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

{"title":"Current Status of Atrial Fibrillation Ablation Surgery.","authors":"Niv Ad, Stephen D Waterford","doi":"10.1093/ejcts/ezag208","DOIUrl":"10.1093/ejcts/ezag208","url":null,"abstract":"<p><strong>Objectives: </strong>Atrial fibrillation (AF) is associated with stroke, congestive heart failure, and mortality. Treatment has evolved from the cut-and-sew Cox-Maze III procedure to energy-based ablation using cryoablation and radiofrequency ablation, often via minimally invasive approaches. This review aims to establish standardized definitions and reporting practices for rhythm outcomes after surgical AF ablation.</p><p><strong>Methods: </strong>In this review, we establish a definition for rhythm success that can be used to compare outcomes across various types of catheter and surgical ablation. We examine biatrial versus uniatrial ablation and the lesion sets that should be recomended for paroxysmal versus persistent AF. We discuss ablation performed during coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement. We also review minimally invasive thoracoscopic and hybrid ablation approaches.</p><p><strong>Results: </strong>We suggest standardizing rhythm monitoring and reporting using electrocardiograms, Holter monitors, mobile devices, and implantable loop recorders. We suggest standardizing antiarrhythmic drug use, both within and after the blanking period, and describe how use of these medications should affect reporting of ablation success. Description of a detailed lesion set and the mode of application by type of device and cardiopulmonary bypass status are also warranted.</p><p><strong>Conclusions: </strong>Standardized reporting of rhythm outcomes is essential in clinical reports of surgical ablation. Detailed description of the mechanism of lesion application is often missing and should be included in research reports as lesion integrity as part of the ablation scheme is a key factor in success. Superior rhythm outcomes with equivalent morbidity and mortality are obtainable with a complete Maze procedure performed via right thoracotomy.</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":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687460","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 Long-Term Impact of a Teleprehabilitation Programme on Modifiable Risk Factors and Quality of Life After Cardiac Surgery.","authors":"Lieke van Susante, Loes Janssen, Elham Bidar, Gerrit Slooter, Peyman Sardari Nia","doi":"10.1093/ejcts/ezag207","DOIUrl":"10.1093/ejcts/ezag207","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the long-term effects of teleprehabilitation on modifiable risk factors and quality of life up to 1 year following elective cardiac surgery.</p><p><strong>Methods: </strong>This secondary analysis of the Digital Cardiac Counselling trial, a randomized controlled trial, compared multimodal teleprehabilitation with standard care in patients undergoing elective cardiac surgery. The teleprehabilitation programme targeted physical fitness, inspiratory muscle training, psychological support, nutritional optimization, and smoking cessation. Outcomes included trajectories of modifiable risk factors and quality of life measured preoperatively and at 3, 6, and 12 months postoperatively. Generalized linear mixed models assessed differences over time between groups, with exploratory post hoc analyses for individual timepoints.</p><p><strong>Results: </strong>Both groups showed postoperative reductions in all assessed modifiable risk factors and improvements in quality of life over time (P < .001), except for nutritional optimization (P = .173). Teleprehabilitation was associated with more favourable trajectories for smoking behaviour (P = .045) and nutritional risk (P = .011), with consistently lower incidences throughout follow-up. Smoking prevalence remained significantly lower in the teleprehabilitation group at all timepoints (P < .05), while malnutrition prevalence was lower at 3 months postoperatively (P = .012). Quality-of-life scores were consistently higher in the teleprehabilitation group throughout follow-up (P = .002).</p><p><strong>Conclusions: </strong>Teleprehabilitation in cardiac surgery patients not only reduces postoperative complications, but may also provide additional long-term benefits, particularly in smoking cessation, nutritional optimization, and quality of life. These findings support teleprehabilitation as a valuable addition to standard preoperative care, with possible sustained benefits for long-term lifestyle and quality of life.</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":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687473","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":"Intercostal Nerve Cryoablation Versus Thoracic Epidural Analgesia for Minimally Invasive Repair of Pectus Excavatum: A Randomized Clinical Trial (ICE-Trial).","authors":"Elise J van Polen, Gaston H N M Duijsens, Nicky Janssen, Jean H T Daemen, Aimée J P M Franssen, Chiel J Franssen, Karel W E Hulsewé, Yvonne L J Vissers, Erik R de Loos","doi":"10.1093/ejcts/ezag203","DOIUrl":"10.1093/ejcts/ezag203","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative pain after the Nuss procedure remains a significant burden for patients. While thoracic epidural analgesia (TEA) has been the standard for postoperative pain management, intercostal nerve cryoablation (INC) has emerged as a promising alternative. Hence, we aimed to determine the impact of INC on recovery after the Nuss procedure for pectus excavatum in comparison to TEA.</p><p><strong>Methods: </strong>This single-centre, unblinded, randomized clinical trial (NCT05731973) was conducted at Zuyderland Medical Center, The Netherlands. Participants aged 12 to 24 years and scheduled for the Nuss procedure were randomly allocated to receive either INC or TEA. The study used a superiority design for the primary outcome, length of hospital stay (LOHS).</p><p><strong>Results: </strong>Fifty patients were randomized, of which 48 were included in the intention-to-treat analysis (INC n = 25, TEA n = 23). A significant reduction in LOHS was seen (INC 1 day [interquartile range (IQR) 1-1] vs TEA 4 days [IQR 4-4]; P < .001, r = -0.94). Further reductions were seen in opioid consumption (83% during hospitalization and 97% after discharge, P < .001) and postoperative pain on day 7 (P = .010) and 14 (P = .035). Patients showed increased mobilization on day 1 (P = .012) and 2 (P = .013); however, no significant differences were seen in return to work/school. Persistent chest wall hypoesthesia at 6 months postoperatively was seen in 56% of patients after INC.</p><p><strong>Conclusions: </strong>INC demonstrates superiority over TEA in reducing LOHS, opioid use and pain postoperatively. However, persistent chest wall hypoesthesia at 6 months postoperatively remains an issue that warrants further investigation into the long-term effects of INC.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov NCT05731973. URL: https://clinicaltrials.gov/study/NCT05731973.</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":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623799","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 Aortic Specialist: Beyond the Surgical-Transcatheter Divide.","authors":"Marco Moscarelli, Francesco Maisano","doi":"10.1093/ejcts/ezag213","DOIUrl":"https://doi.org/10.1093/ejcts/ezag213","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852349","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":"Restrictive Left Ventricle-to-Pulmonary Artery Conduit as an Alternative Biventricular Strategy in Complex Congenitally Corrected Transposition of the Great Arteries.","authors":"Alexander Moiroux-Sahraoui, Neil Derridj, Ségolène Bernheim, Régis Gaudin, Margaux Pontailler, Pascal Vouhé, Damien Bonnet, Olivier Raisky","doi":"10.1093/ejcts/ezag199","DOIUrl":"10.1093/ejcts/ezag199","url":null,"abstract":"<p><strong>Objectives: </strong>Biventricular repair of congenitally corrected transposition of the great arteries (ccTGA) with a nonrestrictive ventricular septal defect (VSD) and left ventricular outflow tract obstruction (\"complex ccTGA\") provides suboptimal long-term results and carry a high risk of surgical atrioventricular block (AVB). We report outcomes of a restrictive left ventricle-to-pulmonary artery (LV-PA) conduit without VSD closure.</p><p><strong>Methods: </strong>Retrospective single-centre review (January 1999-January 2024) of complex ccTGA patients receiving a restrictive LV-PA conduit without VSD closure.</p><p><strong>Results: </strong>Nine of 553 ccTGA patients met inclusion criteria (median age 5 years, weight 18 kg). Unfavorable anatomy was mainly due to inlet or remote VSD (n = 5) and/or atrioventricular valves straddling (n = 2). Over a median follow-up of 12.5 years, there were no operative or late deaths and no permanent pacing for AVB. Freedom from reintervention was 62.5% at 10 years. At last follow-up, 8 of 9 patients were in NYHA class I-II and median SpO2 was 95%. Tricuspid regurgitation was basent or mild in 8 cases and moderate in 1 case. 2 patients had decreased morphologic right ventricle function and morphologic left ventricular function was preserved in all.</p><p><strong>Conclusions: </strong>Restrictive LV-PA conduit placement without VSD closure is a safe biventricular alternative in complex ccTGA unsuitable for anatomic repair or single-ventricle palliation.</p>","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805053","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":"Building the Future: A Proposed Framework for Training Residents in Minimally Invasive Cardiac Surgery.","authors":"Polina Danchenko, Nabil Hussein","doi":"10.1093/ejcts/ezag155","DOIUrl":"https://doi.org/10.1093/ejcts/ezag155","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703213","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":"Erratum to: Is Cooler Safer and More Advantageous? A Feasibility Study in Rabbits.","authors":"","doi":"10.1093/ejcts/ezag209","DOIUrl":"https://doi.org/10.1093/ejcts/ezag209","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805036","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":"The Role of Selective Multidetector Computed Tomography After a Transcatheter Aortic Valve Implant.","authors":"Marco Moscarelli, Philippe Pibarot, Nicolas Van Mieghem, Patrizio Lancellotti, Thomas Modine, Nicolo Piazza, Mani A Vannan, Giuseppe Tarantini, Adriana Zlahoda-Huzior, Lakshmi P Dasi, Khalil Fattouch","doi":"10.1093/ejcts/ezag200","DOIUrl":"10.1093/ejcts/ezag200","url":null,"abstract":"<p><p>Transcatheter aortic valve implants are increasingly performed in younger and lower-risk patients, shifting attention towards long-term prosthetic valve durability. Although transthoracic echocardiography remains the cornerstone of follow-up, it primarily reflects global haemodynamics and may not detect early structural or geometric abnormalities after the valve is implanted. Hypoattenuated leaflet thickening and reduced leaflet motion, collectively referred to as subclinical leaflet thrombosis, represent dynamic phenomena that may precede overt valve dysfunction. Growing evidence suggests that prosthesis geometry, including underexpansion, ellipticity, commissural misalignment, canting, and implant depth, may alter neo-sinus flow and promote thrombotic substrate formation. Multidetector computed tomography enables integrated assessment of leaflet morphology, perivalvular thrombus, and prosthetic geometry, providing insights into the mechanical determinants of thrombosis. In this state-of-the-art review, we examine the role of multimodality imaging in identifying thrombogenic valve phenotypes and propose a pragmatic imaging framework integrating echocardiography with selective multidetector computed tomography to support the surveillance and management of individualized post-transcatheter aortic valve implants.</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":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564323","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":"RE-LOCK and TRACK: A Reproducible Minimally Invasive Repair for Bileaflet Mitral Disease.","authors":"Giuseppe Nasso, Giuseppe Speziale","doi":"10.1093/ejcts/ezag211","DOIUrl":"10.1093/ejcts/ezag211","url":null,"abstract":"<p><p>Complex bileaflet and Barlow-type degenerative disease remains among the most demanding substrates in reconstructive mitral surgery, and a right mini-thoracotomy amplifies every source of intraoperative variability. Two determinants dominate durability: excessive posterior leaflet height, which displaces the coaptation line anteriorly and drives residual regurgitation and systolic anterior motion; and, in anterior prolapse, neochordal length, where a millimetric error produces residual prolapse, restriction or recurrence. We describe RE-LOCK and TRACK, a two-component, posterior-first protocol designed to control both reproducibly. RE-LOCK relocates the redundant posterior leaflet head towards the annular plane and anchors it to a stable posterior reference, converting a mobile prolapsing edge into a controlled hinge and establishing a low, posteriorised coaptation shelf; posterior neochordae are not used. TRACK then calibrates anterior support: expanded-polytetrafluoroethylene neochordae anchored to the papillary head are advanced against a temporary annular guide kept coplanar with the annulus, so that length is set against an anatomical reference rather than by visual estimation or ventricular loading. Complete ring annuloplasty stabilises the result, and intraoperative transoesophageal echocardiography governs any revision. By fixing the sequence, platform first and calibration second, the protocol converts individually demanding manoeuvres into a repeatable, teachable operation particularly well suited to the minimally invasive field.</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":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766555","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":"Robotic Coronary Revascularization: Current Evidence, Training, and Future Directions.","authors":"Yazan N AlJamal, Husam H Balkhy","doi":"10.1093/ejcts/ezag205","DOIUrl":"https://doi.org/10.1093/ejcts/ezag205","url":null,"abstract":"","PeriodicalId":520617,"journal":{"name":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","volume":"68 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761641","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}