Journal of Cardiac Surgery最新文献

{"title":"Survival Outcomes in DCD vs DBD Heart Transplants in Patients Bridged With Fully Magnetically Levitated Centrifugal Flow Left Ventricular Assist Devices","authors":"Zachary W. Sollie,&nbsp;Chakradhari Inampudi,&nbsp;Lefan Xuan,&nbsp;Jingwen Zhang,&nbsp;Brett A. Welch,&nbsp;Arman Kilic","doi":"10.1155/jocs/7212761","DOIUrl":"https://doi.org/10.1155/jocs/7212761","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Heart transplant (HT) for donors after circulatory death (DCD) versus donor after brain death (DBD) have not been fully explored in patients bridged with HeartMate 3 (HM3) left ventricular assist devices (Abbott, Chicago, IL). This study aims to assess survival outcomes in DCD vs DBD HT in patients bridged with HM3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>All adults ≥ 18 years bridged to HT with HM3 between October 18, 2018, and March 31, 2025, were identified from the UNOS database and stratified by donor type (DCD vs DBD). Primary outcome was 90-day, 1-year, and 3-year survival. Multivariable risk adjustment was performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Following exclusion, 2380 patients (296 DCD and 2084 DBD) were identified. DCD patients had longer duration of HM3 support (671 days [343.5, 1122] vs 535 days [294.5, 912.5], <i>p</i> 0.0005), had fewer days on waitlist (83.5 days [20, 356] vs 137.5 days [32, 426], <i>p</i> 0.0072), were more frequently male (82.8% vs 77.4%, <i>p</i> 0.0351), blood type O (55.7% vs 38.4%, <i>p</i> &lt; 0.001), and status 4 listing (44.3% vs 35.2%, <i>p</i> &lt; 0.001). There was no difference in survival between DCD and DBD patients at 90 days (92.9% vs 92.8%, <i>p</i> 0.98), 1 year (89.4% vs 88.4%, <i>p</i> 0.68), or 3 years (78.7% vs 82.2%, <i>p</i> 0.66). Following multivariable adjustment, DCD donor status was not associated with increased mortality (HR 0.97 [0.65–1.45]; <i>p</i> = 0.875).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Survival between DCD and DBD HT in patients bridged with HM3 shows no significant difference. DCD utilization has potential to safely expand the donor pool in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/7212761","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467199","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":"Intraoperative Left Atrial Saline Flooding for Detection of Residual and Additional Ventricular Septal Defects: A Multicenter Retrospective Study of 2739 Pediatric Patients","authors":"Mustafa Kemal Avşar,&nbsp;Onur Benli,&nbsp;İbrahim Özgür Önsel,&nbsp;Barış Kırat,&nbsp;Carl Britto,&nbsp;Jason Kerstein,&nbsp;Cenap Zeybek","doi":"10.1155/jocs/8951430","DOIUrl":"https://doi.org/10.1155/jocs/8951430","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Residual and additional (previously unrecognized) ventricular septal defects (VSDs) can complicate pediatric congenital heart surgery and may necessitate early reintervention. We evaluated the intraoperative detection yield and safety of left atrial saline flooding as a practical adjunct to intraoperative transesophageal echocardiography (TEE) in a large multicenter cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 2739 pediatric patients (mean age 2.6 years; 51% male) undergoing repair of isolated VSD (<i>n</i> = 1252), atrioventricular septal defect (AVSD; <i>n</i> = 644), or tetralogy of Fallot (TOF; <i>n</i> = 843) at four tertiary centers in Türkiye (2000–2023). Left atrial saline flooding was performed via a patent foramen ovale when present or a limited atrial septotomy when required, before separation from cardiopulmonary bypass (CPB), and used alongside intraoperative TEE. Mean additional CPB time attributable to the maneuver was 5 ± 1 min.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Saline flooding identified residual VSDs in 163 patients (5.9%) and additional VSDs in 218 patients (8.0%), with rates differing significantly by diagnosis (highest in AVSD: 12.6% residual and 16.0% additional; <i>p</i> &lt; 0.001 across groups). All detected defects were revised immediately during the index operation. Discharge echocardiography showed 10 trivial residual shunts (0.36%), none requiring intervention. No complications were attributed to the saline flooding maneuver. Postoperative adverse events included prolonged mechanical ventilation (1.7%), arrhythmias (2.4%), and superficial surgical site infection (0.9%). Operative mortality, defined according to Society of Thoracic Surgeons (STS) criteria as death occurring during the index hospitalization or within 30 days postoperatively, was 0.29% (<i>n</i> = 8; AVSD: 5, TOF: 3). No surgical reoperation or transcatheter procedure was performed for residual/additional VSD closure during follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Left atrial saline flooding is a safe, low-cost, and reproducible adjunct that can facilitate intraoperative identification and immediate correction of residual and additional VSDs prior to separation from CPB. Routine use may strengthen intraoperative quality control and reduce clinically significant residual shunting after pediatric congenital heart repairs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/8951430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467004","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":"Agreement of Transthoracic and Three-Dimensional Transesophageal Echocardiography With Surgical Aortic Annular Sizing: Insights From a Retrospective Study","authors":"Hamideh Khesali,&nbsp;Sara Shemshadi,&nbsp;Zahra Ghaffarinejad,&nbsp;Pegah Salehi,&nbsp;Yaghoob Bagheri,&nbsp;Saeid Hosseini,&nbsp;Soheila Salari","doi":"10.1155/jocs/3208983","DOIUrl":"https://doi.org/10.1155/jocs/3208983","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reliable preoperative assessment of the aortic annulus is essential for aortic valve replacement and transcatheter aortic valve implantation (TAVI). Transthoracic echocardiography (TTE) and three-dimensional transesophageal echocardiography (3D TEE) are commonly used noninvasive tools for annular sizing; however, their agreement with intraoperative surgical sizing remains uncertain, particularly because surgical sizing reflects a postexcisional functional annular dimension rather than a direct anatomical gold standard.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate and compare the agreement of TTE and 3D TEE with direct surgical sizing of the aortic annulus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study included 106 patients who underwent aortic valve replacement between January 2019 and December 2023. The mean patient age was 57.2 ± 9.8 years (median 57, IQR 46–66), and 68 patients (64.2%) were male. The surgical annulus diameter had a median of 23 mm (IQR 22–25 mm). TTE and 3D TEE yielded lower annular diameters with medians of 22 mm (IQR 20–23 mm) and 22 mm (IQR 21–24 mm), respectively. Compared with surgical sizing, the median differences were −2 mm (IQR −4 to 0 mm, <i>p</i> &lt; 0.001) for TTE and −1 mm (IQR −3 to 1 mm, <i>p</i> = 0.010) for 3D TEE. Bland–Altman analysis demonstrated wide limits of agreement for both modalities (TTE: −6 to +2 mm; 3D TEE: −6 to +4 mm). The correlation between TTE and 3D TEE was strong (<i>r</i> = 0.790, <i>p</i> &lt; 0.001), whereas correlations between each echocardiographic modality and surgical sizing were very weak and statistically nonsignificant (TTE: <i>r</i> = 0.084; 3D TEE: <i>r</i> = 0.038).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TTE and 3D TEE demonstrated limited agreement with surgical aortic annular sizing, with weak correlations and wide limits of agreement. Although 3D TEE showed smaller mean systematic bias than TTE at the group level, substantial individual-level variability remained. Because surgical sizing is performed after leaflet excision and annular debridement and reflects functional rather than purely anatomical sizing, these findings should be interpreted as agreement with surgical sizing rather than validation against a true anatomical gold standard.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3208983","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148466860","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 Between the Preoperative Haemoglobin–Albumin–Lymphocyte–Platelet Score and Histopathological Diagnosis in Surgically Resected Intracardiac Masses","authors":"Onur Benli,&nbsp;Hafize Yalınız,&nbsp;Burcu Arslan Benli,&nbsp;Mete Kubilay Kasap,&nbsp;Elif Tuğçe Solmaz","doi":"10.1155/jocs/5819636","DOIUrl":"https://doi.org/10.1155/jocs/5819636","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the association between the preoperative haemoglobin–albumin–lymphocyte–platelet (HALP) score and histopathological diagnosis in patients undergoing surgical resection of intracardiac masses, and to assess its potential role as an adjunctive risk stratification tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective single-centre cohort study, 96 adult patients who underwent surgical resection of an intracardiac mass between January 2010 and December 2024 were analysed. Final histopathology classified lesions as benign (<i>n</i> = 76) or malignant (<i>n</i> = 20). The HALP score was calculated from preoperative laboratory parameters. Group comparisons were performed using the Mann–Whitney <i>U</i> test. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis. Multivariable logistic regression adjusted for age and sex was conducted to evaluate the independent association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median HALP was significantly lower in malignant compared with benign lesions (24.69 [IQR 21.71–25.15] vs. 32.29 [IQR 22.63–53.32]; <i>p</i> = 0.003). ROC analysis demonstrated moderate discriminative ability (AUC 0.72; 95% CI 0.61–0.81). The optimal cut-off value (HALP = 26.91) yielded 100% sensitivity and 65.8% specificity. In multivariable analysis adjusted for age and sex, HALP remained independently associated with malignancy (OR 0.95 per unit increase; 95% CI 0.90–0.99; <i>p</i> = 0.027), although the magnitude of the clinical effect was limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Lower preoperative HALP scores were independently associated with malignant intracardiac masses. Although its discriminative performance is moderate, HALP may serve as a simple and readily available adjunctive marker for preoperative risk stratification. External validation in larger, multicentre cohorts is required before clinical implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5819636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148466715","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":"Management of the Left Subclavian Artery in Total Arch Replacement With Frozen Elephant Trunk","authors":"David Choe,&nbsp;Markian Bojko,&nbsp;Joshua Lopez,&nbsp;Valerie Huang,&nbsp;Serge Kobsa,&nbsp;Fernando Fleischman","doi":"10.1155/jocs/8217667","DOIUrl":"https://doi.org/10.1155/jocs/8217667","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The optimal strategy for the left subclavian artery (LSCA) in total arch replacement with frozen elephant trunk (TARFET) is not well defined. Our aim was to evaluate the management of the LSCA for patients undergoing TARFET at our institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 225 consecutive patients underwent TARFET between 2015 and 2023. Patients were divided into two groups based on the presence of preoperative/intraoperative LSCA revascularization. Groups were compared across baseline characteristics and outcomes. The Kaplan–Meier method was used to estimate postoperative survival and freedom from stroke over follow-up and compared between groups using the log rank test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 225 patients, 114 (50.7%) had preoperative/intraoperative LSCA revascularization and 111 (49.3%) did not. Of the 114, 18 patients (15.8%) in the revascularization group had acute Type A dissection, compared to 64/111 (57.7%) in the nonrevascularization group (<i>p</i> &lt; 0.001). The operative mortality rate was 11/114 (9.6%) in the revascularization group and 23/111 (20.7%) in the nonrevascularization group (<i>p</i> = 0.033). The stroke rate was 15/114 (13.2%) and 35/111 (31.5%), respectively (<i>p</i> = 0.002). The left arm ischemia rate was 2/114 (1.8%) and 13/111 (11.7%), respectively (<i>p</i> = 0.001). Among patients with acute Type A dissection, there was no difference in survival or freedom from stroke based on LSCA revascularization. Among patients with all other indications, survival and freedom from stroke were superior in patients undergoing preoperative/intraoperative LSCA revascularization (<i>p</i> &lt; 0.001, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients undergoing TARFET for emergent indications are at risk for LSCA under-revascularization. Among nonemergent cases, LSCA revascularization was associated with improved survival and freedom from stroke.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/8217667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148466690","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":"Anterior Leaflet Neochordal Anchoring to Correct Postmitral Valve Repair Systolic Anterior Motion","authors":"Federico Ranocchi,&nbsp;Francesco Zito,&nbsp;Francesca Mazzone,&nbsp;Elisabetta Giorni,&nbsp;Giovanni Melina","doi":"10.1155/jocs/1648907","DOIUrl":"https://doi.org/10.1155/jocs/1648907","url":null,"abstract":"<p>Systolic anterior motion (SAM) after mitral valve repair may result in left ventricular outflow tract obstruction and residual mitral regurgitation (MR), sometimes requiring prompt surgical revision. We describe a simple and reproducible bailout technique based on anterior leaflet neochordal anchoring to the posteromedial papillary muscle to redirect leaflet motion posteriorly. This approach enables the effective resolution of SAM without modification of the initial repair. In our experience, the technique resulted in the immediate elimination of SAM and residual MR without inducing mitral stenosis.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/1648907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386601","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 Evolution of Minimally Invasive Cardiac Surgery Literature: A 50-Year North American Bibliometric Review and Future Trends","authors":"Samir Cubas W.,&nbsp;Ace Alfabeto,&nbsp;Yasuhiko Kawaguchi,&nbsp;Lin-Rui Guo,&nbsp;Michael W. A. Chu","doi":"10.1155/jocs/2938936","DOIUrl":"https://doi.org/10.1155/jocs/2938936","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study provides the first bibliometric analysis of minimally invasive cardiac surgery (MICS) in North America, mapping its evolution, collaboration networks, and research trends while forecasting future scientific trajectories through 2050.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a bibliometric analysis of North American MICS literature (1975–2025) using Scopus and PubMed. Data processed using R (bibliometrix and biblioshiny) enabled network mapping, keyword analysis, and predictive modeling. Metrics included publication growth, document types, authorship, collaboration, citations, h-index, journals, and research topics. Collaboration networks and thematic evolution were visualized. Future MICS output (2030–2050) was forecasted using linear extrapolation with 95% confidence intervals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 1433 publications (United States: 76.3%; Canada: 23.7%). Original articles comprised 48.7%, and case reports comprised 28.7%, with an 8.51% annual growth rate. Among 4800 authors, 89.9% were male, averaging 5.65 coauthors per paper and 22.2% international collaborations. First authors were mainly faculty–surgeons (67.5%) and fellows (15.3%). Top topics are mitral valve (41.7%) and CABG (28.7%). Leading journals are Innovations (16.0%), Annals of Thoracic Surgery (12.6%), Journal of Cardiac Surgery (5.7%), and JTCVS (5.0%). Key affiliations are Cleveland Clinic (13.8%) and Western University (12.5%). Collaborations were strongest with Italy (43.5%) and Germany (32.8%). Forecasting models predicted an annual output of 79 publications by 2030, 93 by 2040, and 107 by 2050 (95% CI 58–146).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This inaugural bibliometric analysis of North American MICS outlines five decades of growth, projects continued expansion to 2050, and offers a strategic foundation for future research, funding, and collaboration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/2938936","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386258","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":"Intraoperative Biochemical Variations and Short-Term Cognitive Outcomes After Histidine–Tryptophan–Ketoglutarate Versus Plegisol Cardioplegia in Adult Cardiac Surgery","authors":"Yu-Ning Hu,&nbsp;Yu-Ming Chang,&nbsp;Meng-Ta Tsai,&nbsp;Hui-Ling Chan,&nbsp;Dean Chou,&nbsp;Yu-Ching Huang,&nbsp;Chou-Ching Lin,&nbsp;Jun-Neng Roan","doi":"10.1155/jocs/3600210","DOIUrl":"https://doi.org/10.1155/jocs/3600210","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cardioplegia is essential for myocardial protection during cardiac surgery with cardiopulmonary bypass (CPB). Histidine–tryptophan–ketoglutarate (HTK) solution, an intracellular-type cardioplegia, offers prolonged myocardial protection with single-dose administration, whereas Plegisol, an extracellular-type crystalloid cardioplegia solution that can be mixed with blood, requires repeated dosing. However, their distinct ionic compositions may differentially affect intraoperative biochemical stability and neurological outcomes. This study aimed to compare the effects of HTK and blood cardioplegia using Plegisol on intraoperative biochemical parameters, brain injury markers, and postoperative cognitive function.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;From January 2023 to May 2025, 58 adult patients undergoing open-heart surgery with CPB were prospectively enrolled. Patients received either HTK (&lt;i&gt;n&lt;/i&gt; = 24) or blood cardioplegia with Plegisol (&lt;i&gt;n&lt;/i&gt; = 34) according to surgeon preference. Serum electrolytes, glucose, osmolality, and brain injury biomarkers were measured hourly during CPB. Bilateral frontal cerebral oxygen saturation was continuously monitored. Cognitive function was assessed preoperatively and at 3 months postoperatively using the Montreal Cognitive Assessment (MoCA), which evaluates attention, executive function, memory, language, visuospatial skills, and orientation.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Compared with Plegisol, HTK cardioplegia was associated with significantly lower intraoperative sodium levels and transient hypoosmolality. Intraoperative glucose levels were unexpectedly higher in the HTK group after 2 h of CPB. S100 calcium-binding protein B (S100β) levels increased significantly over time, with a greater rise in the HTK group (group × time interaction: &lt;i&gt;p&lt;/i&gt; = 0.029), whereas neuron-specific enolase levels showed no intergroup differences. Despite these intraoperative biochemical variations, 3-month postoperative MoCA scores were comparable between groups (&lt;i&gt;p&lt;/i&gt; = 0.746), and no significant differences were observed in postoperative clinical outcomes, including delirium incidence (12.5% vs. 17.6%, &lt;i&gt;p&lt;/i&gt; = 0.722), agitation, brain events, or length of stay.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;HTK cardioplegia induces expected intraoperative hyponatremia and is associated with greater S100β elevation during CPB, suggesting transient neuronal stress. However, these biochemical differences did not translate into differences in postoperative cognitiv","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3600210","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386954","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 Repair of the Aortic Valve in Children: A State-of-the-Art Systematic Review","authors":"Andrey Semyashkin,&nbsp;Alina Sandica,&nbsp;Leonid Gherta,&nbsp;Lotfi Ben Mime","doi":"10.1155/jocs/6691434","DOIUrl":"https://doi.org/10.1155/jocs/6691434","url":null,"abstract":"<p>Aortic valve repair in children remains an important strategy to preserve native valve tissue, avoid prosthetic valve replacement, and accommodate somatic growth. However, outcomes vary substantially across repair techniques, valve morphologies, and patient subgroups. We performed a systematic review with quantitative synthesis of outcomes to provide a contemporary overview of surgical strategies and long-term results of pediatric aortic valve repair. PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were searched for studies published between January 2000 and January 2026 reporting outcomes of surgical aortic valve repair in patients aged ≤ 18 years. Thirty-four studies, including 2684 children, were analyzed. Repair strategies included commissurotomy, leaflet plication, cusp extension or tricuspidization, annuloplasty-based techniques, pericardial leaflet reconstruction, and aortic valve neocuspidization. Early mortality after pediatric aortic valve repair was low overall (1.3%; 95% confidence interval [CI]: 0.7%–2.1%) but higher in neonates and infants. Long-term durability differed by technique and underlying pathology. Autologous pericardial cusp extension and tricuspidization demonstrated favorable long-term durability in selected patients, with freedom from reoperation approaching 75% at 15 years in some series. Valve neocuspidization was associated with excellent early hemodynamics and no early mortality in the included studies, but currently available pediatric data suggest less certain mid-term durability, with estimated freedom from reintervention of 44% at 10 years; however, interpretation is limited by small sample sizes and relatively short follow-up. Younger age at repair and the use of treated xenograft material were associated with increased risk of reintervention. Pediatric aortic valve repair provides low operative mortality and favorable valve preservation in carefully selected patients, but outcomes depend strongly on patient age, valve morphology, surgical technique, and institutional experience. Pooled estimates should be interpreted cautiously in view of substantial clinical heterogeneity. Surgical decision-making should remain individualized and lesion-specific, with a strong emphasis on valve preservation whenever feasible.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6691434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148386520","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":"Strategic Autologous Posterior Wall Reconstruction Using the Left Atrial Appendage in Nonconduit Right Ventricular Outflow Tract Repair: Two Surgical Patterns to Improve Reoperation-Free Survival","authors":"Shintaro Nemoto,&nbsp;Hayato Konishi,&nbsp;Akiyo Suzuki,&nbsp;Takahiro Katsumata,&nbsp;Kanta Kishi,&nbsp;Yutaka Odanaka,&nbsp;Noriyasu Ozaki,&nbsp;Atsuko Ashida","doi":"10.1155/jocs/8096789","DOIUrl":"https://doi.org/10.1155/jocs/8096789","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the surgical strategy and midterm outcomes of a conduit-less right ventricle-to-pulmonary artery (RV-PA) reconstruction using the left atrial appendage (LAA) for posterior wall augmentation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 17 consecutive patients (median age: 15.2 months; weight: 8.4 kg) who underwent conduit-less RV-PA reconstruction between 2007 and 2025. The LAA was utilized to reconstruct the posterior wall of RV-PA route via two distinct techniques selected according to native anatomy: Type A (augmentation of the diminutive PA trunk), used when native PA tissue was available, where the LAA was attached to augment the left side of the longitudinally incised PA trunk (<i>n</i> = 8); and Type B (interposition), used when native PA tissue was absent, requiring the LAA to be interposed as a bridge between the pulmonary bifurcation and the RV incision (<i>n</i> = 9). The anterior wall was completed with a monocusp-incorporated transannular patch.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Primary diagnoses included pulmonary atresia with ventricular septal defect (<i>n</i> = 11), double-outlet right ventricle (<i>n</i> = 3), truncus arteriosus (<i>n</i> = 2), and tetralogy of Fallot with hypoplastic PA (<i>n</i> = 1). The median follow-up was 3.8 years (up to 11.9 years). There were no technique-specific complications. The median diameter of the reconstructed route was 12 mm. One noncardiac death occurred due to pneumonia. While four patients required catheter interventions for peripheral branch PA stenosis (5-year freedom from intervention: 61.6%), only one patient required reoperation due to a restrictive monocusp. No interventions were required for the LAA posterior wall itself. The estimated 5-year freedom from reoperation was 90.9%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Strategic use of the LAA for reconstruction of a new RV-PA route—either by augmentation (Type A) or interposition (Type B)—is a promising conduit-less approach that achieves favorable midterm freedom from surgical reoperation. Long-term follow-up is warranted to evaluate the cumulative lifetime reintervention burden and the theoretical growth potential of this autologous tissue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2026 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/8096789","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148324503","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}