ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

{"title":"Evidence-based guidelines for aortic stenosis: Focus on surgical aortic valve replacement versus transcatheter aortic valve implantation for young patients.","authors":"Jorge Alcocer, Eduard Quintana, María Ascaso, Robert Pruna","doi":"10.1177/02184923251415153","DOIUrl":"10.1177/02184923251415153","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis and is now an established alternative to surgical aortic valve replacement (SAVR) for all surgical risk categories. However, the extension of TAVI to younger, low-risk patients has raised important questions regarding the long-term outcomes, valve durability, and lifetime management strategies for these patients. This narrative review summarizes the current evidence from pivotal randomized trials and contemporary registries comparing TAVI and SAVR in young, low-risk patients, integrating the latest 2025 ESC/EACTS guidelines. While short-term outcomes and early recovery favor TAVI, SAVR remains associated with proven durability, lower rates of conduction disturbances, and a potential advantage in long-term outcomes as follow-up data extend beyond five years. Anatomical challenges such as bicuspid valves, coronary access, and patient-prosthesis mismatch further complicate the use of TAVI in this population. A \"SAVR-first\" lifetime management approach appears to provide greater procedural flexibility and a lower reintervention risk. Ultimately, the choice between TAVI and SAVR in young patients should be individualized through a multidisciplinary Heart Team process, balancing early procedural benefits with long-term durability and reintervention considerations. This review highlights the need for dedicated long-term data and patient-tailored strategies in the evolving management of aortic stenosis in young low-risk individuals.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"136-145"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087404","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":"Early primary repair of congenital heart disease: Advantages and the importance of database configuration.","authors":"Richard A Jonas","doi":"10.1177/02184923251363060","DOIUrl":"10.1177/02184923251363060","url":null,"abstract":"<p><p>The introduction of the neonatal arterial switch operation in the 1980s demonstrated that early repair of congenital heart anomalies could be performed with improved patient survival relative to initial palliation and delayed repair in later infancy or beyond. Over the next decade or two, there was a continuing move away from a staged approach at most congenital heart programs. Studies from that era documented that the staged approach increased overall cost and reduced ultimate patient survival. However, over the last decade or two, there has been resurgent popularity of a staged approach, particularly for the management of very small and premature newborns. This paper reviews the factors that have led to increasing enthusiasm for the staged approach to management of congenital heart disease. The danger of using procedural databases like the Society for Thoracic Surgery (STS) and European Association for Cardiothoracic Surgery (EACTS) surgical databases to measure the quality of overall patient management strategy is emphasized. Until diagnosis-based, patient survival databases are used for Quality Assurance, it will not be possible to define whether a tipping point exists, below which very small and complex neonates should be managed with a staged approach. However, current data strongly suggest that neonates of at least average size as well as young infants have improved survival and reduced reintervention as well as markedly reduced time in hospital and overall costs when a strategy of early primary repair is pursued.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"146-150"},"PeriodicalIF":0.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754572","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":"Methodological considerations for the meta-analysis of hybrid versus total arch replacement in type A aortic dissection.","authors":"Ankur Sharma, Sushma Narsing Katkuri, Varshini Vadhithala, Arun Kumar, Sushma Verma, Dhanya Dedeepya","doi":"10.1177/02184923251410327","DOIUrl":"10.1177/02184923251410327","url":null,"abstract":"","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"131-132"},"PeriodicalIF":0.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811593","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":"Single centre Asian experience of first 100 cases of frozen elephant trunk procedures: Humble beginning, evolution and lessons learned.","authors":"Paneer Selvam Krishna Moorthy, Kiew Kong Pau, Mohd Azhari Yakub, Mohammad Fairudz Faisal, Deventhiran P Permal, Aini Syakirin Kepli","doi":"10.1177/02184923251409431","DOIUrl":"10.1177/02184923251409431","url":null,"abstract":"<p><p>BackgroundThe frozen elephant trunk (FET) procedure is developed to treat complex aortic arch diseases. We aimed to share our single centre experience of FET operations over time.MethodsA review of first 100 patients who underwent FET procedures for acute, chronic dissection and thoracic aneurysm from January 2016 to January 2024. The patients were divided into two groups: Group 1 (first 50 cases); Group 2 (subsequent 50 cases) and compared the early and late outcomes.ResultsEarly overall mortality was 9% but reduced with time {12% (6/50) in Group 1 vs. 6% (3/50) in Group 2, <i>p</i> = 0.295} with no deaths among the isolated FET procedures. Morbidity included stroke (4%), spinal cord injury (3%) and temporary renal dialysis (9%). Durations of total operation time, cross clamp, circulatory arrest and cerebral perfusion were shorter in group 2; <i>p</i> < 0.05. Concomitant coronary artery bypass grafting, clamp time >180 min, temperature <20 °C and ventilation >72 h were the significant risk factors for all mortality. The overall 1, 5 and 7-year survival were 93.8, 90.7 and 82.5%, respectively, with freedom from aortic re-intervention reflected at 98.8<b>,</b> 87.8 and 87.8%, accordingly.ConclusionsEarly mortality for FET procedure was significantly reduced to 6% with time and no death among isolated FET. The FET operations became faster with better recovery. Doing more cases, refining surgical techniques and post-operative care are the lessons learned for improvements.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"111-118"},"PeriodicalIF":0.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834734","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":"Approaches to single port mediastinal surgery.","authors":"Alan D L Sihoe","doi":"10.1177/02184923261416536","DOIUrl":"10.1177/02184923261416536","url":null,"abstract":"<p><p>Single Port Video-Assisted Thoracic Surgery (VATS) is now the standard of care for many pulmonary operations. The adoption of Single Port VATS for mediastinal surgery has been considerably slower. Nonetheless, intercostal, subxiphoid, and robot-assisted single-port surgery approaches for mediastinal conditions have been explored in recent years. This narrative review looks at the variety of techniques described and offers an appraisal of the clinical evidence surrounding them.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"193-198"},"PeriodicalIF":0.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12882972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated left pulmonary artery of ductal origin: Reconstruction using pedicled main pulmonary artery flap.","authors":"Wu Yilong, Tham Yi Chuan, Chan Jiahui Charmaine, Ilango Sadasivan, Nakao Masakazu","doi":"10.1177/02184923251410320","DOIUrl":"10.1177/02184923251410320","url":null,"abstract":"<p><p>We describe a rare case of left pulmonary artery (LPA) originating from a closed left patent ductus arteriosus (PDA). A neonate underwent left PDA reopening and stenting. Reperfusion injury was minimized while allowing time for interval growth of the distal LPA. At four months of age, surgical reconstruction was performed to reconnect the LPA to the main pulmonary artery (MPA) with an anterior MPA flap augmented with pericardial patch. Autograft reconstruction is preferred to accommodate patients' growth. Postoperative angiogram showed confluent flow into LPA and distal pulmonary branches. Patient was discharged without complications and was well after 1 year.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"119-122"},"PeriodicalIF":0.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145849950","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":"Complete atrioventricular septal defect, Australian repair: Technique and long-term results.","authors":"Cagla Canbay Sarilar, Sertac Cicek","doi":"10.1177/02184923251399044","DOIUrl":"10.1177/02184923251399044","url":null,"abstract":"<p><p>BackgroundSurgical repair of complete atrioventricular septal defect (CAVSD) has evolved substantially, with early mortality markedly reduced over the past decades. However, achieving durable left atrioventricular valve (LAVV) competence and preserving left ventricular outflow tract (LVOT) geometry remain critical determinants of long-term success.MethodsThis review summarizes the anatomical principles, operative details, and clinical outcomes of the Nunn-modified single-patch (\"Australian\") technique for CAVSD repair.ResultsThe Australian technique-characterized by direct approximation of bridging leaflets to the septal crest without a ventricular patch-demonstrates superior preservation of LVOT architecture and promotes symmetrical LAVV coaptation. Contemporary series report >90% freedom from LAVV reoperation and >97% freedom from LVOT obstruction at 10-15 years, outperforming traditional repairs in multiple institutional and multicenter cohorts. These advantages are consistent across a wide spectrum of ventricular septal defect sizes and patient ages, provided anatomical prerequisites are met.ConclusionsBy minimizing prosthetic material and restoring native leaflet geometry, the Australian Repair achieves excellent long-term valve competence and reoperation-free survival. It should be considered a first-line option in appropriately selected CAVSD patients, particularly where durable LAVV function and LVOT integrity are paramount.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"160-166"},"PeriodicalIF":0.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640716","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":"Operative outcomes following robotic-assisted and conventional minimally invasive mitral valve surgery: A meta-analysis of propensity-matched studies.","authors":"Kristine Santos, Leo Consoli, Luiz Gustavo Albuquerque Mello de Oliveira, Webster Donaldy, Tomasz Płonek","doi":"10.1177/02184923251394563","DOIUrl":"10.1177/02184923251394563","url":null,"abstract":"<p><p>BackgroundRobotic-assisted mitral valve surgery (RAMVS) has emerged as an alternative to conventional minimally invasive mitral valve surgery (MIMVS). However, previous studies have been limited by small sample sizes, heterogeneous techniques and reliance on unmatched or indirectly compared cohorts, resulting in inconclusive evidence. This meta-analysis focuses exclusively on propensity-matched studies to provide a more robust comparison of RAMVS and MIMVS.MethodsA comprehensive literature search was performed to identify propensity-matched studies comparing RAMVS and MIMVS. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0. Subgroup analyses, including mitral valve repair only, non-isolated mitral valve surgery and MIMVS via right minithoracotomy, were conducted to explore heterogeneity.ResultsEight studies comprising 3352 patients were included, with 1578 (47.1%) undergoing RAMVS. The RAMVS was associated with a shorter hospital stay (MD -1.8 days; 95% CI -3.0 to -0.5; <i>p</i> = 0.006) but significantly longer cardiopulmonary bypass time (MD 21.8 min; 95% CI 0.8-42.9; <i>p</i> = 0.04), and higher odds of conversion to sternotomy (OR 2.9; 95% CI 1.6-5.4; <i>p</i> = 0.0007) and re-exploration for bleeding (OR 1.86; 95% CI 1.1-3.2; <i>p</i> = 0.02). Intensive care unit stay, operative time and postoperative complications were comparable. All subgroup analyses consistently showed higher conversion rates with RAMVS.ConclusionThe RAMVS offers potential recovery benefits but at the cost of greater intraoperative complexity. Careful patient selection and technical expertise are essential to maximise outcomes.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"57-66"},"PeriodicalIF":0.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490368","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":"Optimization in long-term survival after multiple arterial grafting in coronary artery bypass: A systematic review and meta-analysis.","authors":"Aqyl Hanif Abdillah, Agustian Sofian, Auzan Hakim Agustian, Azzahra Fadhilah, Annisa Fatharani","doi":"10.1177/02184923251399733","DOIUrl":"10.1177/02184923251399733","url":null,"abstract":"<p><p>IntroductionSurgical revascularization through coronary artery bypass is a widely accepted approach for treating diseases affecting multiple coronary vessels. While the standard approach uses a single arterial graft combined with vein grafts, using numerous arterial grafts may improve long-term outcomes. Although supported by observational data and guideline recommendations, the broader adoption of multiple arterial grafting has been limited due to a lack of definitive randomized trial evidence and uncertainties in specific patient subgroups.MethodsA systematic review and meta-analysis were conducted to compare long-term survival in patients receiving multiple versus single arterial grafts during coronary artery bypass surgery. Twenty-seven studies (including one randomized trial) involving more than one million patients were included. The primary outcome was long-term all-cause mortality. Hazard ratios with 95% confidence intervals were pooled using a random-effects model. Subgroup analyses were performed based on age, sex, diabetes status, graft conduit type, extent of arterial revascularization, and left ventricular function. Meta-regression examined the impact of patient characteristics.ResultsMultiple arterial grafting was associated with a significant reduction in long-term mortality compared to single arterial grafting. The pooled hazard ratio indicated an approximate 20% relative reduction in mortality. This survival benefit was consistent across all evaluated subgroups. Meta-regression did not identify any patient characteristic that significantly altered the benefit of multiple arterial grafting. No significant publication bias was detected.ConclusionMultiple arterial grafting is associated with improved long-term survival in coronary artery bypass surgery. These findings support the broader implementation of this strategy in suitable patients while emphasizing the need for individualized surgical decision-making.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"67-81"},"PeriodicalIF":0.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12789258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I do acute type A dissection.","authors":"Worawong Slisatkorn, Wanchai Wongkornrat, Angsu Chartrungsan, Vutthipong Sanphasitvong, Nutthawadee Luangthong","doi":"10.1177/02184923251407824","DOIUrl":"10.1177/02184923251407824","url":null,"abstract":"<p><p>Acute type A aortic dissection is a life-threatening condition that requires urgent surgical intervention. This article presents our institutional approach, offering a systematic, step-by-step guide to surgical management. Key aspects include preoperative preparation, intraoperative monitoring, arterial cannulation strategies, management of malperfusion, cardiopulmonary bypass, myocardial and cerebral protection, and reconstruction of the aortic root, arch, coronary artery, and left subclavian artery. The use of the frozen elephant trunk technique with hybrid devices is described in detail. Operative photographs, echocardiography, and computed tomography angiography are incorporated to support technical understanding and clinical practice.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"92-95"},"PeriodicalIF":0.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811569","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}