 cases, followed by the vertebral column and bony tissues, with 6 and 5 cases, respectively.</p><p><strong>Conclusion: </strong>An infant suffering from respiratory distress or even recurrent infections, particularly with a mass revealed in its chest radiography, should raise a suspicion of FIF. This doubt will be strengthened if an axial skeleton or bony densities are found.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470766","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":"Valve-specific structural vulnerability in infective endocarditis: a narrative review of surgical complexity and outcomes.","authors":"Najmi Hakim Abd Rani, Afifah Mohamed, Zaleha Md Isa, Suhaini Kadiman, Taty Anna Kamarudin","doi":"10.1186/s13019-026-04523-w","DOIUrl":"10.1186/s13019-026-04523-w","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) carries in-hospital mortality of 15-20% and 1-year mortality approaching 40%, with surgery required in 40-50% of cases. IE is not uniformly distributed across cardiac valves aortic 30-45%, mitral 25-30%, tricuspid 5-10%, pulmonary < 2%, PVE 10-30% and this distribution reflects valve-specific anatomical determinants governing surgical complexity and outcomes. Despite the 2023 ESC Guidelines, a unified structural framework linking anatomical vulnerability to surgical decision-making remains absent.</p><p><strong>Objective: </strong>To propose a valve-specific structural vulnerability framework and examine its implications for surgical complexity, perioperative outcomes, and re-surgery risk across all cardiac valve types.</p><p><strong>Methods: </strong>A narrative review of peer-reviewed literature (2015-2025) was conducted across PubMed, Scopus, and MEDLINE. Systematic reviews, meta-analyses, multicentre registries, and guideline documents were synthesised narratively.</p><p><strong>Key findings: </strong>A structural vulnerability gradient (prosthetic valves > aortic > mitral > tricuspid > pulmonary) is proposed as a conceptual model of valve-specific disease behaviour. Aortic IE carries maximal vulnerability through peri-annular extension, 30-40% of cases, requiring radical root reconstruction with elevated operative mortality. Mitral IE exhibits conditional vulnerability; repair yields superior outcomes over replacement. Tricuspid IE is predominantly IVDU-associated with comparatively lower operative mortality. PVE carries the highest operative risk, with prolonged operative times and significant reoperation rates.</p><p><strong>Conclusions: </strong>IE is best understood as a valve- and substrate-specific disease in which anatomical determinants drive surgical complexity and clinical prognosis. This proposed vulnerability hierarchy may enable preoperative risk stratification, inform valve-specific surgical planning, and provide a mechanistic framework for understanding differential outcomes across valve types. Prospective outcome registries and standardised complexity metrics are needed to validate and refine this conceptual model.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470845","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":"Hybrid coronary revascularization versus off-pump coronary artery bypass grafting in high-risk patients: a single-centre retrospective study of early outcomes.","authors":"Giorgi Gabaidze, Nino Zhvania, Nia Chkhartishvili, Gvantsa Diasamidze, Ioseb Sikharulidze","doi":"10.1186/s13019-026-04636-2","DOIUrl":"10.1186/s13019-026-04636-2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;It is hard to efficiently revascularize high-risk patients with multivessel coronary disease, especially when conventional coronary artery bypass grafting is correlated with high perioperative risk and doing it percutaneously can be bigger issue for high-risk patients. Less invasive and modern alternative to OPCAB is Hybrid coronary revascularization. So we decided to compare this two methods and see which one will have better outcomes for high-risk patients. Our research involves comparing early (30 days) postoperative outcomes between Hybrid Coronary Revascularization (HCR) and Off-Pump Coronary Bypass surgery (OPCAB) in high surgical risk patients with coronary artery disease (EUROSCORE II &gt; 6%, STS &gt; 4% and SYNTAX SCORE &gt; 32).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-centre retrospective study, we reviewed high-risk patients treated between Feb 18, 2024 and Dec 14, 2025. After applying predefined eligibility criteria, 87 patients were included, from 28 patients (Mean Age = 66.6 ± 10.7) underwent HCR and 59 (Mean Age = 76.6 ± 4.1) underwent off-pump open aorto-coronary bypass surgery via median sternotomy. We compared early (30 days) postoperative clinical outcomes between two groups. Statistical analysis was performed using IBM SPSS statistics, applying independent-samples t-test and chi-square test as appropriate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Hybrid Coronary Revascularisation (MIDCAB + PCI) required shorter operative time than Off-Pump Coronary Bypass surgery (OPCAB), but with higher in-hospital costs. HCR was also associated with shorter intubation duration (245.5 ± 51.2 min vs. 576.7 ± 97.3 min, P &lt; 0.001), ICU stay (66.4 ± 15.5 h vs. 102.7 ± 12.7 h, P &lt; 0.001), hospital length of stay (7.3 ± 0.8 days vs. 13.0 ± 3.7 days, P &lt; 0.001), and lower thoracic drainage output (275.4 ± 74.1 ml vs. 615.3 ± 88.5 ml, P &lt; 0.001). Blood transfusion requirements were higher in the HCR group (14.3% vs. 0.0%, P = 0.009). Wound infection occurred only in the OPCAB group (0.0% vs. 27.1%, P = 0.002). The composite 30-day MACCE rate was numerically lower in the HCR group (0.0% vs. 13.6%), but this difference did not reach statistical significance (P = 0.050).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In high-risk patients with multivessel coronary artery disease, Hybrid Coronary Revascularization (MIDCAB + PCI), compared with traditional Off-Pump Coronary Artery Bypass surgery (OPCAB), was associated with a faster early-recovery profile, including shorter intubation time, ICU stay, and hospitalization, and lower chest-drain output. Multivariable analysis confirmed that these recovery benefits were independent of age, whereas the apparent advantage in overall complications was largely explained by the younger age of the HCR group. Differences in 30-day mortality and MACCE favoured HCR numerically but did not reach statistical significance in this underpowered cohort.Given the retrospective, non-randomized design with unequal g","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470746","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":"Surgical management of an acquired aortic interruption suspected from severe aortic coarctation in an adult with massive collaterals.","authors":"Min Qiu, Chengyi Hui, Qikun Zhu, Zewen Chen, Yong Zhang, Shusheng Wen, Hujun Cui","doi":"10.1186/s13019-026-04600-0","DOIUrl":"10.1186/s13019-026-04600-0","url":null,"abstract":"<p><strong>Background: </strong>Interrupted aortic arch (IAA) is a severe congenital anomaly typically fatal in infancy without surgical intervention. Adult presentation of isolated IAA is exceedingly rare and usually relies on an extensive compensatory collateral vascular network.</p><p><strong>Case presentation: </strong>We present the case of a 25-year-old man who presented with malignant hypertension. Computed tomography angiography with 3D reconstruction revealed complete occlusion of the aortic arch distal to the left subclavian artery, accompanied by a massive collateral circulation derived from dilated intercostal and internal mammary arteries. Open surgical repair was performed via a left posterolateral thoracotomy. Intraoperative findings identified an atretic fibrous cord at the occlusion site, suggesting an extreme progression of severe coarctation of the aorta into an acquired interruption. An 18-mm Dacron tube graft was successfully interposed between the arch and descending aorta. Crucially, this was performed as an off-pump extra-anatomic bypass without cardiopulmonary bypass. The postoperative course was uneventful. At 4 months, his blood pressure was significantly improved, though a small residual gradient persisted.</p><p><strong>Conclusion: </strong>This case suggests that severe coarctation can progress to an acquired atresia mimicking IAA. Off-pump extra-anatomic bypass is a safe and effective strategy expected to alleviate refractory hypertension and prevent long-term cardiovascular and cerebrovascular complications in heavily collateralized adults.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470906","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":"Mid-ascending aortic pseudoaneurysm causing left main coronary artery compression in a patient with a history of tuberculosis.","authors":"Hyun-Ah Lim, June Lee","doi":"10.1186/s13019-026-04529-4","DOIUrl":"10.1186/s13019-026-04529-4","url":null,"abstract":"<p><strong>Background: </strong>Aortic pseudoaneurysm secondary to Mycobacterium tuberculosis infection is exceedingly rare. Extrinsic compression of the left main coronary artery by an aortic pseudoaneurysm is also uncommon, and cases attributable to tuberculosis are particularly rare. This report describes a mid-ascending aortic pseudoaneurysm causing left main coronary artery compression resulting in cardiac arrest in a patient with a history of tuberculosis, which was successfully managed with emergent surgical intervention.</p><p><strong>Case presentation: </strong>A 76-year-old man with a history of tuberculosis and radiologic findings suggestive of previous tuberculous disease experienced cardiac arrest prior to transfer and was referred to the authors' institution. Coronary angiography, performed because of chest pain and elevated cardiac biomarkers, demonstrated extrinsic compression of the left main coronary artery by an ascending aortic pseudoaneurysm. Return of spontaneous circulation was achieved after approximately 48 min of cardiopulmonary resuscitation. Upon arrival at our emergency department, computed tomography revealed a 6-cm pseudoaneurysm of the proximal-to-mid ascending aorta. Emergent surgical resection of necrotic ascending aortic tissue and graft replacement of the ascending aorta were performed, and the postoperative course was favorable.</p><p><strong>Conclusion: </strong>Ascending aortic pseudoaneurysm may cause sudden cardiac arrest through extrinsic compression of the left main coronary artery. In patients with a history or radiologic evidence of tuberculosis, tuberculosis-related involvement may be considered, but definitive surgical treatment should not be delayed in life-threatening presentations.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470825","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":"Outcome analysis of bioprosthetic valve replacement in patients aged ≥ 50 years with Ebstein's anomaly.","authors":"Xiaojun Xie, Nailin Gong, Jiao Bai, Mingbin Deng","doi":"10.1186/s13019-026-04530-x","DOIUrl":"10.1186/s13019-026-04530-x","url":null,"abstract":"<p><strong>Objective: </strong>Cone reconstruction has become the preferred surgical technique for Ebstein's anomaly (EA). However, some patients aged ≥ 50 years are unsuitable for repair due to severe leaflet dysplasia, marked annular dilation, or impaired right ventricular function. This study evaluates the clinical outcomes of domestic bioprosthetic valve replacement in patients aged ≥ 50 years with EA.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 15 consecutive patients aged ≥ 50 years with EA who underwent initial bioprosthetic tricuspid valve replacement at the Department of Cardiovascular Surgery, Affiliated Hospital of Southwest Medical University, from June 2019 to August 2024. Preoperative evaluations included electrocardiography, echocardiography, chest CT, and coronary angiography. Operative times, cardiopulmonary bypass time, aortic cross-clamp time, perioperative complications, and mortality were recorded. Follow-up assessed cardiac function, valve performance, and cardiac chamber dimensions.</p><p><strong>Results: </strong>Among the 15 patients (11 females, 4 males; mean age 55.0 ± 4.2 years), cardiopulmonary bypass time was 127.9 ± 20.4 min and aortic cross-clamp time 69.5 ± 17.5 min. One patient died of cardiogenic shock on postoperative day 8. The remaining 14 were discharged alive. During follow-up (1-39 months), 13 patients (92.6%) of 14 survivors were followed; no late deaths or reoperations occurred. Symptomatic improvement was observed in 12 patients. No moderate or severe tricuspid regurgitation or bioprosthetic stenosis was detected.</p><p><strong>Conclusion: </strong>Bioprosthetic valve replacement appears feasible with acceptable early outcomes in patients aged ≥ 50 years with EA who are unsuitable for cone reconstruction, significantly improving symptoms in most patients. These preliminary findings require validation in larger studies with longer follow‑up.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470743","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 and safety of prothrombin complex concentrate versus fresh frozen plasma in adult patients undergoing cardiac surgery: a systematic review and meta-analysis.","authors":"Muhammad Sheraz Hameed, Azeen Razzaq, Abeeha Zia, Amna Iftihar, Muhammad Zaeem, Ammarah Tariq, Muhammad Umer Javaid, Sohaib Alvi, Irsa Munir, Vien T Truong, Muhammad Hammad Ul Hassan, Syed Rafay Hussain Zaidi, Saria Qaiser, Rida Fatima, Muhammad Usama Naveed","doi":"10.1186/s13019-026-04513-y","DOIUrl":"10.1186/s13019-026-04513-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Postoperative bleeding is a common and potentially life-threatening complication following cardiac surgery, often exacerbated by multifactorial coagulopathy from cardiopulmonary bypass, hypothermia, and platelet dysfunction. While fresh frozen plasma (FFP) has traditionally been used for coagulation correction, it has significant limitations, including large volume requirements, slow onset, and increased risk of transfusion-related complications. Prothrombin complex concentrate (PCC) has emerged as a potential alternative, offering rapid coagulation correction with reduced volume load and no ABO compatibility requirements. This systematic review and meta-analysis compared the efficacy and safety of PCC versus FFP in managing coagulopathic bleeding in adult cardiac surgery patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a systematic review and meta-analysis following PRISMA guidelines. Electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) were searched using MeSH terms and keywords related to \"Cardiothoracic Surgery\", \"Prothrombin Complex Concentrate\", and \"Fresh Frozen Plasma\", from inception to Jan 2026. Cohort studies and randomized controlled trials comparing PCC and FFP in patients aged &gt; 18 years undergoing cardiac surgery complicated by bleeding or coagulopathy were included. Primary outcomes were RBC transfusion requirement, chest tube drainage, and thromboembolic events. Secondary outcomes included surgical re-exploration for bleeding, stroke, duration of mechanical ventilation, hospital and ICU stays, and acute kidney injury. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for RCTs and the Newcastle-Ottawa Scale for observational studies. Statistical analysis was conducted using Review Manager (RevMan) version 5.4, applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under protocol number CRD420251088737.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This meta-analysis included ten studies with 2,643 patients. PCC use moderately reduced RBC transfusion in the first 24 h (RR = 0.84; 95% CI: 0.76-0.93; p = 0.05; I&lt;sup&gt;2&lt;/sup&gt; = 47%), 12-24-h chest tube drainage (MD =  - 188.89 mL; 95% CI: - 248.48 to - 125.30; p &lt; 0.00001; I&lt;sup&gt;2&lt;/sup&gt; = 50%), and hospital stay (MD =  - 1.19 days; 95% CI: - 2.21 to - 0.18; p = 0.004; I&lt;sup&gt;2&lt;/sup&gt; = 67%). No significant differences were observed for surgical re-exploration (RR = 0.81; 95% CI: 0.66-1.00; p = 0.05; I&lt;sup&gt;2&lt;/sup&gt; = 0%), mechanical ventilation (MD =  - 0.08; 95% CI: - 0.34 to 0.19; p &gt; 0.05; I&lt;sup&gt;2&lt;/sup&gt; = 73%), ICU stay (MD =  - 0.07 days; 95% CI: - 0.59 to 0.45; p = 0.78; I&lt;sup&gt;2&lt;/sup&gt; = 59%), all-cause mortality (RR = 1.10; 95% CI: 0.82-1.50; p = 0.51; I&lt;sup&gt;2&lt;/sup&gt; = 0%), thromboembolic events (RR = 1.22; ","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470930","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}