Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Temporal Trends in Outcomes and Predictors of Length of Stay following Lung Cancer Resection over 10 Years with Enhanced Recovery After Surgery.","authors":"Lauren Kari Dixon, David Messenger, Lesley Wood, Neil Rasburn, Douglas West, Eveline Internullo, Rakesh Krishnadas, Igor Saftic, Stylianos Gaitanakis, Laura Socci, Michelle Brack, Timothy Batchelor, Natasha Joshi","doi":"10.1093/icvts/ivaf216","DOIUrl":"https://doi.org/10.1093/icvts/ivaf216","url":null,"abstract":"<p><strong>Objectives: </strong>Enhanced Recovery After Surgery aims to accelerate recovery, with length of stay as a key metric. This study assessed temporal trends in short-term outcomes within a maturing programme and identified factors associated with increased hospital stay.</p><p><strong>Methods: </strong>Data were prospectively collected for consecutive patients undergoing lung cancer resection following a 14-step protocol between 2013 and 2023. Primary outcome was length of stay. Secondary outcomes included 30-day mortality, morbidity, re-admission, and reoperation rates. Predictors of length of stay were analysed using linear regression.</p><p><strong>Results: </strong>We included 2192 patients; procedures included lobectomy (61%), wedge resection (23%), segmentectomy (10%), pneumonectomy (3.5%), and bi-lobectomy (2.7%), Video-assisted thoracoscopic surgery was used in 80% of cases. Median length of stay decreased from 5 to 4 days (p < 0.001), while protocol adherence increased from 10/14 to 12/14 (p = 0.01). In-hospital mortality (2.9% to 1.0%, p < 0.001) and major-morbidity (12.2% to 5.6%, p < 0.001) both declined. In multivariable linear regression, factors associated with longer stay included age (β = 0.17, CI 0.13-0.20, p < 0.001), higher American Society of Anesthesiologists score (β = 1.12, CI 1.04-2.2, p = 0.02), open surgery (β = 1.0, CI 0.17-2.2, p = 0.043), thoracoscopic-to-open converted surgery (β = 1.49, CI 0.96-1.9, p = 0.03) and intensive care (β = 3.4, CI 2.5-4.3, p < 0.001). Protective factors were early mobilisation (β=-0.90, CI -1.9-0.33, p = 0.005) and opioid avoidance (β=-0.72, CI -2.4-0.99, p = 0.038).</p><p><strong>Conclusions: </strong>Sustained use of an Enhanced Recovery After Surgery programme was associated with shorter hospitalisation and reduced morbidity. Factors associated with length of stay can identify patients at risk of delayed recovery and prioritise elements for optimisation within recovery pathways.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310153","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":"Treatment of aortoesophageal fistula in a tertiary German aortic and esophageal center-a multidisciplinary effort.","authors":"Felix Strobl, Jan Stana, Agnes Klara Böhm, Aldin Mehmedovic, Maximilian Pichlmaier, Hubert J Stein, Martin Angele, Nikolaos Tsilimparis","doi":"10.1093/icvts/ivaf236","DOIUrl":"https://doi.org/10.1093/icvts/ivaf236","url":null,"abstract":"<p><strong>Objectives: </strong>Although rare, aorto-oesophageal fistula remains one of the most critical diseases in cardiovascular surgery. The lack of prospective studies or large case series leads to an absence of evidence based therapeutic concepts.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients treated for Aorto-oesophageal fistula between 2014 and 2023. Primary end-points of analysis were 30-day mortality and median survival, subgroup analysis was performed for etiolgoy as well as treatment strategy. Additionally, a systematic search was conducted for all studies researching treatment of the disease including ≥5 patients and published within the last 10 years.</p><p><strong>Results: </strong>In the collective of 10 patients, 4 manifested as primary fistula, while in 6 patients the fistula occurred secondary to previous thoracic endovascular aortic repair. Median duration to manifestation post-TEVAR was 20.1 (34.1) months. Initial treatment consisted of TEVAR or TEVAR-relining in 7 cases, followed by bovine open aortic replacement (n = 1) or partial bovine patch repair (n = 2) when viable. Treatment of the oesophagus consisted of primary suture (n = 1) or oesophagectomy (n = 5) with gastric pull-up or colon interposition. Overall 30-day mortality was 40%, overall median survival was 7.5 (12.8) month. Patients receiving surgical treatment of the oesophagus exhibited longer survival than patients who did not (12.8 (4.7) vs 0.35 (0.4) months). Across the reviewed literature, the strongest effect on survival originates from surgical treatment of the oesophagus. Specific surgical strategies as well as patient characteristics vary widely.</p><p><strong>Conclusions: </strong>We found TEVAR effective in stabilizing the initial Haemorrhage. Short interval oesophagectomy seems to improve survival and should be considered in most patients. Open aortic replacement with bovine pericardium is a viable option. Interventional treatment options alone do not appear to be sufficient.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310156","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":"Understanding barriers to adjuvant therapy in resected non-small cell lung cancer: A multicenter analysis.","authors":"Paula Duarte D'Ambrosio, Leticia Leone Lauricella, Benoit Jacques Bibas, Fabio Eiti Minamoto, Flavia Alves Corrêa De Queiroz, Pedro Henrique Xavier Nabuco De Araújo, Jefferson Luiz Gross, Federico Enrique Garcia Cipriano, Henrique Nietmann, Fabio May Da Silva, Paulo Manuel Pêgo-Fernandes, Ricardo Mingarini Terra","doi":"10.1093/icvts/ivaf174","DOIUrl":"https://doi.org/10.1093/icvts/ivaf174","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate variables associated to not receiving adjuvant therapy in patients with resected pathological IB-IIIA NSCLC from a national registry.</p><p><strong>Methods: </strong>Patients who had lung resections were analyzed retrospectively for stages IB-III from 2009-2023, sourced from a multicentre registry. Uni/Multivariable logistic regression was performed, and a predictive tool was created to predict adjuvant therapy probability and cut-off values were determined through ROC analysis. The model's discrimination, performance and fit were evaluated using AUC-ROC, sensitivity/specificity and Hosmer-Lemeshow test respectively.</p><p><strong>Results: </strong>Of the 427 patients analyzed, the mean age was 65.4 years and 83.1% were treated under public insurance. 38.4% of patients received adjuvant chemotherapy after surgery. Multivariable analysis identified older age (OR = 1.06, p < 0.001), histological subtype (OR = 21.3, p < 0.001), public insurance (OR = 2.65, p = 0.006), stage I-B (OR = 8.10, p = 0.002), and negative lymph node status (OR = 3.34, p < 0.001) as independent factors associated with not receiving adjuvant therapy. Using the final equation, a calculated probability > 42.5% categorizes a patient for exclusive surgical intervention. The model's performance yielded an AUC of 0.833, with a sensitivity of 90.2%. The Hosmer-Lemeshow test resulted in a p ≥ 0.05.</p><p><strong>Conclusions: </strong>Underutilization of adjuvant therapy in NSCLC is influenced by age, insurance type, and pathological factors. Public insurance status indicates healthcare access but does not fully capture social disparities. The absence of race, income, and geographic data limits broader analysis. Our model identifies patients at risk of treatment omission, aiding targeted interventions.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304866","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":"Long-term surgical outcome for idiopathic acute rupture of mitral chordae tendineae in infants.","authors":"Yuji Tominaga, Kenta Imai, Motoki Komori, Keisuke Shibagaki, Rieko Kutsuzawa, Shota Kawai, Kenichi Kurosaki, Isao Shiraishi, Shigemitsu Iwai","doi":"10.1093/icvts/ivaf252","DOIUrl":"https://doi.org/10.1093/icvts/ivaf252","url":null,"abstract":"<p><strong>Objectives: </strong>Acute rupture of mitral valve chordae tendineae in infants is rare and rapidly leads to cardiorespiratory failure. Acute progression with slight mitral valve annulus dilatation and valve degeneration limits the surgical treatment options. This study investigated the long-term surgical outcomes and factors influencing prognosis.</p><p><strong>Methods: </strong>We assessed 20 infants who underwent surgical treatment for acute mitral valve chordal rupture between 2001 and 2015. The median age was 5.5 months (interquartile range: 4.5-7.2). Seventeen experienced cardiogenic shock. Twenty had severe mitral regurgitation with a mitral valve diameter z-score of 1.1 (0.06-2.5). The infants underwent mitral valve repair primarily with artificial chordae reconstruction. Mitral valve replacement was performed when regurgitation control was unsuccessful.</p><p><strong>Results: </strong>The follow-up period was 12.9 (10.6-14.4) years, with no mortality. The number of prolapsed leaflet segments was 3 (1-3). Twelve patients (60%) exhibited intraoperatively yellowish edematous degeneration of the mitral valve. Although 13 underwent mitral valve repair at initial surgery, three were converted to mitral valve replacement before discharge. Consequently, 10 required mitral valve replacement because of uncontrollable mitral regurgitation before discharge.Univariable logistic regression revealed that mitral valve degeneration (odds ratio: 21, p = 0.015) and the number of prolapsed leaflet segments (odds ratio: 4.6, p = 0.025) were significantly associated with mitral valve replacement before discharge.</p><p><strong>Conclusions: </strong>Prompt valve surgery yields good long-term outcomes. Mitral valve repair using artificial chordae reconstruction is a reasonable option for infants. Mitral valve degeneration and numerous prolapsed segments are associated with uncontrollable mitral regurgitation.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304865","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":"Predicting the need for tube thoracostomy in blunt trauma patients with occult pneumothorax: Observation versus intervention.","authors":"Nilay Çavuşoğlu Yalçın, Muharrem Özkaya","doi":"10.1093/icvts/ivaf250","DOIUrl":"https://doi.org/10.1093/icvts/ivaf250","url":null,"abstract":"<p><strong>Objectives: </strong>Occult pneumothorax is increasingly diagnosed in trauma patients due to widespread use of computed tomography (CT), yet its optimal management remains controversial. This study aimed to identify clinical and radiological predictors of deterioration requiring tube thoracostomy and to develop a predictive model to guide management decisions.</p><p><strong>Methods: </strong>In this retrospective single-center study, 166 patients with blunt trauma-associated occult pneumothorax were analyzed. Clinical and radiological variables-including subcutaneous emphysema, haemothorax volume, pneumothorax size, mechanical ventilation, and rib fractures-were evaluated for association with delayed tube thoracostomy. A weighted multivariable logistic regression model addressed class imbalance, and model performance was assessed using receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Of 166 patients, 17 (10.2%) required delayed tube thoracostomy. Subcutaneous emphysema (OR 20.10, p = 0.001) and mechanical ventilation (OR 17.30, p = 0.002) were the strongest independent predictors of deterioration. Haemothorax volume also showed a significant association (OR 1.06, p = 0.045). Other factors, including pneumothorax size, rib fractures, age, and sex, were not predictive. The predictive model demonstrated excellent discrimination (AUC = 0.97), suggesting potential for clinical risk stratification.</p><p><strong>Conclusions: </strong>Physiological indicators such as subcutaneous emphysema and mechanical ventilation are superior to anatomical parameters in predicting deterioration among patients with occult pneumothorax. Our findings support a selective management strategy and highlight the utility of predictive modelling to guide tube thoracostomy decisions. Prospective multicentre studies are warranted to validate these results.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304797","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":"Surgically treated left ventricular myxomas: a 75-year systematic review of patient demographics, tumor characteristics, and outcomes.","authors":"Hamza A Abdul-Hafez, Asmaa Sarama, Tammah Safadi, Mahmoud N Khadra, Hasan Husni Salman, Ahmad K Darwazah, Hasan Alkhatib","doi":"10.1093/icvts/ivaf248","DOIUrl":"https://doi.org/10.1093/icvts/ivaf248","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiac myxomas are rare primary heart tumors, most commonly originating in the left atrium. A smaller proportion occurs in the left ventricle, where they are even more uncommon and present unique diagnostic and therapeutic challenges. This systematic review aims to characterize the clinical features, management strategies, and outcomes of left ventricular cardiac myxomas.</p><p><strong>Methods: </strong>A systematic search of the PubMed database was conducted to identify articles published up to May 2025. A total of 174 cases of surgically treated left ventricular myxomas were included. Data were extracted on patient demographics, tumor characteristics, surgical approaches, and follow-up outcomes.</p><p><strong>Results: </strong>Patients showed a broad geographic distribution, with the highest number of cases reported from the United States. The mean age was 38.2 ± 20.37 years, with a slight female predominance (48.9%). Tumors were most commonly attached to the left ventricular wall (43.7%) and interventricular septum (25.3%). Complete surgical excision was achieved in 92.5% of cases and was strongly associated with survival; nearly all patients with complete resection survived, compared to only 20% among those without. Overall postoperative survival was high (83.9%), with a low mortality rate (2.9%). Survival rates were comparable across genders and age groups, although pediatric patients had a slightly higher mortality rate (9.1%).</p><p><strong>Conclusion: </strong>This systematic review represents the most comprehensive analysis to date of surgically treated left ventricular myxomas. The findings highlight the importance of complete excision in achieving favorable outcomes and highlight demographic and geographic patterns that can inform clinical suspicion, surgical planning, and patient counseling.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304792","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":"Efficacy of Impella Microaxial left ventricular assist device as bridge to transplant in children with end stage heart disease.","authors":"Bahaaldin Alsoufi, Deborah Kozik, Bradley Oelkers, Sarah Wilkens, Joshua Sparks, Jaimin Trivedi","doi":"10.1093/icvts/ivaf249","DOIUrl":"https://doi.org/10.1093/icvts/ivaf249","url":null,"abstract":"<p><strong>Objectives: </strong>The Impella microaxial left ventricular assist device (Abiomed) is increasingly used in adults as extended support bridging to heart transplantation. In recent years, its off-label use in children has also expanded. This review summarizes current experiences with Impella support in pediatric patients listed for heart transplantation and compares outcomes with contemporaneous cohorts who either received no support or other ventricular assist device support.</p><p><strong>Methods: </strong>We analyzed data from the United Network for Organ Sharing registry between January 2018 and July 2024, including all children listed for heart transplantation. Longitudinal outcomes were assessed using Kaplan-Meier analysis, with comparisons made between children supported with Impella, those receiving other device support, and those managed without mechanical support.</p><p><strong>Results: </strong>Impella utilization increased steadily over time. The Impella cohort included 59 children, with a median age of 14 years (interquartile-range 13-16) at listing and 15 years (interquartile-range 13-16) at transplant. The underlying pathologies were: cardiomyopathy (75%,n=44), congenital heart disease (14%,n=8), and other conditions (12%,n=7). Impella device types used were: 5.0/5.5 (59%,n=35), CP (33%,n=20), and RP (8%,n=4). Ten patients (17%) were converted to durable ventricular assist device with a median support of 5 days (interquartile-range 2-11). Forty-two patients (71%) received transplantation while on Impella support (median 15 days, interquartile-range 8-22). Five patients (8%) died while awaiting transplantation. Among those who received transplantation, four deaths occurred during follow-up. Three-year post-transplant survival was not statistically significantly different for children who received Impella, other device, and no device prior to transplantation.</p><p><strong>Conclusion: </strong>Impella use in children as a bridge to heart transplantation has increased, with favorable early outcomes. The Impella 5.5 has contributed to this trend, likely due to its high-flow capacity and mobility potential. Further assessment of its advantages, efficacy, and safety is needed.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304864","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":"Surgical repair of ruptured giant coronary artery aneurysm and pulmonary artery fistula.","authors":"Zi-Lin Xiong, Qing-Hua Zhang, Bing-Ji You","doi":"10.1093/icvts/ivaf247","DOIUrl":"https://doi.org/10.1093/icvts/ivaf247","url":null,"abstract":"<p><p>This article reports a rare case of a 66-year-old female patient. The patient was admitted to the hospital due to multiple episodes of syncope over a 5-day period and was diagnosed with possible congenital coronary artery-pulmonary artery fistula and ruptured coronary artery aneurysm. After admission, the patient received treatments including pericardiocentesis drainage, and was subsequently transferred to the cardiac surgery department for operation. During surgery, a giant coronary artery aneurysm and multiple fistulous openings were discovered and successfully managed through a series of surgical procedures. The patient recovered well postoperatively with no residual fistulas or aneurysms. In this case, the combination of a giant coronary artery aneurysm with coronary artery-pulmonary artery fistula is extremely rare, and the patient survived aneurysm rupture and cardiac tamponade before successfully undergoing surgery, providing valuable clinical experience for the diagnosis and treatment of similar diseases.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304813","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":"Redo aortic root replacement for acute infective endocarditis: A tension-free proximal suturing technique.","authors":"Nabila El Gueddari, Alizee Porto, Alexis Theron, Marien Lenoir, Laurence Camoin, Nicolas Jaussaud, Frederic Collart, Gilbert Habib, Alberto Riberi","doi":"10.1093/icvts/ivaf162","DOIUrl":"10.1093/icvts/ivaf162","url":null,"abstract":"<p><strong>Objectives: </strong>Acute infective endocarditis after aortic root replacement is challenging. Peri-annular complications are often present and worsen the prognosis due to the risk of aortic root dehiscence. We perform a modified Bentall procedure with a tension-free proximal suturing technique. The aim of this study was to describe the results of this technique in terms of mortality, reintervention and endocarditis recurrence.</p><p><strong>Methods: </strong>We retrospectively analysed the data of 20 patients undergoing surgery for acute infective endocarditis on aortic root replacement between 2014 and 2021. The surgical technique involved a graft with pseudosinuses and an aortic valve prosthesis sutured to this tube, keeping 5 mm of the tube under the prosthesis, allowing tension-free suturing between the reconstructed aortic annulus and the graft. Primary end-points were overall mortality and reintervention at 1 year.</p><p><strong>Results: </strong>The median age was 57.9 years (26.0-77.0), 80.0% patients were men, and mean EuroSCORE II was 36.0% (± 17.7). Thirteen patients (65.0%) had periannular complications, 5 patients (25.0%) had severe aortic regurgitation. At 30 days, the overall mortality rate was 10.0% (2 patients). The Kaplan-Meier survival estimates at 1-year and 6-years were 90.0% and 85.0%, respectively. During a mean 42-month (± 44.5) follow-up period, no recurrence of endocarditis or reintervention was observed. Two patients experienced Bentall dehiscence without need for reintervention.</p><p><strong>Conclusions: </strong>The use of a modified Bentall technique with tension-free proximal suturing yields encouraging outcomes for patients undergoing redo aortic root replacement for acute infective endocarditis.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282088","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":"Successful coronary artery bypass grafting in a moyamoya patient with prior Encephaloduroarteriosynangiosis.","authors":"Emrah Ereren, Şenay Canikli Adıgüzel, Vaner Köksal, Hüseyin Ağırbaş","doi":"10.1093/icvts/ivaf246","DOIUrl":"https://doi.org/10.1093/icvts/ivaf246","url":null,"abstract":"<p><p>Moyamoya disease is a progressive steno-occlusive vasculopathy affecting the intracranial internal carotid arteries and posing significant perioperative challenges during cardiac surgery. We present a 54-year-old male with bilateral carotid artery occlusion who had previously undergone left-sided encephaloduroarteriosynangiosis (EDAS), with angiography confirming robust collateral formation from the superficial temporal to middle cerebral artery territory. Three years later, he developed severe multivessel coronary artery disease requiring surgical revascularization. Coronary artery bypass grafting (CABG) was performed using a pump-assisted beating-heart technique without aortic cross-clamping due to heavy ascending aortic calcification. Intraoperative neuroprotection included near-infrared spectroscopy monitoring, controlled PaCO2, hematocrit and blood pressure maintenance, mild hypothermia, and avoidance of vasoconstrictors. The patient recovered uneventfully and was discharged without neurological deficits on postoperative day 10. Importantly, unlike previous Moyamoya cases undergoing CABG, this report describes one of the very few documented instances performed after EDAS. The presence of established indirect collaterals likely contributed to a favourable neurological outcome, underscoring that staged revascularization may confer significant neuroprotection and should be considered in preoperative planning for selected Moyamoya patients.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276725","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}