Journal of Cardiac Surgery最新文献

{"title":"Myocardial Protection in Complete AVSD Repair: A Decade of Comparative Outcomes Between Custodiol-HTK and Blood Cardioplegia","authors":"Mustafa Kemal Avşar,&nbsp;Yasin Güzel,&nbsp;İbrahim Özgür Önsel,&nbsp;Barış Kırat,&nbsp;İlker Kemal Yücel,&nbsp;Cenap Zeybek,&nbsp;Deniz Yorgancılar","doi":"10.1155/jocs/1280973","DOIUrl":"https://doi.org/10.1155/jocs/1280973","url":null,"abstract":"<p><b>Objective:</b> This study compared early postoperative outcomes of Custodiol-HTK versus cold intermittent blood cardioplegia in patients undergoing complete atrioventricular septal defect (CAVSD) repair.</p><p><b>Methods:</b> From January 2012 to December 2022, we retrospectively analyzed 305 patients undergoing CAVSD repair at our center. Patients were divided into two groups based on cardioplegia: Group 1 received Custodiol-HTK (<i>n</i> = 159), and Group 2 received cold intermittent blood cardioplegia (<i>n</i> = 146). Outcomes that were compared included mortality, ECMO requirement, cross-clamp and cardiopulmonary bypass (CPB) times, cardioplegia doses, valvular edema (assessed intraoperatively via a visual scale), postoperative intubation time, ICU stay, and hospital stay.</p><p><b>Results:</b> Mortality was 1.9% in Group 1 versus 8.2% in Group 2 (<i>p</i> = 0.01). ECMO was required in 0.6% of Group 1 versus 11.0% of Group 2 (<i>p</i> &lt; 0.001). Cross-clamp time (56 ± 12 min vs. 76 ± 16 min, <i>p</i> &lt; 0.001) and CPB time (83 ± 14 min vs. 97 ± 17 min, <i>p</i> = 0.002) were shorter in Group 1. Cardioplegia doses were 1 in Group 1 versus 4.7 ± 1.2 in Group 2 (<i>p</i> &lt; 0.001). Intubation time, ICU stay, and hospital stay were significantly shorter in Group 1 (<i>p</i> &lt; 0.01 for each).</p><p><b>Conclusion:</b> Custodiol-HTK was associated with improved early outcomes, including reduced mortality, ECMO use, and shorter operative and recovery times, in CAVSD repair. It appears to offer superior myocardial protection, particularly in complex cases, though potential risks such as hyponatremia require careful perioperative management.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/1280973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037944","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 Outcomes of the Ozaki Procedure With Right Infra-Axillary Mini-Thoracotomy Approach","authors":"Ahmet Yavuz Balcı,&nbsp;Hüseyin Gemalmaz,&nbsp;Ahmet Arif Ağlar","doi":"10.1155/jocs/5579009","DOIUrl":"https://doi.org/10.1155/jocs/5579009","url":null,"abstract":"<p><b>Objective:</b> The research evaluated both safety and effectiveness of the Ozaki procedure when performed through right infra-axillary mini-thoracotomy on adult patients. Mini-thoracotomy approaches in the surgical treatment of aortic valve diseases produce better cosmetic outcomes and faster recovery times than traditional sternotomy procedures. The study examined clinical results from the Ozaki procedure when surgeons used this approach for short- and medium-term follow-up.</p><p><b>Methods:</b> Between January 2021 and March 2025, 21 patients aged 18 years or older with symptomatic aortic valve pathology and eligible for elective surgery were included in the study. The Ozaki procedure was performed on all patients using the right infra-axillary mini-thoracotomy approach. Clinical and demographic data, surgical technique details, early postoperative, and 6-month follow-up findings were examined. The main analysis parameters included surgery duration, complication rates, intensive care and hospital stay duration, echocardiographic results, and the need for reoperation.</p><p><b>Results:</b> The mean age was 65 ± 12 years, and 62% were male. Aortic stenosis was the most common pathology (81%). The mean surgery duration was 210 ± 30 min, and the intensive care unit stay was 2.5 ± 1 day. No cases of aortic valve insufficiency or major complications were observed in the early postoperative period. At 6-month follow-up, no reoperation was required except for endocarditis development in one patient (5%). Mortality was zero.</p><p><b>Conclusion:</b> The Ozaki procedure with mini-thoracotomy provides successful and safe results in suitable patients. This method, which offers both cosmetic and functional advantages, can be considered an effective alternative in aortic valve surgery.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5579009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037629","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":"Combined Treatment for Coronary Artery Disease and Aortic Valve Stenosis","authors":"Zulfugar T. Taghiyev,&nbsp;Martin V. Fuchs,&nbsp;Katharina E. Jäger,&nbsp;Oliver Dörr,&nbsp;Peter Roth,&nbsp;Andreas Böning","doi":"10.1155/jocs/3489054","DOIUrl":"https://doi.org/10.1155/jocs/3489054","url":null,"abstract":"<p><b>Objectives:</b> This study evaluated early and midterm prognostic outcomes of transcatheter aortic valve implantation (TAVI) in combination with percutaneous coronary intervention (PCI) compared with surgical aortic valve replacement (SAVR) plus coronary artery bypass grafting (CABG) in patients with severe aortic stenosis and anatomically complex coronary artery disease (CAD).</p><p><b>Methods:</b> Between 2010 and 2020, 1232 consecutive patients underwent TAVI with PCI or SAVR with CABG at a tertiary referral center. Eligibility required the presence of complex CAD (SYNTAX I score &gt; 22). Propensity score matching (1:1) generated 76 well-balanced patient pairs. The primary endpoint was early mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCE) and midterm mortality.</p><p><b>Results:</b> Matched cohorts exhibited intermediate operative risk (STS score: 3.0 ± 1.7 vs. 3.4 ± 1.2; EuroSCORE II: 6.89 ± 4.3 vs. 7.41 ± 4.7). No significant intergroup differences were observed regarding all-cause mortality (<i>p</i> = 0.262), ischemic stroke (<i>p</i> = 0.527), or myocardial infarction (<i>p</i> = 0.474) during follow-up. Similarly, reintervention rates did not differ (<i>p</i> = 0.515, HR: 2.1, 95% CI: 0.282–15.200). MACCE (<i>p</i> = 0.061, HR: 1.8, 95% CI: 0.938–3.509) and new pacemaker implantation (<i>p</i> = 0.087, HR: 0.5, 95% CI: 0.187–1.089) occurred numerically more frequently in the TAVI + PCI group without statistical significance. Prosthetic valve regurgitation &gt; Grade II was less common in SAVR + CABG, whereas mean transvalvular gradients favored TAVI + PCI.</p><p><b>Conclusion:</b> In patients with severe aortic stenosis and advanced CAD, TAVI + PCI yielded overall outcomes comparable to SAVR + CABG. However, the surgical strategy demonstrated superiority in terms of MACCE incidence and device-related conduction disturbances. Prospective randomized evidence is imperative to optimize patient selection and refine guideline-directed decision-making in this complex cohort.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3489054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012388","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":"Assessment of Inferior Vena Cava Dynamics as a Backup Strategy for Intraoperative Fluid Management in Robotic-Assisted Off-Pump Coronary Bypass Surgery","authors":"Han-Yu Lin,&nbsp;Shu-Yu Wu,&nbsp;I-Shiang Tzeng,&nbsp;Chun-Yu Chang,&nbsp;Nien-Hsun Wu,&nbsp;Ping-Cheng Shih","doi":"10.1155/jocs/4373211","DOIUrl":"https://doi.org/10.1155/jocs/4373211","url":null,"abstract":"<p>The inferior vena cava distensibility index (dIVC) has been proposed as an alternative dynamic parameter for predicting fluid responsiveness (FR) in mechanically ventilated patients. This study explored the correlation between dIVC and commonly used FR indicators in patients undergoing robotic-assisted off-pump coronary artery bypass (OPCAB) surgery. Thirty-two patients were prospectively enrolled, and hemodynamic parameters, including stroke volume variation (SVV), pulse pressure variation (PPV), central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), and the right ventricular end-diastolic volume index (RVEDVI), were recorded at four intraoperative time points. These time points were selected to represent distinct physiological phases during surgery: two-lung ventilation (TLV), one-lung ventilation (OLV), capnothorax, and mini-thoracotomy. dIVC showed a weak but significant positive correlation with SVV (<i>r</i> = 0.28, <i>p</i> &lt; 0.001) and PPV (<i>r</i> = 0.28, <i>p</i> &lt; 0.001), whereas no significant correlation was observed with static preload indicators (CVP, PCWP, and RVEDVI). Given that transesophageal echocardiography (TEE) is routinely employed in OPCAB surgery, dIVC measured via TEE may serve as a valuable adjunct for FR assessment when the SVV and PPV are unreliable, such as in patients with irregular heartbeats. However, using dIVC to predict intraoperative FR should be approached with caution, considering factors such as ventilator settings, inspiratory efforts, cardiopulmonary conditions, and intraabdominal hypertension.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/4373211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145012387","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":"Short-Term Outcomes of the Ross Procedure in Patients Greater and Less than 45 Years of Age","authors":"Anne Reimann-Moody,&nbsp;Arjune Dhanekula,&nbsp;Bret DeGraaff,&nbsp;Michael Shang,&nbsp;Audrey Mossman,&nbsp;Rachel Flodin,&nbsp;Dominique DeGraaff,&nbsp;David Mauchley,&nbsp;Christopher R. Burke,&nbsp;Scott C. DeRoo","doi":"10.1155/jocs/6684560","DOIUrl":"https://doi.org/10.1155/jocs/6684560","url":null,"abstract":"<p><b>Background:</b> There is no ideal aortic valve replacement. When compared to bioprosthetic and mechanical valves, a Ross procedure may offer significant advantages such as improved durability and restoration of normal life-expectancy. Whether such advantages are maintained in older patients is not well established. This study compares perioperative and medium-term outcomes of the Ross procedure in patients under the age of 45 and 45–65 years.</p><p><b>Methods:</b> This study retrospectively reviewed 76 patients undergoing the Ross procedure between 2020 and 2023 at a single academic center. The patients were stratified into young (18–44, <i>n</i> = 47) and middle-aged groups (ages 45–65, <i>n</i> = 29). Perioperative and medium-term outcomes to 1 year are reported.</p><p><b>Results:</b> The average age of the young group was 32 (± 6.5) years versus 54.1 (± 5.2) years in the older group (<i>p</i> &lt; 0.001) with more comorbidities and bicuspid aortic valve disease in the older group and no difference in primary symptoms, NYHA class, or ventricular function between the groups. There were no significant differences in the operative details between the groups. Perioperative outcomes showed a higher rate of atrial fibrillation 34.5% (<i>n</i> = 10) versus 12.8% (<i>n</i> = 6), <i>p</i> &lt; 0.05 and prolonged inotrope use (over 48 h) 20.7% (<i>n</i> = 6) versus 2.1% (<i>n</i> = 1), <i>p</i> &lt; 0.05 for the older group. There were no in-hospital mortalities. Medium-term outcomes showed no differences in ventricular or valvular function between the groups. There was one postdischarge mortality in the entire cohort (2.13%). No patients required autograft reintervention.</p><p><b>Conclusions:</b> The Ross procedure can be safely performed in selected patients 45–65 years of age with comparable perioperative and short-term outcomes to younger patients.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6684560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934950","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":"Coronary Revascularization Surgical Techniques and Outcomes in Octogenarians: A Multicenter Retrospective Matched Study","authors":"Amber Malhotra,&nbsp;Md. Anamul Islam,&nbsp;Kyle A. McCullough,&nbsp;John B. Eisenga,&nbsp;Giuseppe Tavilla,&nbsp;Ramachandra Reddy,&nbsp;Daniel Beckles,&nbsp;Thomas d’Amato,&nbsp;Robert L. Smith,&nbsp;Charles S. Roberts,&nbsp;Michael J. Mack,&nbsp;J. Michael DiMaio","doi":"10.1155/jocs/5329892","DOIUrl":"https://doi.org/10.1155/jocs/5329892","url":null,"abstract":"<p><b>Introduction:</b> Coronary artery bypass grafting (CABG) is commonly performed for treating coronary artery disease (CAD) in octogenarians. This entails higher risk and resource utilization compared to younger patients. This retrospective multicenter study evaluates CABG outcomes in octogenarians, with a particular focus on the impact of off-pump (OPCAB) versus on-pump (ONCAB) CABG techniques.</p><p><b>Methods:</b> We conducted a retrospective analysis of isolated OPCAB and ONCAB procedures in octogenarians from January 1, 2015, to June 30, 2023, across 8 centers within a single health system. All cases submitted to the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were included. The primary outcome was 30-day mortality; secondary outcomes included STS-defined postoperative complications. We performed a stabilized inverse probability treatment weighted (sIPTW) matching technique to balance baseline covariates between the two groups.</p><p><b>Results:</b> Across eight centers, 470 (7%) CABG procedures were performed in octogenarians, with 207 (44%) underwent OPCAB and 263 (56%) ONCAB. Prior to matching, overall 30-day all-cause mortality rate was 6.6% in octogenarians. After sIPTW matching, 30-day mortality (primary outcome) rates were comparable between OPCAB and ONCAB (2.4% vs. 4.4%; <i>p</i> = 0.71). However, OPCAB was associated with lower rates of composite complications (28% relative risk reduction (RRR), <i>p</i> = 0.003), including pneumonia (89% RRR, <i>p</i> = 0.023), atrial fibrillation (30% RRR, <i>p</i> = 0.013), and discharge-to-acute care facilities (ACFs) (36% RRR, <i>p</i> = 0.003). Resource utilization was also lower in the OPCAB group, with shorter median hospital stays (6 [3–7] vs. 7 [6–9] days, <i>p</i> = 0.002) and reduced ventilator time (4.3 [0.8–9] vs. 8.4 [4.7–21] hours, <i>p</i> = 0.009).</p><p><b>Conclusion:</b> In octogenarians, OPCAB and ONCAB found comparable 30-day mortality. However, OPCAB was associated with fewer complications, shorter hospital stays, reduced ventilator hours, lower blood transfusion requirements, and higher discharge-to-home rates, suggesting potential advantages in resource utilization and patient recovery.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5329892","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869874","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":"Contemporary Outcomes and Predictors of Adverse Events After Repair of Acute Type A Aortic Dissection: Report From an Aortic Center","authors":"Abdulrahman H. M. Hassab,&nbsp;James W. Antonios,&nbsp;Alan Chou,&nbsp;Matthew Williams,&nbsp;Arnar Geirsson,&nbsp;Prashanth Vallabhajosyula,&nbsp;Roland Assi","doi":"10.1155/jocs/6991973","DOIUrl":"https://doi.org/10.1155/jocs/6991973","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> This study evaluates short-term outcomes in patients undergoing surgery for acute Type A aortic dissection (ATAAD) at a specialized aortic referral center.</p>\u0000 <p><b>Methods:</b> Between October 2019 and October 2022, 80 consecutive patients underwent surgery for ATAAD at Yale New Haven Hospital. The patients were categorized into three groups: Penn Class A (<i>n</i> = 27) without malperfusion, Penn Class B (<i>n</i> = 22) with localized malperfusion without circulatory shock, and Penn Class C (<i>n</i> = 31) with generalized malperfusion and shock. Statistical analysis was performed to assess differences in perioperative descriptive variables, operative outcomes, and survival across Penn classification groups.</p>\u0000 <p><b>Results:</b> The mean age of patients was 65.2 ± 13.7 years, with 65% being male. Cerebral malperfusion was the predominant type (<i>p</i> &lt; 0.001). The most common surgical procedures performed were ascending and hemiarch aortic replacement with aortic valve/root repair. Antegrade thoracic endovascular aortic repair (TEVAR) was more frequent in Penn Class B and Class C than in Penn Class A (50.0%, 41.9% vs. 14.8%, <i>p</i> = 0.02). Postoperative complications included pneumonia (23.8%), postoperative renal failure (48.8%), and unplanned reoperation (18.8%, mostly for bleeding). Postoperative strokes occurred in 10%, all but one with preoperative neurologic deficits; none in Penn Class A. Persistent neurologic deficits were more common in Penn Class C than Class B (19.4% vs. 9.1%, <i>p</i> = 0.049). Postoperative renal failure and dialysis were associated with both malperfusion groups. Penn Class C had higher postoperative pneumonia (38.7%, <i>p</i> = 0.04) and tracheostomy (35.5%, <i>p</i> = 0.003). Overall postoperative mortality was 10%, highest in Penn Class C (19.4%, <i>p</i> = 0.048). Three-year postdischarge survival rates showed no significant differences between the groups (log-rank, <i>p</i> = 0.57).</p>\u0000 <p><b>Conclusion:</b> Emergent surgical repair was linked to excellent survival (90%) and resolution of neurological deficit in 80% of patients. Circulatory shock showed the strongest association with operative mortality, followed by visceral malperfusion. No significant postdischarge survival differences were observed, though follow-up was limited.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6991973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767815","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":"Augmentation of the Anterior Mitral Leaflet With an Untreated Autologous Pericardial Patch in Functional Mitral Regurgitation","authors":"Egzon Memedi,&nbsp;Philipp Rellecke,&nbsp;Bedri Ramadani,&nbsp;Dmytro Stadnik,&nbsp;Tong Li,&nbsp;Stephan Sixt,&nbsp;Artur Lichtenberg,&nbsp;Hug Aubin,&nbsp;Igor Tudorache","doi":"10.1155/jocs/3901792","DOIUrl":"https://doi.org/10.1155/jocs/3901792","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> Patch augmentation of the anterior mitral leaflet (AAML) is being used to treat functional mitral regurgitation (fMR) with the choice of patch material, however, still being a matter of debate. Therefore, the aim of this study was to determine the early- and 1-year results of AAML for fMR.</p>\u0000 <p><b>Methods:</b> Between 2020 and 2022, 30 patients underwent AAML for Carpentier Type IIIb fMR using an untreated autologous pericardial patch in our institution. The mean age of the patients was 61.3 ± 19.3 years, and 16 patients (53.3%) were male. Early- and 1-year results of mitral valve repair were assessed via clinical follow-up including echocardiographic examination.</p>\u0000 <p><b>Results:</b> Twenty patients (66.7%) were operated on through a right mini-thoracotomy and 10 patients (33.3%) via a median sternotomy, with 19 patients (63.3%) receiving a concomitant procedure. Three patients (10%) required postoperative mechanical circulatory support (MCS), with one of those patients (3.3%) deceasing due to multiple organ failure. Postoperative echocardiography showed that all patients (100%) had either no or mild MR. Freedom from moderate to severe MR was 100% (<i>n</i> = 29) at discharge as well as after a 1.1 ± 0.17-year follow-up (<i>n</i> = 26; with an additional three patients (10%) that deceased during the first postoperative year due to non–valve-related causes). No patient required mitral valve-related reoperation or intervention.</p>\u0000 <p><b>Conclusions:</b> AAML using an untreated autologous pericardial patch is a safe and reproducible surgical technique for fMR, with promising early results up to a 1-year follow-up. Further follow-up is warranted to determine long-term results especially with regard to the durability of mitral valve repair.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3901792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144716929","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":"New Reproducible Porcine Aortic Root Calcification Model: An Ex Vivo Study Under Dynamic Conditions","authors":"Najla Sadat,&nbsp;John Habakuk Lojenburg,&nbsp;Michael Scharfschwerdt,&nbsp;Matthias Klinger,&nbsp;Stephan Ensminger","doi":"10.1155/jocs/5519548","DOIUrl":"https://doi.org/10.1155/jocs/5519548","url":null,"abstract":"<div>\u0000 <p><b>Background:</b> Calcific aortic valve disease results in severe aortic valve stenosis, the most frequent valvular disorder. Ex vivo animal models provide an essential resource to understand the mechanism of valvular calcification. Therefore, we aimed to develop a new ex vivo porcine aortic root calcification model.</p>\u0000 <p><b>Methods:</b> Porcine aortic roots were subjected to a procalcific treatment with a buffer solution containing a defined calcium concentration (CaCl₂ = 2.2 mmol) in a durability tester (Hi-Cycle tester) with over 53.2 million cycles. The control group consisted of native porcine aortic roots that were not treated. Cusps of porcine aortic valves of both groups (total <i>n</i> = 10) were compared through macroscopic evaluation, analysis of tissue thickness, scanning and transmission electron microscopy, histological examination and calcium determination.</p>\u0000 <p><b>Results:</b> After durability testing, macroscopic examination demonstrated pronounced calcification at regions with high mechanical stress—the commissures and the nadirs of the cusps. Calcific nodules cause tissue thickness after Hi-Cycle testing. Hydroxyapatite crystals were found by scanning electron microscopy, and calcium deposits were noticed by transmission electron microscopy within calcified cusps in the calcified group. The proof of cusp calcification was seen histologically in the calcified group. Calcium content of the aortic cusps differed significantly after treatment with calcification buffer vs control group (7.240 [6.383–9.494] vs. 3.178 [3.140–3.701] μg/cm² cusp area, <i>p</i> = 0.008).</p>\u0000 <p><b>Conclusion:</b> We established a new reproducible and dynamic porcine aortic root calcification model. This ex vivo model may be a helpful alternative for investigating treatment modalities of calcification and functional analysis of heart valves instead of a complex animal model.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5519548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705622","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":"Fast-Track Extubation in the Operating Room After Minimally Invasive Direct Coronary Artery Bypass Grafting","authors":"Sebastian Johannes Bauer,&nbsp;Tomoyuki Suzuki,&nbsp;Yukiharu Sugimura,&nbsp;Anna Fischbach,&nbsp;Ajay Moza,&nbsp;Arash Mehdiani,&nbsp;Evangelos Karasimos,&nbsp;Gereon Schaelte,&nbsp;Rolf Rossaint,&nbsp;Gernot Marx,&nbsp;Payam Akhyari","doi":"10.1155/jocs/9180245","DOIUrl":"https://doi.org/10.1155/jocs/9180245","url":null,"abstract":"<div>\u0000 <p><b>Introduction:</b> Minimally invasive direct coronary artery bypass grafting (MIDCAB) offers a less traumatic alternative to conventional median sternotomy. The benefits of avoiding sternotomy align with the goals of enhanced recovery after surgery (ERAS). While early extubation benefits have been demonstrated in conventional CABG, evidence on extubation in the operating room remains scarce. We present a single-center experience with immediate extubation outside of a structured ERAS concept.</p>\u0000 <p><b>Methods:</b> Patients undergoing MIDCAB via a left anterolateral thoracotomy with unilateral ventilation between August 2022 and March 2024 were retrospectively analyzed. Patients who were extubated in the operating room (extubation in tabula, EIT) were compared to those who were extubated in the intensive care unit (ICU) (control, CTRL). The primary outcome was a transfer to general ward within 24 h after admission to ICU. Secondary outcomes aimed to assess safety endpoints, including the rate of reintubation, major adverse cardiac and cerebrovascular events, and length of stays.</p>\u0000 <p><b>Results:</b> A total of <i>n</i> = 79 patients were included. After propensity score matching, the cohorts consisted of <i>n</i> = 20 (CTRL) and <i>n</i> = 35 (EIT) patients, who had a median age of 68 years (IQR: 63–75), were 83.6% male, and showed comparable baseline characteristics. The majority of patients (92.7%) underwent single arterial bypass grafting. Fifteen patients (27.3%) met the primary endpoint with no significant difference between the two cohorts (CTRL 20.0%, EIT 31.4%, <i>p</i> = 0.531). Three patients in the EIT cohort required reintubation due to revision surgery (<i>n</i> = 2) and cardiopulmonary resuscitation (<i>n</i> = 1) due to thrombotic ischemia. The median stay in ICU was 23 h (IQR: 18–28), the total length of hospital stay 6d (IQR: 5–8) respectively.</p>\u0000 <p><b>Conclusion:</b> EIT after MIDCAB is safe and feasible. However, on its own, it does not affect subsequent transfers and should therefore be only considered as the first step toward a comprehensive ERAS approach.</p>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9180245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705490","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}