Thoracic and Cardiovascular Surgeon最新文献

{"title":"Enhanced Uptake of FDG in PET/CT After the Use of Bone Wax During Sternotomy.","authors":"Michael Jüptner, Bernd Panholzer, Anette Friedrichs, Gregor Warnecke, Jochen Cremer, Alexander Thiem, Ulf Lützen, Jan Schöttler","doi":"10.1055/a-2796-6952","DOIUrl":"10.1055/a-2796-6952","url":null,"abstract":"<p><strong>Objective: </strong>Physiologic healing processes and foreign body reactions can mimic infective conditions in ¹⁸F-FDG-PET/CT for the detection of deep sternal wound infections. To date, nothing is known about the metabolic presentation of surgically applied bone wax to the sternum for hemostasis during sternotomy in ¹⁸F-FDG-PET/CT imaging. Therefore, this study aims to assess the sternal FDG uptake after the application of bone wax during sternotomy.</p><p><strong>Methods: </strong>A total of 25 patients with a history of cardiac surgery (1.3-5.5 years ago) were examined by ¹⁸F-FDG-PET/CT with dual time point imaging. The sternal FDG uptake was assessed visually (as positive or negative) and metrically using the maximum standardized uptake values (SUV_max) calculated automatically. The SUV_max was compared between the patients with and without the use of bone wax and among patients with and without positive sternal findings in the visual analysis. A correlation analysis was performed between the time since surgery and the sternal SUV_max.</p><p><strong>Results: </strong>In all eight patients (32%) had received bone wax. In those patients, the mean sternal SUV_max was higher compared to the group without bone wax, both in the early (4.74 ± 1.28 vs. 3.70 ± 1.44; <i>p</i> = 0.0969) and in the late images (6.62 ± 2.67 vs. 4.36 ± 1.44; <i>p</i> = 0.0289). Moreover, the use of bone wax was strongly associated with positive sternal findings in the visual analysis (OR = 10; 95%CI = 0.995-100.462; <i>p</i> = 0.0421). The correlation analysis revealed a slightly decreasing trend without significance (Spearman's ρ = -0.139; <i>p</i> = 0.505).</p><p><strong>Conclusion: </strong>The use of bone wax during sternotomy could be associated with increased sternal uptake of FDG on ¹⁸F-FDG-PET/CT, even several years after surgery. This finding should be considered in the evaluation of potential deep sternal wound infections.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"485-491"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228168","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":"Physician Assistants in Cardiac Surgery: Insights from a German University Hospital.","authors":"Freya S Jenkins, Anna Kathrin Assmann, Giuseppina P Pellegrino, Artur Lichtenberg, Alexander Assmann","doi":"10.1055/a-2836-2282","DOIUrl":"10.1055/a-2836-2282","url":null,"abstract":"<p><strong>Background: </strong>The rising complexity of cardiac surgery patients, coupled with new regulations reducing working hours for surgical residents, and increased healthcare costs, has led to the growing introduction of physician assistants (PAs) into cardiacsurgery teams in German hospitals. This study aims to systematically explore the experience of introducing PAs into the cardiac surgery workforce in a tertiary university hospital in Germany, identifying what is working well and areas for improvement, as well as offering suggestions for appropriate measures.</p><p><strong>Methods: </strong>The study was of an observational nature and comprised both quantitative assessments and qualitative interviews. For the quantitative component, a survey was distributed internally to employees of the cardiovascular surgery department. The survey was first distributed within 1 month of the first PAs starting in our department (\"baseline\") and again 1 year later (\"follow-up\" [FU]).</p><p><strong>Results: </strong>Forty-one healthcare professionals completed the baseline, and 37 completed the FU survey. Overall satisfaction with PAs was high across all professional groups. Among residents,73.3% reported being satisfied at baseline and 70% at FU. All cardiovascular surgeons (6/6) and PAs (10/10) reported high satisfaction at both time points, and 90% of nursing staff reported being satisfied or very satisfied at baseline, with no dissatisfaction reported at baseline or FU. All PAs reported providing workload relief and feeling fully integrated into the team, while two-thirds of residents reported workload relief due to PAs assuming ward-based clinical and administrative tasks. PAs were consistently perceived as improving continuity of care as a stable point of contact for patients and nursing staff.</p><p><strong>Conclusion: </strong>PAs substantially strengthen cardiac surgery teams in the German healthcare system. To successfully establish the implementation of PAs, the challenges of long-term retention incentives and clear delineation of responsibilities have to be addressed.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"450-454"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676947","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":"Postoperative Cardiac Biomarker Release After Minimally Invasive AV-Valve Surgery with or without Cryoablation.","authors":"Jang-Sun Lee, Dilara M Berberoglu, Majd Ismail, Markus Schönburg, Yeong-Hoon Choi, Oliver J Liakopoulos","doi":"10.1055/a-2749-9396","DOIUrl":"10.1055/a-2749-9396","url":null,"abstract":"<p><strong>Background: </strong>Concomitant cryoablation is routinely performed in patients with atrial fibrillation who undergo minimally invasive atrioventricular (AV) valve surgery. While biomarker thresholds for postoperative myocardial infarction (pMI) are established in coronary artery bypass surgery, no clear thresholds exist after concomitant cryoablation in endoscopic valve surgery. This study aimed to analyze the perioperative cardiac biomarker release patterns in this patient cohort and to evaluate the applicability of SCAI-defined pMI thresholds.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent endoscopic AV valve surgery from 2018 to 2024, comparing those with cryoablation (<i>n</i> = 165; mean age: 66.5 ± 9.5 years) to those without (<i>n</i> = 513; mean age: 62.4 ± 12.0 years). Perioperative creatine kinase-myocardial band (CK-MB) and troponin T (TnT) levels were measured before surgery, at 1 and 4 hours after surgery, and on postoperative day 1 (1POD). In-hospital outcomes were also assessed.</p><p><strong>Results: </strong>Cryoablation significantly increased CK-MB (6.4 × ULN vs. 2.4 × ULN, <i>p</i> < 0.001) and TnT (257 × ULN vs. 80 × ULN, <i>p</i> < 0.001). Compared with SCAI pMI criteria (CK-MB > 10 × ULN; TnT > 70 × ULN), CK-MB remained below the threshold, while TnT exceeded it in most cases (<i>p</i> < 0.05). Despite these elevations, clinical pMI was rare (two cases vs. three cases). In-hospital mortality did not differ significantly between the groups (1.2% vs. 1.6%; <i>p</i> = 1.000).</p><p><strong>Conclusion: </strong>Cryoablation during minimally invasive AV valve surgery markedly increases postoperative cardiac biomarkers without higher clinical pMI rates. Procedure-specific biomarker thresholds and validation of SCAI criteria are essential for accurate diagnosis and patient management.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"460-467"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145557826","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":"Recoarctation after neonatal hypoplastic aortic arch repair: impact of patch material.","authors":"Thibault Schaeffer, Marina Huhnke, Doris Kienmoser, Maria von Stumm, Paul Philipp Heinisch, Masamichi Ono, Cordula Wolf, Jürgen Hörer, Julie Cleuziou","doi":"10.1055/a-2942-3381","DOIUrl":"https://doi.org/10.1055/a-2942-3381","url":null,"abstract":"<p><strong>Background: </strong>Recoarctation remains a frequent complication after neonatal aortic arch repair. This study aimed to identify risk factors for recoarctation, with particular emphasis on the patch material used for aortic enlargement.</p><p><strong>Methods: </strong>All neonates who underwent aortic arch repair with patch augmentation through median sternotomy at our institution between 2000 and 2024 were retrospectively reviewed. The primary endpoint was recoarctation, defined as any catheter-based or surgical reintervention on the reconstructed distal aortic arch. Risk factors were assessed using multivariable cause-specific Cox regression, and cumulative incidences of recoarctation and death were estimated using competing-risk methods.</p><p><strong>Results: </strong>A total of 597 patients were included (38% female; 61% with single-ventricle physiology; median age and weight at surgery, 8 days and 3.2 kg, respectively). The cumulative incidence of recoarctation was 23% at 1 year. Smaller preoperative aortic arch dimensions (cause-specific hazard ratio [csHR], 0.84 per mm; 95% CI, 0.73-0.97), younger age at surgery (csHR, 0.96 per day; 95% CI, 0.93-0.99), and patch material were independently associated with recoarctation. Compared with glutaraldehyde-fixed autologous pericardium, bovine pericardium (csHR, 2.94; 95% CI, 2.01-4.65) and equine pericardium (csHR, 2.18; 95% CI, 1.36-3.24) were associated with higher recoarctation risk, whereas cryopreserved pulmonary homograft was associated with lower risk (csHR, 0.27; 95% CI, 0.16-0.48).</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148814237","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":"Interpretable Machine Learning for 30-Day Mortality in PIVSR: A Cohort Study.","authors":"Bing-Ran Wang, Zhao-Yun Cheng, Zi-Niu Zhao, Guo-Bao Zhang, Zhou-Liang Xie, Jian-Chao Li, Yan Zhang","doi":"10.1055/a-2926-9824","DOIUrl":"https://doi.org/10.1055/a-2926-9824","url":null,"abstract":"<p><strong>Objective: </strong>Post-infarction ventricular septal rupture (PIVSR) is a fatal mechanical complication of acute myocardial infarction. We aimed to develop and interpret a machine learning (ML) model to predict 30-day mortality using routinely available clinical variables in PIVSR patients.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive PIVSR patients treated at Fuwai Central-China Cardiovascular Hospital from 2018 to 2024. Candidate predictors were screened by three complementary procedures including bootstrap resampling with LASSO, stepwise logistic regression, and the Boruta algorithm. Nine supervised ML algorithms were trained and compared. Model performance was comprehensively evaluated using multiple discrimination, calibration, and clinical utility metrics. Model interpretability was examined using Shapley Additive Explanations (SHAP). We additionally implemented the final model as a web-based calculator to support individualized risk estimation.</p><p><strong>Results: </strong>A total of 237 PIVSR patients were analyzed. Nine clinical predictors were identified. The CatBoost model demonstrated favorable overall performance in both the training set (AUC = 0.92, 95%CI: 0.89-0.94) and testing set (AUC = 0.88, 95%CI: 0.79-0.95). In the testing set, CatBoost achieved an accuracy of 0.79, sensitivity of 0.85, specificity of 0.71, F1-score of 0.82, and Brier score of 0.15. SHAP analysis identified operation, hemodynamic status, inflammatory markers, and renal function as key contributors.</p><p><strong>Conclusion: </strong>We developed, evaluated, and interpreted ML models for predicting 30-day mortality in patients with PIVSR. The CatBoost model demonstrated favorable predictive performance and transparent interpretability. Hemodynamic compromise, inflammation, and renal dysfunction were identified as key predictors of adverse outcomes. An exploratory web-based calculator was developed to support dynamic in-hospital prognostication.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798059","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":"Risk Factors for Stage 3 Acute Kidney Injury after Acute Stanford Type A Aortic Dissection Repair.","authors":"Yaling Cui, Haisheng Chen, Chunxi Zhang, Bin Li, Zhigen Li","doi":"10.1055/a-2923-5881","DOIUrl":"10.1055/a-2923-5881","url":null,"abstract":"<p><strong>Background: </strong>This study explored the risk factors for developing severe acute kidney injury (AKI, stage 3) after acute type A aortic dissection (ATAAD) surgery.</p><p><strong>Methods: </strong>In total, 163 patients with ATAAD who underwent Bentall or ascending aortic replacement combined with total arch replacement and elephant trunk repair at our center between January 2017 and December 2022 were retrospectively analyzed. Postoperative stage 3 AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. Multivariate logistic regression analyses were performed to identify independent risk factors for postoperative stage 3 AKI.</p><p><strong>Results: </strong>Stage 3 AKI occurred in 35 patients (21.5%), who demonstrated a significantly higher in-hospital mortality than the stage 0 to 2 AKI group (risk ratio = 4.88, χ² = 11.557; <i>p</i> = 0.001). Preoperative serum creatinine (sCr), preoperative estimated glomerular filtration rate, chronic kidney disease history, long-term smoking history, surgical method, cardiopulmonary bypass time, aortic cross-clamp time, postoperative low cardiac output, and postoperative stroke were significantly associated with stage 3 AKI (<i>p</i> < 0.05). Multivariate logistic regression analysis identified preoperative sCr (odds ratio [OR] = 1.023, 95% confidence interval [CI]: 1.013-1.034; <i>p</i> = 0.000), surgical method (OR = 0.089, 95% CI: 0.025-0.319; <i>p</i> = 0.000), and postoperative low cardiac output (OR = 15.214, 95% CI: 1.765-131.135; <i>p</i> = 0.013) as independent risk factors for AKI3. Preoperative sCr could effectively predict postoperative AKI3 (area under the curve = 0.747; cutoff value: 123.5 μmol/L; sensitivity: 63%; specificity: 83%).</p><p><strong>Conclusion: </strong>Postoperative AKI3 was significantly associated with in-hospital mortality after ATAAD surgery. Preoperative sCr, surgical method, and postoperative low cardiac output are independent risk factors for postoperative AKI3. Patients with preoperative sCr >123.5 µmol/L should be closely monitored for increased risk.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607802","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":"Redo Coronary Artery Bypass Grafting: The Hidden Challenges of Propensity-Matched Comparisons.","authors":"Khaled Ebrahim Al Ebrahim","doi":"10.1055/a-2933-1982","DOIUrl":"10.1055/a-2933-1982","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726909","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":"Enhanced Trocar Design Optimizes Robotic-Assisted Lung Resection.","authors":"Shuenn-Wen Kuo, Jang-Ming Lee, Pei-Ming Huang","doi":"10.1055/a-2924-6258","DOIUrl":"10.1055/a-2924-6258","url":null,"abstract":"<p><p>This study aims to assess the initial experience with a downsized bevel-cut trocar to enhance lung resection in robot-assisted thoracoscopic surgery (RATS). In addition, we provide a mathematical model to support the scientific rationale and functional advantages of this design.We analyzed the impact of trocar cannula diameter using software and conducted a retrospective review of patients who underwent lung resection using a modified bevel-cut trocar for uniportal or biportal RATS between July 2024 and February 2025. Perioperative and postoperative outcomes, including incision length, surgery duration, complications, and hospital stay, were compared with those of conventional trocar RATS.A total of 34 patients underwent RATS anatomical lung resection, including 12 with modified bevel-cut trocars and 22 with conventional trocars. Baseline demographic and clinical characteristics were comparable between groups. The modified trocar group had shorter utility incision lengths than the conventional trocar group (overall <i>p</i> < 0.001). Mean incision length was 3.75 cm (range, 3.0-4.5) versus 6.0 cm for uniportal RATS and 3.0 cm versus 4.6 cm (range, 4.0-6.0) for biportal RATS. In exploratory approach-specific comparisons, operative time was shorter in the modified trocar group for both uniportal and biportal RATS (<i>p</i> = 0.007 and <i>p</i> = 0.039, respectively), whereas this finding should be interpreted cautiously because of the small subgroup sizes and non-randomized approach selection. No conversion, major postoperative complication, or mortality occurred.The modified bevel-cut trocar offers a safer and more practical solution for performing uniportal or biportal RATS.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607735","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":"Partial Upper Sternotomy versus Right Thoracotomy with Central Cannulation for Surgical Aortic Valve Replacement.","authors":"Laura Rings, Rasha E Boulos, Stak Dushaj, Igor Tudorache, Petar Risteski, Hector Rodriguez Cetina Biefer, Omer Dzemali","doi":"10.1055/a-2922-5500","DOIUrl":"https://doi.org/10.1055/a-2922-5500","url":null,"abstract":"<p><strong>Objectives: </strong>This study compared surgical aortic valve replacement (SAVR) via partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT) with central aortic cannulation regarding intraoperative perfusion parameters, transfusion requirements, and early postoperative outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 380 patients who underwent isolated SAVR via PUS or RALT. Propensity score matching yielded 107 matched pairs. All patients underwent central aortic and peripheral venous cannulation.</p><p><strong>Results: </strong>Cardiopulmonary bypass, aortic cross-clamp, and total operative times were longer in the RALT group, whereas reperfusion time was shorter (all <i>p</i> < 0.001). Transfusion requirements for packed red blood cells, fresh-frozen plasma, and platelet concentrates did not differ between groups. Cell salvage volume was generally lower in the RALT group after matching. Intubation times were comparable between groups. Intensive care unit (ICU) length of stay and total postoperative hospital stay were shorter in the RALT group (<i>p</i> < 0.001 and <i>p</i> = 0.008, respectively). Peak catecholamine requirements were lower in the RALT group (<i>p</i> = 0.005). Rates of permanent pacemaker implantation and pulmonary, wound, and urinary tract infections did not differ. In-hospital mortality was 0.9% in the PUS group; no deaths occurred in the RALT group.</p><p><strong>Conclusion: </strong>Both approaches achieved low in-hospital mortality and comparable complication rates. Despite longer operative times, RALT was associated with shorter ICU and hospital stays and lower vasopressor requirements. RALT with central aortic cannulation is a safe and feasible alternative to PUS for minimally invasive aortic valve surgery.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702209","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":"Adjunct Coronary Endarterectomy in CABG: Risk Stratification and Midterm Outcomes.","authors":"Ahmed Hasan, Mohamed Gad, Yasser Mubarak","doi":"10.1055/a-2923-5942","DOIUrl":"10.1055/a-2923-5942","url":null,"abstract":"<p><strong>Background: </strong>Complete revascularization in diffuse coronary artery disease (CAD) is challenging when target vessels are small and circumferentially diseased. Coronary endarterectomy (CE) can enable reconstruction where a standard distal anastomosis is not feasible, but its impact remains debated. This study aimed to evaluate the impact of concomitant CE with coronary artery bypass grafting (CABG) on midterm outcomes and explore the potential risk factors for adverse events.</p><p><strong>Methods: </strong>A single-center, retrospective cohort (2017-2022) of patients who underwent CABG with or without CE (<i>n</i> = 406; CE <i>n</i> = 97, CABG-only <i>n</i> = 309). The prespecified primary endpoint was major adverse cardiovascular events (all-cause mortality or myocardial infarction [MI]) assessed in-hospital/30 days and up to 72 months. CE-subgroup risk modelling used Firth penalized logistic regression. Effects were summarized as odds ratios (95% confidence intervals [CIs]); time-to-event analyses used Kaplan-Meier.</p><p><strong>Results: </strong>Early perioperative MI and in-hospital mortality did not differ significantly between groups. Over 72 months, overall survival was similar (log-rank <i>p</i> = 0.289). Within the CE cohort, midterm MI (1.0%) and stroke (2.1%) were infrequent. In multivariable CE-subgroup modelling, renal impairment, female sex, peripheral vascular disease (PVD), and age ≥65 were independently associated with complications.</p><p><strong>Conclusion: </strong>Selective CE with CABG yielded comparable early and midterm outcomes to CABG-only, with low midterm complication rates. Risk was concentrated among women, patients with renal impairment or PVD, and those aged ≥65 years, supporting heightened perioperative vigilance and tailored follow-up in these subgroups.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148607763","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}