Thoracic and Cardiovascular Surgeon最新文献

{"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":"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":"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":"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}

{"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":"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":"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":"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}