Thoracic and Cardiovascular Surgeon最新文献

{"title":"Impact of Upper Lobe Resection and Potassium on AF After Lung Surgery.","authors":"Taner Şahin","doi":"10.1055/a-2951-2202","DOIUrl":"https://doi.org/10.1055/a-2951-2202","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) following lung resection and surgical factors, particularly the extent and location of resection, alongside preoperative electrolyte levels. We also sought to develop and internally validate a composite risk model for identifying high-risk patients.</p><p><strong>Methods: </strong>In this single-center retrospective cohort study, 422 patients who underwent lung resection (sublobar, lobar, or major resection) between December 2024 and April 2025 were analyzed. Patients with pre-existing atrial substrate, heart failure, or left atrial dilatation (≥40 mm) were excluded. Independent predictors were identified using multivariable logistic regression. To further address potential confounding, inverse probability of treatment weighting (IPTW) analysis was performed.</p><p><strong>Results: </strong>POAF developed in 66 patients (15.6%). In multivariable analysis, lower preoperative potassium levels (OR 0.40; 95% CI 0.21-0.79; p=0.008), major resection (OR 4.10; 95% CI 1.98-8.49; p<0.001), and upper lobe resection (OR 4.23; 95% CI 2.22-8.05; p<0.001) were independent predictors of POAF. In the IPTW-adjusted analysis, upper lobe resection remained significantly associated with POAF (OR 2.08; 95% CI 1.16-3.75; p=0.013). The composite model demonstrated moderate discrimination (AUC 0.716; 95% CI 0.641-0.777), which remained stable after bootstrap validation. POAF was associated with longer ICU stay and higher in-hospital mortality (16.7% vs. 1.4%, p<0.001).</p><p><strong>Conclusion: </strong>POAF after lung resection is a predictable complication associated with the extent of surgery, upper lobe involvement, and preoperative potassium levels. These findings highlight the importance of closer rhythm surveillance and perioperative electrolyte optimization in high-risk patients.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Surgery 2025 Reviewed.","authors":"Hristo Kirov, Tulio Caldonazo, Murat Mukharyamov, Angelique Runkel, Philine Fleckenstein, Sebastian Freiburger, Thierry Siemeni, Torsten Doenst","doi":"10.1055/a-2835-1473","DOIUrl":"10.1055/a-2835-1473","url":null,"abstract":"<p><strong>Abstract: </strong>For the 12th consecutive time, we systematically reviewed the cardio-surgical literature for the past year, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for a results-oriented summary. In 2025, the discussion on the value of randomized and observational evidence continued, showing converging results in the treatment of coronary artery disease and further diverging results in the field of invasive aortic valve therapies. Across randomized trials, meta-analyses, and registries, coronary artery bypass grafting (CABG) consistently provides superior long-term outcomes compared with percutaneous coronary intervention in complex coronary artery disease, driven primarily by sustained reductions in future myocardial infarctions. In addition, atrial fibrillation after CABG was shown to be more frequent than expected, but its long-term burden was negligible, while prolonged dual antiplatelet therapy after CABG for acute coronary syndrome offered no benefit but increased bleeding risk. The \"valve treatment arena\" in 2025 was heavily affected by the new guidelines, which clarified many aspects in mitral and tricuspid valve treatment but generated great controversy for aortic stenosis treatment. The latter was based on a reduction of the age cut-off for transcatheter aortic valve implantation to 70 years (unsupported by new data) and the selective reliance on only randomized studies (despite contradictory risk-adjusted registry evidence). Across mitral and tricuspid valve disease, publications showed improvements in symptoms and quality of life without survival benefits with transcatheter therapies and the most consistent long-term outcomes with surgery, particularly when appropriately timed and performed in experienced centers. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but it provides up-to-date information for patient-specific decision-making.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"433-444"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Preoperative Positron Emission Tomography - Computed Tomography for Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer.","authors":"Sarah Häufglöckner, Peter Kleine, André Althoff, Neelam Lingwal","doi":"10.1055/a-2855-2535","DOIUrl":"10.1055/a-2855-2535","url":null,"abstract":"<p><strong>Background: </strong>Accurate mediastinal lymph node staging is essential in non-small cell lung cancer (NSCLC) treatment. While 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used for noninvasive staging, its diagnostic reliability, particularly for nodal assessment, remains debated.</p><p><strong>Methods: </strong>A retrospective multicenter analysis included 278 patients with histologically confirmed NSCLC who underwent FDG-PET/CT followed by surgery with systematic lymphadenectomy between 2015 and 2021. PET/CT-based nodal staging was compared with histopathology. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and Cohen's κ. Logistic regression was performed to identify predictors of correct N staging. Patients receiving neoadjuvant therapy were excluded from subgroup analyses (<i>n</i> = 252).</p><p><strong>Results: </strong>Histopathology revealed nodal metastases in 112 patients (40.3%). PET/CT detected nodal involvement with sensitivity of 66.8% and specificity of 85.2%. PPV was 50.7% and NPV 85.5%, with an overall concordance of 43.3%. Sensitivity for N1 disease was 38.2%, whereas N2 and N3 metastases were detected with sensitivities of 55.3% and 100.0%. The false-negative rate was 25.2%, with intrapulmonary nodes (station 11) most frequently missed. False-positive findings occurred in 20.1%, predominantly in hilar nodes. Multivariable analysis identified lymph node involvement and tumor stage as independent predictors of staging accuracy, whereas extracapsular extension showed a non-significant trend.</p><p><strong>Conclusion: </strong>FDG-PET/CT demonstrates high specificity and NPV but limited sensitivity for mediastinal nodal staging in NSCLC under real-world conditions. These findings are primarily driven by disease characteristics rather than methodological factors. A multimodal approach remains essential, with histopathological confirmation of PET-positive findings and selective invasive staging in PET-negative patients to ensure accurate treatment allocation.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"510-517"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Gaps in Cardiothoracic Surgery: Are Patient Outcomes Shaped by Workforce Inequity?","authors":"Khaled Ebrahim Al-Ebrahim","doi":"10.1055/a-2867-5247","DOIUrl":"10.1055/a-2867-5247","url":null,"abstract":"<p><strong>Background: </strong>Gender disparities persist across cardiac and thoracic surgical care, influencing access, procedural selection, perioperative risk, and long-term outcomes. Despite major advances in operative technique and perioperative pathways, women continue to experience delayed diagnosis, lower procedural referral rates, and distinct complication profiles after high-risk procedures, including coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR), and transcatheter edge-to-edge repair (TEER). These patient-level disparities parallel persistent inequities within the cardiothoracic surgery workforce, raising the possibility that structural workforce imbalances may influence clinical outcomes.</p><p><strong>Objective: </strong>This study aimed to synthesize contemporary evidence (2020-2025) characterizing sex- and gender-based disparities across cardiac and thoracic surgery, identify interconnected root causes, and outline strategies and research priorities for reducing inequities.</p><p><strong>Methods: </strong>A narrative review (2020-2025) combined structured database searches of trials and registries with synthesis of mechanistic and health-system literature to interpret heterogeneous evidence.</p><p><strong>Results: </strong>Women undergoing cardiothoracic procedures often present at older age with greater frailty, smaller anatomical dimensions, and more atypical symptoms, increasing procedural complexity and perioperative risk. CABG and SAVR show higher early morbidity in women, while PCI disparities have narrowed but persist due to delayed recognition; TAVR demonstrates higher early complications yet better mid- and long-term survival. In thoracic surgery, women generally have lower perioperative mortality, but experience delayed diagnosis, lower screening rates, and reduced use of minimally invasive approaches. These outcome differences occur alongside persistent workforce inequities, including the underrepresentation of women in surgical practice, leadership, and academia.</p><p><strong>Conclusion: </strong>Gender disparities in cardiac and thoracic surgery are multifactorial and closely intertwined with systemic workforce inequities. Solutions require sex-aware risk assessment, equitable referral pathways, inclusive device development, mandated sex-stratified reporting, and targeted workforce reforms. Addressing both patient-level and structural contributors is essential to achieve durable gender equity in cardiothoracic surgical care.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"445-449"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147933674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral Valve Procedures and Multivessel CABG through a Single Left Anterior Minithoracotomy.","authors":"Volodymyr Demianenko, Hilmar Dörge, Markus Schlömicher, Marius Grossmann, Ahmed Belmenai, Christian Sellin","doi":"10.1055/a-2765-7072","DOIUrl":"10.1055/a-2765-7072","url":null,"abstract":"<p><strong>Abstract: </strong>We describe a technique for concomitant coronary artery bypass grafting (CABG) and mitral valve (MV) replacement or annuloplasty with ring implantation performed through a single left anterior minithoracotomy (LAmT). Four patients underwent combined MV and CABG surgery using peripheral cardiopulmonary bypass, a transseptal approach to the MV, and complete coronary revascularization. MV exposure was successfully achieved in all cases without conversion to sternotomy. No major complications such as stroke, reoperation for bleeding, or early mortality occurred. Our initial results demonstrate that single LAmT is a feasible sternum-sparing approach for patients requiring simultaneous coronary and mitral procedures.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"500-502"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688166","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":"Fluoroscopic Pericardiocentesis by Cardiac Surgeons: Hybrid Setup Outcomes.","authors":"Erturk Karaagac, Nuri Utkan Tunca, Serkan Yazman, Hasan Iner, Yuksel Besir, Levent Yilik, Ali Gurbuz","doi":"10.1055/a-2849-6543","DOIUrl":"10.1055/a-2849-6543","url":null,"abstract":"<p><strong>Background: </strong>Pericardiocentesis is a life-saving intervention in the treatment of cardiac tamponade. This study aims to evaluate the safety, efficacy, and short-term outcomes of fluoroscopy-guided pericardiocentesis performed by cardiovascular surgeons in a hybrid operating room setting.</p><p><strong>Methods: </strong>Data from 64 patients who underwent fluoroscopy-guided percutaneous drainage for symptomatic pericardial effusion in a hybrid operating room between January 2020 and December 2024 were analyzed retrospectively. Procedures were performed using a standard subxiphoid approach and a pigtail catheter.</p><p><strong>Results: </strong>The etiology was malignancy in 31.2% (<i>n</i> = 20) of the patients. The median maximum effusion diameter measured on preoperative echocardiography was 24 mm (interquartile range [IQR]: 20-28 mm), which decreased significantly to 7 mm (IQR: 5-9 mm) on postoperative evaluation (<i>p</i> < 0.001). The minor complication rate was 1.5% (<i>n</i> = 1, pneumothorax). No surgical conversion (sternotomy) was required during the procedures. Reintervention was required in only two patients (3.1%) during the 3-month follow-up.</p><p><strong>Conclusion: </strong>Fluoroscopy-guided pericardiocentesis performed under hybrid operating room conditions represents a safe option with low complication and recurrence rates, even in high-risk groups such as malignancy. The real-time anatomical visualization provided by fluoroscopy, combined with the surgical infrastructure of the hybrid environment, provides a feasible workflow for cardiac surgeons. However, these findings need to be supported by more extensive and comparative studies.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"455-459"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Differences Among T3 Descriptor Subgroups in Resected Lung Cancer.","authors":"Canberk Heskiloğlu, Necati Citak, Serkan Yazgan, Ahmet Üçvet, Kenan C Ceylan","doi":"10.1055/a-2722-4702","DOIUrl":"10.1055/a-2722-4702","url":null,"abstract":"<p><strong>Objective: </strong>Prognostic heterogeneity may exist among T3 nonsmall cell lung cancers depending on specific T3 descriptors. Our study aimed to evaluate the survival differences among T3 subgroups in patients with resected lung cancer.</p><p><strong>Methods: </strong>This retrospective cohort study included 381 patients with pathologically confirmed (p)T3N0/1 nonsmall cell lung cancer. Patients with mediastinal lymph node metastases or superior sulcus tumors were excluded. Patients were classified into three subgroups; the T3-ordinary group (only tumor diameter >5 cm but ≤7 cm, or only an additional tumor nodule in the same lobe as the primary tumor, <i>n</i> = 246), the T3-invasion group (the primary tumor directly invades any of the structures; only the phernic nerve, pericardium, parietal pleura or the chest wall, <i>n</i> = 57), and the T3-multiple group (the tumor had at least two T3 descriptors, <i>n</i> = 78).</p><p><strong>Results: </strong>The 5-year overall survival rate was 52% (median survival time: 63 months; 95% CI: 53-72 months). A significant difference was observed between the three groups in terms of median survival time (T3-ordinary, 70 months; T3-invasion, 58 months; T3-multiple, 43 months; chi-square = 5.86, <i>p</i> = 0.04-log rank). Moreover, the 5-year survival rate was significantly higher in the T3 single group than in the T3 multiple group (54.5% vs. 40.4%, <i>p</i> = 0.03). Multivariate analysis showed that lymph node status (<i>p</i> = 0.007), adjuvant treatment (<i>p</i> < 0.001), major surgical complications (<i>p</i> < 0.001), and T3-subgroups (<i>p</i> = 0.02) were independent prognostic factors.</p><p><strong>Conclusion: </strong>Patients with two or more pT3 descriptors or tumors exhibiting invasion have the worst survival rates. Stage migration can be discussed in these patients.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"503-509"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Myectomy with Anterior Mitral Leaflet Extension Versus Isolated Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy.","authors":"Tijn J P Heeringa, Marieke Hoogewerf, Romy Hegeman, Dimitri van Wylick, David Stecher, Maarten Jan Cramer, Giulia De Zan, Yvonne Koop, Ronald C A Meijer, Nicolaas P A Zuithoff, Pim van der Harst, Marco Guglielmo, Ilonca Vaartjes, Mostafa M Mokhles, Niels P van der Kaaij","doi":"10.1055/a-2768-2815","DOIUrl":"10.1055/a-2768-2815","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the echocardiographic parameters and complication rates of surgical myectomy with concomitant anterior mitral leaflet extension (SM + AMLE) and isolated SM in hypertrophic obstructive cardiomyopathy (HOCM) patients.</p><p><strong>Methods: </strong>All HOCM patients undergoing SM + AMLE (2006-2015) and isolated SM (2015-2020) in our centre were analysed. The primary outcome was left ventricular outflow tract (LVOT)-gradient and surgical reoperation (SM/mitral surgery). Secondary outcomes were aortic cross-clamping (ACC) time, iatrogenic ventricular septal defect (VSD), and mortality at 30-day and 3-year follow-up. Mixed-effects models assessed postoperative changes in LVOT-gradient measurements over time until a 3-year follow-up.</p><p><strong>Results: </strong>This cohort (<i>n</i> = 59) consisted of 34 (58%) SM + AMLE and 25 (42%) isolated SM procedures. There were 32 (54%) males and 27 (46%) females with a mean age of 55 ± 13 years at the time of the intervention. Postoperatively, no differences were observed over time in the median LVOT-gradient (<i>p</i> = 0.34). In the SM + AMLE group, 6% (<i>n</i> = 2) required surgical reoperation (due to patch dehiscence) versus 0% in the SM group. In the SM + AMLE group, the ACC time was significantly higher (86 minutes [interquartile range [IQR]: 74-103]) than in the isolated SM group (48 minutes [IQR: 39-57]; <i>p</i> < 001). In both groups, the VSD complication rate was 0%, and neither procedure led to death at 3-year follow-up.</p><p><strong>Conclusion: </strong>HOCM-patients who underwent SM + AMLE had comparable clinical and echocardiographic outcomes to patients who underwent isolated SM. This suggests that increasing procedural complexity may not improve outcomes. However, given potential confounding, this should be interpreted with caution, future prospective randomised controlled trials are necessary.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"468-476"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744295","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 Acquired Ventricular Septal Defects: Outcomes and Quality of Life.","authors":"Henrik Heuer, André Truong, Kostiantyn Kozakov, Cedric van Sprang, Christian Schach, Jozef Micek, Lukas Krämer, Sergey Vasin, Walter Petermichl, Daniele Camboni, Christof Schmid, Jing Li","doi":"10.1055/a-2894-6436","DOIUrl":"10.1055/a-2894-6436","url":null,"abstract":"<p><strong>Background: </strong>Acquired ventricular septal defect (VSD), typically following myocardial infarction (MI) or infective endocarditis (IE), remains a rare but life-threatening condition. Surgical repair represents the standard of care, yet data on long-term outcomes and health-related quality of life (HRQoL) are limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 44 consecutive patients (median age 65 years, interquartile range [IQR] 57-72.5; range 20-83) who underwent surgical VSD closure at our institution between 2008 and 2023. Clinical characteristics, perioperative variables, and outcomes were assessed according to defect etiology and survival status. Long-term survival was assessed using Kaplan-Meier analysis. HRQoL among survivors was evaluated with the European Quality of Life-5-Dimensions-5-Level Version (EQ-5D-5L) questionnaire.</p><p><strong>Results: </strong>Post-MI VSD accounted for 65.9% of cases, and IE-related VSD for 20.5%. Preoperative cardiogenic shock was present in 52.3%. Overall, 30-day mortality was 34.1% (MI-VSD 46.4%, IE-VSD 22.2%). Non-survivors were older (69.2 vs. 60.8 years, <i>p</i> = 0.015), more frequently in shock (80.0% vs. 37.9%, <i>p</i> = 0.013), and experienced more postoperative complications per patient (1.9 vs. 0.4, <i>p</i> = 0.001). Median follow-up among survivors was 10.7 years (IQR 6.6-13.8; range 2.0-17.2). Kaplan-Meier survival at 2 and 5 years was 61.4% and 56.8%, respectively. HRQoL was generally preserved, with favorable mental and social domain scores (e.g., anxiety/depression: mean 1.6/5) and acceptable physical functioning (e.g., pain/discomfort: mean 1.9/5). Younger age at repair and longer follow-up were associated with higher HRQoL.</p><p><strong>Conclusion: </strong>Despite substantial perioperative mortality-particularly in post-MI VSD and hemodynamically unstable patients-surgical closure provides durable long-term survival with overall satisfactory HRQoL in survivors.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"492-499"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Chamber: Left Atrial Diameter Index Shapes Outcome in Valve Surgery.","authors":"Nizar R Alwaqfi, Rana B Altawalbeh, Majd M AlBarakat, Zina Alwaqfi, Abdullah Almomani, Amjed Abdel Al, Haya Alsheqerat, Manaf Alibraheem, Khalid Shaker Ibrahim, Qusai Aljarrah","doi":"10.1055/a-2828-9823","DOIUrl":"10.1055/a-2828-9823","url":null,"abstract":"<p><strong>Background: </strong>Left atrial enlargement is a well-recognized marker of adverse cardiovascular outcomes, but its impact on early morbidity and mortality after valve replacement remains uncertain.</p><p><strong>Methods: </strong>We retrospectively reviewed 422 patients who underwent aortic and/or mitral valve replacement (MVR) for rheumatic heart disease at X between 2004 and 2022. Preoperative left atrial diameter index (LADI) was measured, and patients were classified as normal (<2.3 cm/m²) or abnormal (≥2.3 cm/m²). Clinical, operative, and postoperative outcomes were compared. The primary endpoint was 30-day all-cause mortality; secondary endpoints included postoperative atrial fibrillation (POAF), neurological events, renal impairment, re-exploration for bleeding, and intraoperative pacing wire requirement.</p><p><strong>Results: </strong>Nearly half of patients (48.8%) had abnormal LADI. Patients with enlarged atria were more often female, had smaller body size, and were significantly more likely to undergo MVR (42.7% versus 18.1%, <i>p</i> < 0.001). Abnormal LADI was strongly associated with POAF (16.0% versus 7.4%, <i>p</i> = 0.006) and intraoperative pacing wire insertion (38.3% versus 23.5%, <i>p</i> = 0.001). Multivariate analysis confirmed severe LADI as an independent predictor of POAF (OR 3.91, <i>p</i> = 0.001) and pacing requirements (OR 2.31, <i>p</i> = 0.004). No significant differences were observed in 30-day mortality, stroke/transient ischemic attack, renal dysfunction, or bleeding complications.</p><p><strong>Conclusion: </strong>Preoperative LADI is an independent predictor of postoperative arrhythmic complications and pacing needs after valve replacement, but not early mortality. Incorporating LADI into preoperative risk assessment may improve rhythm surveillance and perioperative planning. Future prospective studies should evaluate its long-term prognostic value and role in reverse remodeling after surgery.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"477-484"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}