ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

{"title":"Restraint before routine: Left atrial appendage clipping beyond atrial fibrillation.","authors":"Jeffrey H Shuhaiber","doi":"10.1177/02184923261478978","DOIUrl":"10.1177/02184923261478978","url":null,"abstract":"<p><p>Surgical left atrial appendage (LAA) exclusion has transitioned from a disease-specific therapy for atrial fibrillation (AF) to an increasingly routine adjunct during cardiac surgery, including in patients who present in sinus rhythm. This shift has occurred not through definitive evidence, but through a convergence of technical feasibility, biologic plausibility, and expanding clinical momentum. Contemporary studies in non-AF populations have largely focused on risk-enriched cohorts and suggest a possible reduction in late cerebrovascular events, yet these findings remain heterogeneous and context-dependent. At the same time, real-world data highlight a consistent early clinical burden, including postoperative AF, anticoagulation exposure, and variability in downstream management. The central issue is therefore not simply one of efficacy or safety, but of sequencing and definition: a preventive intervention has entered routine use before its net clinical value and care pathway have been clearly established. In this setting, prophylactic LAA exclusion in sinus rhythm should not be viewed as a settled extension of surgical practice, but as an evolving strategy that warrants selectivity, transparency, and disciplined evaluation.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"2184923261478978"},"PeriodicalIF":0.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From risk to results: Multi-arterial coronary bypass approaches in high-risk cohorts.","authors":"Alexandra N Schwann, Irbaz Hameed, Thomas A Schwann","doi":"10.1177/02184923261450018","DOIUrl":"10.1177/02184923261450018","url":null,"abstract":"<p><p>Over the past 30 years, multi-arterial coronary artery bypass grafting techniques have been shown to be associated with improved patient outcomes compared to the current standard, single-arterial coronary bypass grafting technique, in the general patient population undergoing surgical coronary revascularization. Whether a survival benefit exists in high-risk patient sub-cohorts is less well defined, calling into question the value of the higher technical complexity of multi-arterial bypass grafting. Herein, we review the most current evidence for multi-arterial bypass grafting versus single arterial bypass grafting in several higher-risk patient cohorts. Discussion will focus on the two most common techniques for multi-arterial bypass grafting: the use of bilateral internal thoracic arteries and the use of the left internal thoracic artery in conjunction with the radial artery with or without supplemental saphenous vein grafts.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"507-514"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147943084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repair strategy for acute type A aortic dissection in a regional center.","authors":"Kotaro Mukasa, Shinichiro Abe, Soichi Asano","doi":"10.1177/02184923261455651","DOIUrl":"10.1177/02184923261455651","url":null,"abstract":"<p><p>BackgroundThe optimal extent of repair for DeBakey type I acute aortic dissection remains controversial, particularly in low- to medium-volume centers. We compared outcomes of ascending and arch replacement under a tear-oriented strategy in DeBakey type I dissection.MethodsWe retrospectively analyzed 114 consecutive patients with acute DeBakey type I dissection between April 2008 and July 2025 at a regional cardiovascular center. Ascending aortic replacement was performed in 55 patients, and arch replacement, including both partial and total arch replacement, in 59 patients. The primary endpoint was overall survival. Secondary endpoints included in-hospital mortality, major complications, and open aortic reoperation.ResultsArch replacement required longer operative, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. In-hospital mortality was 5.5% after ascending aortic replacement and 13.6% after arch replacement (<i>P</i> = 0.143). Rates of major complications were comparable between groups. Long-term survival was better after ascending aortic replacement than after arch replacement (5-year, 87.1% vs 69.4%; 10-year, 83.5% vs 59.8%; <i>P</i> = 0.015). Freedom from open aortic reoperation was similar between groups (5-year, 90.4% vs 88.3%; 10-year, 70.2% vs 88.3%; <i>P </i>= 0.201). In the subgroup analysis restricted to patients with an intimal tear in the aortic root or ascending aorta, there were no differences in the primary or secondary endpoints.ConclusionsA tear-oriented limited replacement strategy appears reasonable in centers with limited volume of acute type A dissection repair.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"525-534"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148057294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic dissection after sutureless valve and chest compressions.","authors":"Yoshiki Hori, Kenichiro Sato, Kei Akiyoshi","doi":"10.1177/02184923261458094","DOIUrl":"10.1177/02184923261458094","url":null,"abstract":"<p><p>Sutureless aortic valves, such as the Perceval (Corcym) valve, provide important procedural advantages and favorable mid- to long-term outcomes; however, potentially serious aortic complications related to their self-expanding stent structure remain incompletely understood. Thus, we report the case of an 85-year-old woman who developed early-onset localized ascending aortic dissection after aortic valve replacement with a sutureless valve. The entry tear was located at the level of the stent edge, slightly proximal to the aortotomy suture line, and the dissection extended only between these two points, suggesting a localized stent-aortic wall interaction with external mechanical stress as a potential trigger.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"542-544"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right internal thoracic artery versus radial artery as the second-best arterial conduit in multi-arterial coronary artery bypass grafting.","authors":"Tohru Asai","doi":"10.1177/02184923261450667","DOIUrl":"10.1177/02184923261450667","url":null,"abstract":"<p><p>BackgroundMulti-arterial coronary artery bypass grafting (maCABG) improves long-term outcomes compared to single internal thoracic artery grafting. Choosing the second arterial conduit-the right internal thoracic artery (RITA) or the radial artery (RA)-is critical. RITA offers superior biological integrity but raises deep sternal wound infection (DSWI) concerns; RA provides ease of harvest but is susceptible to vasospasm and patency issues.MethodsThis narrative review synthesizes recent high-quality clinical investigations, including propensity-matched cohort studies and meta-analyses, comparing RITA and RA as the second conduit in left internal thoracic artery-based CABG. We analyzed comparative long-term survival, graft patency, and complication rates.FindingsMultiple propensity score-matched studies demonstrate the superiority of RITA/bilateral internal thoracic artery (BITA) use, reporting significantly improved long-term survival and major adverse cardiac event-free survival compared to RA. BITA use was associated with a 35% reduction in the long-term hazard of death. Conversely, recent large-scale registries and randomized trials increasingly support the use of RA. The risk of DSWI with BITA use can be mitigated through skeletonized harvesting; however, this technique requires significant expertise to ensure graft patency.ConclusionThe second arterial graft selection must be individualized, balancing patient-specific risks-such as diabetes and obesity-against the surgeon's proficiency in multi-arterial revascularization.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"515-522"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enterprise and innovation in thoracic surgery.","authors":"Sanghoon Jheon, Mike Dowding, Tim Jheon, Jae Hyun Jeon","doi":"10.1177/02184923261458084","DOIUrl":"10.1177/02184923261458084","url":null,"abstract":"","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"523-524"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of lymph node dissection techniques on survival in stage I non-small cell lung cancer.","authors":"Esra Yamansavcı Şirzai, Gizem Özçıbık Işık, Oğuzhan Bayraktar, Celal Buğra Sezen, Özkan Saydam, Ahmet Üçvet","doi":"10.1177/02184923261456799","DOIUrl":"10.1177/02184923261456799","url":null,"abstract":"<p><p>BackgroundThis study aimed to evaluate the effect of lymph node dissection technique on survival outcomes in patients who underwent surgery for clinical stage I non-small cell lung cancer.MethodsA total of 442 patients with stage I non-small cell lung cancer who underwent surgical resection at multiple centers between 2011 and 2022 were retrospectively analyzed. Patients were divided into two groups according to the lymph node dissection technique: lobe-specific lymph node dissection and systematic lymph node dissection. Survival outcomes and postoperative complications were compared between the groups. Multivariate Cox regression analysis was performed to identify prognostic factors affecting survival.ResultsPostoperative complications occurred in 86 patients (19.5%). Complications were significantly less frequent in the lobe-specific lymph node dissection group compared to the systematic lymph node dissection group (9.4% vs. 22.4%, respectively; p = 0.027). The overall annual survival rate was 68.3%. The 5-year survival rate was significantly higher in female patients than in male patients (83.6% vs. 61.7%, p < 0.001). The 5-year survival rate was 69.3% in patients who underwent systematic lymph node dissection and 64.8% in those who underwent lobe-specific lymph node dissection, with no statistically significant difference between the two techniques (p = 0.332). In multivariate Cox regression analysis, advanced age was not a significant predictor of survival (p = 0.119, HR = 0.714, 95% CI: 0.467-1.090), whereas male gender was identified as an independent poor prognostic factor (p = 0.01, HR = 2.781, 95% CI: 1.506-5.138).ConclusionsLymph node dissection remains a critical component of surgical treatment in early-stage lung cancer. The comparable survival outcomes and lower complication rates observed with lobe-specific lymph node dissection suggest that it may be a preferable option in selected patients with stage I non-small cell lung cancer. Nevertheless, prospective multicenter studies are required to confirm these findings.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"535-541"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal approach to valve-sparing root replacement and aortic valve repair in aortic insufficiency.","authors":"Lauren V Huckaby, Edward P Chen","doi":"10.1177/02184923261455742","DOIUrl":"10.1177/02184923261455742","url":null,"abstract":"<p><p>Despite the technically challenging nature of valve-sparing root replacement, restoration of aortic valve competence can be achieved through a complete understanding of the aortic root anatomy and pathophysiology. In this review, we discuss the physiology of normal aortic root function as well as pathophysiologic mechanisms contributing to aortic valve incompetence. Preoperative planning for valve-sparing root replacement is discussed, including the use of imaging to guide surgical decision-making. Pitfalls and pearls of the critical technical steps for both valve-sparing root replacement and repair of both tricuspid and bicuspid aortic valves are provided. Finally, current evidence guiding best practices in valve-sparing root replacement and aortic valve repair is presented to support decision-making for patient selection.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"545-550"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic principles of arterial cannulation: Orientation, wall shear stress, turbulence, plaque destabilization, and cerebral microembolization.","authors":"Ignazio Condello, Michele Dell'Aquila, Youssef El Dsouki, Salvatore Condello, Giorgia Falco, Antonio Totaro, Branden Tejada, Monica Gianoli, Carlo Zebele, Sotirios Prapas, Konstantinos Katsavrias, Augusto D'Onofrio, Joshua Newman, Stevan Pupovac, Omar Jarral, Frank Manetta, Nirav Patel, Derek Brinster, Robert Kalimi, Mario Gaudino, Antonio M Calafiore","doi":"10.1177/02184923261458087","DOIUrl":"10.1177/02184923261458087","url":null,"abstract":"<p><p>BackgroundArterial cannulation during cardiopulmonary bypass (CPB) significantly alters native aortic hemodynamics by generating a high-velocity jet that interacts with the ascending aorta and aortic arch geometry. These flow disturbances may influence wall shear stress (WSS), turbulence intensity, embolic trajectories, and cerebral perfusion. Cannula depth, orientation, and tip design have emerged as potentially important determinants of intra-aortic flow behavior.Materials and methodsA structured narrative review of the literature was conducted. PubMed/MEDLINE, Scopus, and Web of Science were searched from January 1990 to April 2025. Keywords included combinations of \"aortic cannulation,\" \"cardiopulmonary bypass,\" \"computational fluid dynamics,\" \"wall shear stress,\" \"turbulence,\" \"atherosclerotic plaque,\" \"cerebral perfusion,\" \"microembolization,\" \"gaseous emboli,\" \"NIRS,\" and \"transcranial Doppler.\" Studies were included if they evaluated hemodynamic effects of cannulation strategies using computational, in vitro, or clinical models. Articles not directly related to CPB intra-aortic flow dynamics were excluded.ResultsThe available evidence suggests that cannula positioning significantly influences intra-aortic flow behavior. Centrally aligned cannulation directed toward the descending thoracic aorta promotes axial flow and is associated with reduced jet-wall impingement and lower peak WSS. This configuration decreases arch turbulence and limits embolic transport toward supra-aortic vessels.ConclusionArterial cannulation strategy during CPB is a modifiable determinant of flow behavior and potential cerebral embolic exposure. Hemodynamically informed cannulation principles may contribute to intraoperative neuroprotection, although prospective clinical validation is still required.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"551-559"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148228258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Realignment of NSCLC staging from 8 to 9 TNM edition: Impact on survival in Stage IIA to IIIB disease.","authors":"Darryl Chin, Eric Jin, Shu Ting Chong, Ethel Ng, Jun Rey Leong, Jianye Chen","doi":"10.1177/02184923261441205","DOIUrl":"10.1177/02184923261441205","url":null,"abstract":"<p><p>PurposeThe ninth edition TNM staging of non-small-cell lung cancer (NSCLC) was introduced in 2023 with changes that may impact neoadjuvant and adjuvant chemotherapy use. This study evaluates the changes to overall survival (OS) and disease-free survival (DFS) prognosis in our mixed Asian population with this realignment.MethodsWe reviewed 634 lung cancer patients who underwent lung resection between 1 January 2015 and 30 June 2023. About 152 stage IIA to IIIB NSCLC patients were included, further stratified according to TNM subgroups and adjuvant chemotherapy uptake for survival analysis.ResultsStage IIB patients derived OS benefit with adjuvant chemotherapy use, which was not observed in Stage IIA patients. Among the subgroups comprising Stage IIB (eighth edition), T3N0 patients observed a significant prognostic OS benefit from adjuvant chemotherapy, but not in downstaged T1N1 patients (Stage IIA, ninth edition). In patients who did not receive neoadjuvant chemotherapy prior to surgery, OS and DFS in downstaged T1N2a disease were not significantly worse compared to Stage IIB patients (eighth edition), while T2N2a patients (Stage IIIA, eighth and ninth edition) had significantly lower DFS prognosis.ConclusionOur study ascertained the impact of the ninth edition NSCLC TNM staging on current clinical practice. Upfront resection can be considered in T1N2a disease, in concordance with its downstaging to Stage IIB. Adjuvant chemotherapy use in Stage IIA patients and N1 disease can be further evaluated in the ninth edition. In the future, we expect there to be more evidence for further validation of the new staging system.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"497-506"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}