European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery最新文献

{"title":"Development and validation of a surgical performance assessment scale for lung lobectomy and lymph node dissection.","authors":"Clément Colombier, Géraldine Allain, Lisa Durocher, Stéphanie Ragot, Jean-Pierre Faure, Denis Oriot, Christophe Jayle","doi":"10.1093/ejcts/ezaf265","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf265","url":null,"abstract":"<p><strong>Objectives: </strong>Assessing surgical trainees' performance requires objective, validated, and reliable evaluation tools. We developed and validated the Lung Lobectomy Performance Assessment Scale Score (LOB-PASS) to objectively evaluate lung lobectomy performance, including lymph node dissection, across different surgical approaches (postero-lateral thoracotomy, video-assisted, and robot-assisted).</p><p><strong>Methods: </strong>The LOB-PASS scale was developed using the Delphi consensus method and response process testing in simulation sessions. Validation was performed on 48 thoracic surgery residents, assessed by independent observers through simulation-based response testing. Internal structure was evaluated using Cronbach's alpha, intraclass correlation coefficient (ICC), correlation scores from linear regression (R2), and Bland-Altman analysis. Inter-observer score comparisons were conducted using the Wilcoxon test and the F-test.</p><p><strong>Results: </strong>The final scale included 52 items categorized into seven domains: opening (n = 6), cavity exploration and lymph node dissection (n = 12), vein time (n = 5), arterial time (n = 8), bronchial time (n = 6), parenchymal time (n = 7), and closure (n = 8), with a total score of 104 points. Internal structure analysis based on 48 simulation procedures: Cronbach's alpha = 0.89, ICC = 0.92, R2 = 0.84. No significant interobserver differences were found (p > 0.05). Bland-Altman analysis demonstrated a mean difference of 0.19, with 95% limits of agreement ranging from -13.3 to 13.7.</p><p><strong>Conclusions: </strong>LOB-PASS is a valid and reliable tool for assessing lung lobectomy performance with lymph node dissection across all surgical approaches. Integrating LOB-PASS into surgical training curricula could standardize competency assessment and optimize technical skill acquisition in thoracic surgery.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765948","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":"Material safety of styrene-block-ethylene/butylene-block-styrene copolymers used for cardiac valves: 6-month in-vivo results from a juvenile sheep model.","authors":"Raimondo Ascione, Joanna R Stasiak, Daniel Baz-Lopez, Marta Serrani, Geoff D Moggridge","doi":"10.1093/ejcts/ezaf266","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf266","url":null,"abstract":"<p><strong>Objective: </strong>To assess the in-vivo 6-month safety of styrene-block-ethylene/butylene-block-styrene (SEBS) block copolymers material used to make cardiac valves.</p><p><strong>Methods: </strong>Research grade mitral valve prototypes made from SEBS29/SEBS20 copolymers (n = 7; 3 with heparin-coating) were implanted in juvenile sheep under cardiopulmonary bypass and kept for 6-month. No vitamin K antagonists were used. Anticoagulation included enoxaparin 1mg/kg SC twice/day from day-1 until day-120 along with clopidogrel 300mg once/day with food from Day-1 until sacrifice. Safety measures included SEBS-related calcification, degradation, hemolysis, cytotoxicity, clinical pathology (biochemistry, complete blood count, coagulation), structural integrity, damage to surrounding tissue, overall animal health, device embolization and function.</p><p><strong>Results: </strong>Surgery was feasible in all cases. Four animals reached the final 180±5 days timepoint, while 1 needed non-SEBS related sacrifice on day 2, 1 suffered non-SEBS related death on day 81, and 1 needed sacrifice on day 169 due to prototype dysfunction. High resolution X-ray, spectroscopy and histology showed absence of SEBS calcification, while gel permeation chromatography confirmed no SEBS degradation at 6-month. At histology there was no SEBS-related calcification, thrombosis, cytotoxic or neoplastic degeneration and no damage of the cardiac and downward organs. Blood testing showed no haemolysis while clinical pathology and animal health remained within normal reference intervals. The function of the research-grade mitral prototypes was clinically acceptable. The use of heparin-coating did not add benefit.</p><p><strong>Conclusions: </strong>This preclinical in-vivo study in juvenile sheep confirms the 6-month safety of SEBS29/SEBS20 material used to make cardiac valves. A future early feasibility study is warranted to confirm long-term durability, hemocompatibility and function in humans.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765949","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":"Role of Sarcopenia in Predicting 1-Year Outcomes After Mini-invasive Surgical or Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms.","authors":"Pasqualino Sirignano, David Barillà, Giulia Colonna, Chiara Pranteda, Arianna Pignataro, Carmen Emanuela Setteducati, Stefano Brizzi, Noemi Baronetto, Maurizio Taurino, Efrem Civilini","doi":"10.1093/ejcts/ezaf241","DOIUrl":"10.1093/ejcts/ezaf241","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcome of frail patients electively treated for abdominal aortic aneurysm (AAA) by open surgery with enhanced repair protocol (OSER) or endovascular aneurysm repair (EVAR).</p><p><strong>Design: </strong>A retrospective study on frail AAA patients treated by EVAR and OSER was conducted. Patients were defined as frail if they present a normalized total psoas muscle area (nTPA) <500 mm2/m2. This study aimed to evaluate the association between sarcopenia and AAA-related as well as all-cause mortality rates. Secondary outcomes included reinterventions, operative time, blood transfusion, length of intensive care unit (ICU), and postoperative hospital stay.</p><p><strong>Results: </strong>A total of 403 patients were included in the study, of which 122 (30.3%) had a nTPA < 500mm2/m2. Among them, 272 (67.5%) patients were treated with EVAR while 131 (32.5%) with OSER. Although EVAR was more frequently performed in sarcopenic patients than OSER (P<0.001), there were no significant differences between the 2 groups in terms of intraoperative and postoperative outcomes. Likewise, no statistically significant differences were found regarding mortality and reintervention rates at Kaplan-Meier analysis. However, sarcopenic patients undergoing OSER exhibited a significantly higher all-cause mortality rate at 1 month (P = 0.031) and cumulative follow-up (P = 0.004) compared to all other subgroups.</p><p><strong>Conclusions: </strong>The present experience demonstrates that less invasive approaches, but surgical or endovascular, are viable for AAA patients with no significant difference in intraoperative and immediate postoperative outcomes. Nevertheless, the potential of EVAR as a preferred strategy should be considered for frail patients based on ascertained sarcopenia.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664145","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":"Assessing the Safety, Feasibility, and Clinical Outcomes of a Fast-Track Strategy in Open Cardiac Surgery.","authors":"Anna Sundström, Mark Larsson, Anna Falk, Malin Stenman, Francesca Campoccia Jalde, Magnus Dalén, Magnus Fredby, Ulrik Sartipy, Per Nordberg","doi":"10.1093/ejcts/ezaf238","DOIUrl":"10.1093/ejcts/ezaf238","url":null,"abstract":"<p><strong>Objectives: </strong>To study feasibility, safety, and clinical outcomes after the implementation of a fast-track concept after open cardiac surgery.</p><p><strong>Methods: </strong>A single-centre observational study (2018-2023) using data from the cardiothoracic intensive care unit (ICU) registry at the Karolinska University Hospital and the SWEDEHEART registry. The fast-track intervention included immediate extubation, early and frequent mobilization, prompt oral intake, and transfer to regular ward the day after surgery. Main outcomes were proportion of patients discharged to regular ward on the first postoperative day, length of hospital stay, and 30-day mortality.</p><p><strong>Results: </strong>Totally, 5234 open cardiac procedures were performed, of which 2801 patients (78% men, median age 63 years SD 12.3, mean EuroSCORE II 2.0 SD 2.0) were treated at the fast-track unit. The most common procedures were coronary artery bypass grafting (CABG, 42.4%) and single non-CABG procedure (37.5%). In total, 94.6% (n = 2649) of patients were discharged the day after surgery. Of those requiring ICU care (n = 152), circulatory failure (n = 57) and reoperation due to bleeding or tamponade (n = 51) were most frequent. Patients with fast-track failure had a EuroSCORE II of 2.9 vs 1.9 in discharged patients (P < 0.001). Median hospital stay was 5 days for patients discharged as planned, compared to 8.7 days for those transferred to ICU (P < 0.001). The 30-day mortality was 0.3%, with 0.2% in patients discharged as planned and 1.3% in those requiring ICU transfer (P = 0.096).</p><p><strong>Conclusions: </strong>Following the fast-track implementation after open cardiac surgery, approximately 95% of patients were discharged the day after surgery, with a 30-day mortality rate of 0.3%.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661706","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":"Prognostic value of 18fluorodeoxyglucose-positron emission tomography/computed tomography in type A aortic intramural hematoma.","authors":"Tianyu Chen, Hui Yuan, Hailong Qiu, Lei Jiang, Jinlin Wu, Jue Yang, Kan Zhou, Tucheng Sun, Jian Zhuang, Zerui Chen","doi":"10.1093/ejcts/ezaf261","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf261","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we aimed to assess 18fluorodeoxyglucose (18 F-FDG) uptake in patients with type A aortic intramural haematoma (IMH) to establish its association with disease progression.</p><p><strong>Methods: </strong>Patients with type A IMH receiving medical management were included. After the patient agreed to participate, 18 F-FDG PET/CT was performed. The aortic 18 F-FDG uptake was measured in standardized uptake value (SUV). The primary outcome was disease progression, which was defined as a condition requiring aortic intervention. The median follow-up was calculated by the inverse Kaplan-Meier method.</p><p><strong>Results: </strong>A total of 32 patients were included in this study. During a median follow-up of 28.3 months (95% CI 4.8-51.7), 14 events occurred in 14 patients (43.8%). Patients with disease progression had significantly higher SUVmax compared to the stable group (4.9 ± 1.1 vs 3.5 ± 1.0, p =0.001). ROC curve analysis revealed that an SUVmax cut-off of 4.25 had a sensitivity of 78.6% and specificity of 77.8% for predicting disease progression, with an area under the curve (AUC) of 0.806 (95% CI: 0.653-0.958). The 2-year progression-free survival rates for the SUVmax increased (>4.25) and non-increased (≤4.25) were 20.7% and 75.0% (p = 0.019), respectively.</p><p><strong>Conclusions: </strong>Increased aortic 18 F-FDG uptake was associated with high risk for adverse aortic events in type A IMH. The SUVmax of 18 F-FDG should be considered in the risk stratification and management of these patients.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765950","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 role of surgery in contemporary infective endocarditis.","authors":"Shekhar Saha, Benjamin Zauner, Philipp Schnackenburg, Konstantinos Rizas, Martin Orban, Steffen Massberg, Christian Hagl, Dominik Joskowiak","doi":"10.1093/ejcts/ezaf259","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf259","url":null,"abstract":"<p><strong>Objectives: </strong>Infective endocarditis (IE) is a multifaceted disease, whose treatment can often be challenging. Furthermore, along with a rising incidence, the clinical manifestation of IE has changed over the years. This study analyses the interdisciplinary Endocarditis team management of IE in a tertiary care hospital.</p><p><strong>Methods: </strong>We reviewed the patients who were admitted for infective endocarditis at our institution between January 2012 and December 2021. Risk estimation was performed by calculating the EuroSCORE II and the EndoSCORE.</p><p><strong>Results: </strong>A total of 812 consecutive patients were admitted to our centre for IE. Among these patients, 249 patients (30.7%) underwent conservative treatment for IE (Group C) and 563 patients (69.3%) underwent surgery (Group S). The EuroSCORE II was 5.5(2.6-10.1) in Group C and 5.1(2.5-10.7) in group S, whereas the EndoSCORE was 7.6 (6.9-19.6) in Group C and 12.3(6.9-19.5) in Group S. The Duke criteria were not met in 297 patients (36.6%) and patients not meeting the Duke criteria were more often treated conservatively. A higher number of patients suffering from TAVR-endocarditis and tricuspid valve endocarditis were treated conservatively. Whereas patients with aortic valve endocarditis were treated surgically more often.</p><p><strong>Conclusions: </strong>Infective endocarditis is a multifaceted disease, which requires a specialized interdisciplinary approach. Decisions on treatment modalities should be made on a case-to-case basis in an endocarditis team setting. In addition to treatment modality, adequate consideration should be given to the pathogen causing IE and the extent of IE.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755639","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":"Postoperative acute kidney injury requiring dialysis after lung transplantation: factors associated and long-term outcomes.","authors":"Mélanie Mallet, Alban Todesco, Gabrielle Drevet, Arnaud Rodriguez, Jacques Jougon, Xavier Demant, David Boulate, Xavier-Benoit D'journo, Pascal-Alexandre Thomas, Alex Fourdrain, Jean-Michel Maury, Francois Tronc, Matthieu Thumerel, Yaniss Belaroussi","doi":"10.1093/ejcts/ezaf247","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf247","url":null,"abstract":"<p><strong>Objectives: </strong>Acute kidney injury (AKI) requiring dialysis after lung transplantation is a significant source of morbidity. This study investigates the incidence, mortality, and variables associated with the need for dialysis.</p><p><strong>Methods: </strong>This retrospective analysis included patients aged ≥15 years who underwent lung transplantation between 2014 and 2019 at three French institutions. Patients were grouped based on the need for dialysis in the postoperative period. Outcomes analyzed included the incidence of AKI requiring dialysis and short- and long-term mortality. We also examined the association between recipient, donor, and intraoperative variables and the need for dialysis.</p><p><strong>Results: </strong>The study population consisted of 478 patients, with a mean age of 49.7 (SD 14.3) years. Dialysis was required for 88 patients (18.4%). In multivariable logistic regression, recipient characteristics (diagnosis), donor characteristics (cardiac arrest), and intraoperative variables (total ischaemic time, norepinephrine dose at the end of the procedure, red blood cell and plasma transfusions) were independently associated with postoperative dialysis (p < 0.05). The median overall survival for patients requiring dialysis was 6.2 months (not reached for those without dialysis). Patients requiring dialysis had a higher risk of all-cause mortality (p < 0.01), with higher 30-day (29.5% vs 7.2%) and 1-year (63.6% vs 13.4%) mortality rates.</p><p><strong>Conclusions: </strong>AKI requiring dialysis after lung transplantation is associated with significantly higher 30-day and long-term mortality. Identifying high-risk patients for postoperative renal failure requiring dialysis may improve long-term outcomes after lung transplantation.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755638","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":"Planned versus emergency coronary artery bypass grafting during elective aortic root replacement: short- and long-term outcomes.","authors":"Eilon Ram, Christopher Lau, Alexander Gregg, Lamia Harik, Giovanni Soletti, Mario Gaudino, Leonard N Girardi","doi":"10.1093/ejcts/ezaf255","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf255","url":null,"abstract":"<p><strong>Objectives: </strong>Evaluate the impact of coronary artery bypass grafting (CABG) on outcomes in patients undergoing aortic root replacement (ARR).</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients undergoing elective ARR at a single high-volume center. Patients were stratified based on whether they underwent concomitant CABG, and outcomes were compared using multivariable regression and survival analysis.</p><p><strong>Results: </strong>A total of 1518 patients (87.2%) underwent isolated ARR while 223 (12.8%) underwent ARR with CABG. A majority (N = 205, 91.9%) of CABG procedures were elective. In 18 patients (8.1%) CABG was needed emergently. Patients requiring CABG were older (64.8 ± 9.8 vs 55.1 ± 14.5 years, p < 0.001) with a greater incidence of comorbidities. Female sex [OR 4.54 (1.57-12.62), p = 0.004] and smaller aortic root size [OR 0.34 (0.16-0.75), p = 0.007] were associated with need for emergency CABG on multivariable analysis. Operative mortality (OM) was significantly higher in all patients needing concomitant CABG [1.8% vs 0.2%; OR 6.08 (1.16-35.3), p = 0.032]. Among those needing CABG, emergency CABG patients had a higher OM than elective CABG [11.1% vs 1%; OR 12.5 (1.45-100), p = 0.014]. Respiratory complications were more common after emergency CABG as was the incidence of postoperative renal dysfunction and a composite of major adverse events. 10-year survival for all patients requiring CABG was not significantly compromised [73.8% vs 86.2%, HR 0.98, (0.6-1.59), p = 0.937].</p><p><strong>Conclusions: </strong>Elective and emergency CABG increase operative risk but do not reduce long-term survival in patients undergoing ARR. Females and those with small aortic roots are at particular risk for needing emergency CABG.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755637","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":"Cardiac Surgery during and after the Pandemic: A Retrospective Analysis of UK Trends and Outcomes.","authors":"Tim Dong, Norman Briffa, Pradeep Narayan, Jeremy Chan, Gianni D Angelini","doi":"10.1093/ejcts/ezaf246","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf246","url":null,"abstract":"<p><strong>Objectives: </strong>The full extent of the COVID-19 pandemic's impact during different phases of the pandemic and the recovery of cardiac surgical services in the UK have not been comprehensively assessed. This study aims to evaluate these disruptions' impact and immediate recovery on delivering adult cardiac surgical care in the UK.</p><p><strong>Methods: </strong>The periods investigated were divided into pre-lockdown, first lockdown, first relaxation, second lockdown, second relaxation, third lockdown, and post-lockdown (recovery). Changes in surgical practice, early and mid-term clinical outcomes, and hospital readmission were analysed using various metrics across different time periods.</p><p><strong>Results: </strong>Coronary artery bypass grafts were the most performed procedure across all time periods, with the average number of urgent and emergency increasing compared to the pre-pandemic period. Aortic valve replacement was the next most frequent, followed by combined aortic valve and coronary artery bypass surgery. However, those procedures remained predominantly elective across all periods. There was a significant change in 30-day mortality rates across the pandemic phases (p < 0.001), with higher mortality observed post-pandemic. There was a gradual increase in the waiting times for elective and urgent surgeries from January 2018 to March 2022 Patients who had surgery before March 2020 had a significantly lower hazard of mid-term mortality than those who were operated on after this period (HR: 0.638, 95% CI: 0.5875-0.6921). All procedures showed gradual recovery across the pandemic periods following an initial decline at the beginning of the pandemic.</p><p><strong>Conclusions: </strong>COVID-19 had a significant negative impact on adult cardiac surgical case mix and volume and has not recovered to the pre-pandemic levels. This work, we believe, is important for policymakers, healthcare providers, and patients, as it offers insights into the challenges faced by a critical healthcare sector during a global crisis and highlights potential avenues for improvement.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736625","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":"Comment on \"Concurrent spread through air spaces in dominant tumors impacts prognosis in synchronous multiple primary lung adenocarcinoma\".","authors":"Saraswati Sah, Rachana Mehta, Ranjana Sah","doi":"10.1093/ejcts/ezaf248","DOIUrl":"https://doi.org/10.1093/ejcts/ezaf248","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736626","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}