Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Corrigendum to: Repair of aortic coarctation in neonates less than two kilograms.","authors":"","doi":"10.1093/icvts/ivag220","DOIUrl":"https://doi.org/10.1093/icvts/ivag220","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"41 8","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763095","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":"Haemodynamics from Induction to Cardiopulmonary Bypass Improve Prediction of Right Ventricular Failure Following Left Ventricular Assist Device.","authors":"Shruti Rajendra, Yousuf Salmasi, Binu Raj, Owais Dar, Nandor Marczin, Darrel Francis, Espeed Khoshbin","doi":"10.1093/icvts/ivag215","DOIUrl":"10.1093/icvts/ivag215","url":null,"abstract":"<p><strong>Objectives: </strong>Right ventricular failure (RVF) remains a frequent complication following left ventricular assist device (LVAD) implantation. Conventional risk scores rely on preoperative data acquired under stable conditions, which may overlook early signs of RV decompensation that emerge under perioperative stress. This study evaluates whether perioperative haemodynamic markers prior to cardiopulmonary bypass (CPB) improve RVF prediction compared to preoperative assessment obtained by right heart catheterization (RHC), echocardiographic parameters, and scoring systems such as the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) RHF score.</p><p><strong>Methods: </strong>We conducted a retrospective single-centre study of 203 LVAD patients (2013-2023). The primary outcome was RVF. Preoperative data included clinical variables, echocardiography, and RHC. Perioperative data included vasoactive-inotropic score (VIS), pulmonary artery (PA) catheter, and arterial-line monitoring between induction and start of CPB. Two multivariable models were developed using least absolute shrinkage-and-selection operator (LASSO) logistic regression: (1) Preoperative model; (2) Pre-CPB model. Model performance was assessed using area under the curve (AUC) and compared against EUROMACS-RHF using DeLong tests.</p><p><strong>Results: </strong>Thirty-six patients (17.7%) developed RVF. No preoperative RHC-derived parameter independently predicted RVF. The Preoperative model achieved moderate discrimination (AUC: 0.747). Incorporating intraoperative mean arterial pressure (MAP), pulmonary artery pulsatility index (PAPi), and maximum VIS yielded a Pre-CPB model with strong discrimination (AUC: 0.834). The Pre-CPB model significantly outperformed both EUROMACS-RHF (P = 0.0299) and the Preoperative model (P = 0.049), with no significant difference between our Preoperative model and EUROMACS-RHF (P = 0.222).</p><p><strong>Conclusions: </strong>Perioperative markers prior to CPB significantly outperform preoperative prediction of RVF post-LVAD. Incorporating these into real-time risk stratification can improve decision-making, enabling earlier RV support in the operating theatre for high-risk LVAD patients.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13480432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623053","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":"Failing Fontan Following Total Cavopulmonary Connection: Extracardiac Biomarkers Reveal 2 Distinct Phenotypes With Divergent Clinical Courses.","authors":"Muneaki Matsubara, Havva Aldogan, Thibault Schaeffer, Christina Ruda, Christoph Röhlig, Jonas Palm, Nicole Piber, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1093/icvts/ivag213","DOIUrl":"10.1093/icvts/ivag213","url":null,"abstract":"<p><strong>Objectives: </strong>Failing Fontan is an increasingly recognized complication after total cavopulmonary connection (TCPC), yet longitudinal biomarker data remain scarce. We aimed to characterize the incidence, biomarker trajectories, and prognostic determinants of failing Fontan.</p><p><strong>Methods: </strong>All patients who underwent primary TCPC (n = 650) or conversion to TCPC (n = 19) at our centre between 1994 and 2022 were reviewed. Lymphocyte count, N-terminal pro-brain natriuretic peptide (NT-proBNP) and its zlog value, and Fibrosis-4 index were assessed at 1 year before, 6 months before, at onset, and at last follow-up. Patients were classified into protein-losing enteropathy (PLE)/plastic bronchitis (PB) and heart failure phenotypes.</p><p><strong>Results: </strong>Failing Fontan developed in 78 primary TCPC patients (12.0%) and 12 conversion patients (63.2%). Conversion patients developed failing Fontan earlier (P < .001), but survival after onset was comparable. Lymphocyte counts declined before onset (2.49 to 0.89 × 10³/µL, P < .001) and the Fibrosis-4 index increased (0.060 to 0.330, P < .001). Phenotypes showed divergent profiles: zlog-NT-proBNP at onset was 0.71 in PLE/PB versus 5.34 in heart failure (P < .001). Lymphocytopenia (LP) predicted mortality early (hazard ratio 6.77, P = .013) but appeared protective at last follow-up (hazard ratio 0.18, P = .049), reflecting a phenotypic shift. On multivariable analysis, lower lymphocyte count independently predicted mortality (hazard ratio 2.44, P = .041), while stent implantation was independently associated with lower mortality (hazard ratio 0.32, P = .040).</p><p><strong>Conclusions: </strong>Lymphocyte counts and the Fibrosis-4 index change progressively before clinical onset and may serve as early warning biomarkers. The prognostic interpretation of LP depends on the underlying phenotype, underscoring the need for phenotype-aware monitoring.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622987","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":"Perioperative Management of Ruxolitinib in Primary Myelofibrosis During Coronary Artery Bypass Graft Surgery.","authors":"Michael Kay, Martin Yates, Emma O'Donovan, Lauren Tully","doi":"10.1093/icvts/ivag211","DOIUrl":"10.1093/icvts/ivag211","url":null,"abstract":"<p><strong>Objective: </strong>Primary myelofibrosis (PMF) is a myeloproliferative neoplasm frequently treated with the Janus kinase (JAK) inhibitor ruxolitinib. Perioperative management of ruxolitinib presents a clinical dilemma. Continued therapy may increase the risk of infection, cytopenia, and impaired wound healing during major surgery, whereas abrupt discontinuation can precipitate ruxolitinib discontinuation syndrome (RDS), an inflammatory rebound syndrome that may be life-threatening. Currently, there are no established perioperative guidelines for the management of ruxolitinib.</p><p><strong>Methods: </strong>We report a case of a 65-year-old patient with PMF undergoing elective coronary artery bypass graft (CABG) surgery.</p><p><strong>Results: </strong>Following multidisciplinary discussion with the haematology, ruxolitinib was withheld for 48 hours perioperatively and prophylactic corticosteroids were administered. The patient underwent an uncomplicated surgery and recovery without evidence of infection, thrombocytopaenia, or RDS.</p><p><strong>Conclusion: </strong>This case highlights the challenges associated with perioperative ruxolitinib management and emphasises the importance of multidisciplinary decision-making and individualized risk assessment. Reporting such cases contributes to the limited literature on guiding perioperative management of JAK inhibitor therapy in patients undergoing major surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623004","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":"Spread Through Air Spaces in Multiple Synchronous Bilateral Primary Lung Cancer: Prognostic Implications in a Surgical Cohort.","authors":"Stefano Bongiolatti, Simone Tombelli, Antonio Burlone, Lavinia Gatteschi, Giovanni Mugnaini, Rossella Oselin, Ilaria Zenobi, Luca Voltolini","doi":"10.1093/icvts/ivag209","DOIUrl":"10.1093/icvts/ivag209","url":null,"abstract":"<p><strong>Objectives: </strong>The surgical treatment of multiple synchronous bilateral primary lung cancer (mSBPLC) showed promising results and the aims of this retrospective study were to assess the oncologic outcomes and the presence of risk factors of worse survival.</p><p><strong>Methods: </strong>Patients underwent radical (all lesions removed) lung resection for mSBPLC from 2017 to 2024 were included. Exclusion criteria: patients unfit for bilateral surgery, pneumonectomy, multifocal ground-glass opacities, clinical stage IIIA or more, and preoperative treatment. Overall and disease-free survival (DFS) analyses were conducted with the Kaplan-Meier method and log-rank test, Cox-regression analysis was used to identify the predictors of worse survival.</p><p><strong>Results: </strong>During the study period, 64 patients were screened for the presence of bilateral lung nodules, 45 patients (median age 69 years) were operated for mSBPLC and during the follow-up (median 34 months) we observed 11 deaths and 15 cancer recurrence. In the 80% of patients the main cancer was solid, contralateral was a part-solid in 20%, or pure ground-glass opacity in 20%. Adenocarcinoma was present in 77.8% at first surgery and in 80% at the second. Spread Through the Air Spaces (STAS) was present in 17.8%. The 5-year overall and DFS rate were 77% (median 86 months, 95% CI 72.4-99.5-) and 57% (median 69 months, 95% 32-105.9), respectively. Comparing survivals among patients with and without STAS, we had an overall survival of 0% vs 85% (86 vs 29 months, P < .01) and a DFS of 0% vs 63% (69 vs 9 months, P < .01). The multivariable analysis demonstrated STAS as significant predictor of worse overall (HR 7.08, P = .02) and DFS (HR 5.63, P = .017).</p><p><strong>Conclusions: </strong>Taking into account the small and highly selected study population, staged bilateral surgery could be considered safe and oncologically adequate, showing the association between the presence of STAS and unfavourable long-term outcomes.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148594864","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":"Impact of Antegrade Selective Cerebral Perfusion Flow Ranges on Clinical and Neurological Outcomes in Aortic Arch Surgery.","authors":"Antonio Piperata, Jef Van den Eynde, Sabrina Castagnini, Fulvio Carotenuto, Riccardo Garofalo, Silvia Snaidero, Alessandro Leone, Luca Di Marco, Davide Pacini","doi":"10.1093/icvts/ivag200","DOIUrl":"10.1093/icvts/ivag200","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between selective antegrade cerebral perfusion (SACP) flow ranges and early clinical outcomes in a large cohort of patients undergoing aortic arch surgery.</p><p><strong>Methods: </strong>We retrospectively analysed 492 adult patients who underwent aortic arch surgery with bilateral antegrade cerebral perfusion under moderate hypothermia between 2015 and 2024. Patients were stratified into low, intermediate, or high-indexed SACP pump flow groups according to measured intraoperative flow rates (mL/kg/minute). Primary outcomes included in-hospital mortality, permanent neurologic dysfunction, and transient neurological deficit.</p><p><strong>Results: </strong>Overall, 80.3% of patients received antegrade selective cerebral perfusion flows within the intermediate range (10-15 mL/kg/minute). No statistically significant differences were observed among groups in terms of early mortality, permanent neurological dysfunction, or transient neurological deficit. When cerebral perfusion flow was analysed as a continuous variable, no linear association with adverse outcomes was identified (all P > .15). Importantly, intraoperative perfusion strategies were largely guided by clinical judgement, with flow adjustments tailored to individual patient characteristics and dynamic intraoperative factors, including extremes of body weight.</p><p><strong>Conclusions: </strong>No significant association was observed between SACP flow ranges and clinical outcomes within the flow ranges and management strategy applied in this cohort. Nonetheless, maintaining SACP within an optimal range remains advisable. Individualized flow adjustments by the clinical team, based on patient-specific factors, likely contributed to the observed flow distribution and outcomes.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458005","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":"Extent of Acute Type A Aortic Dissection in Patients With Organ Cysts.","authors":"Essi Pirskanen, Ivana Kholova, Otso Arponen, Petteri Kauhanen, Timo Paavonen, Ari Mennander","doi":"10.1093/icvts/ivag212","DOIUrl":"10.1093/icvts/ivag212","url":null,"abstract":"<p><strong>Objectives: </strong>We investigated whether the extent of degeneration of the ascending aortic wall found in patients with acute type A aortic dissection is associated with the presence of organ cysts.</p><p><strong>Methods: </strong>In total, 120 consecutive patients diagnosed for acute type A aortic dissection using computer tomography at Tampere University Hospital were evaluated, screened for organ cysts, and followed for a mean 6.7-years (SDs 4.6) after surgery. The ascending aortic wall resected in surgery in patients with and without cysts was analysed for 11 different histopathological variables expressed as point score units (PSU). Multivariable binary logistic regression analysis adjusted for age and sex was performed to investigate the association of the presence of elastic fibre thinning with the presence of cysts.</p><p><strong>Results: </strong>Out of 120 patients, there were 45 patients with at least 1 cyst including ovarian, renal, liver or epididymis cysts, and 75 with none. The mean age was 65.6 years (SD 11.8). Increased extent of elastic fibre thinning and the presence of thickening of the medial layer of the vasa vasorum were often present in patients with cysts as compared with those without (2.0 [1.0-2.0] vs 1.0 [0-2.0], PSU, P = .020 and 26.7% vs 12.0%, P = .049, respectively). According to the adjusted multivariable binary logistic regression analysis, the presence of elastic fibre thinning was associated with cysts (adjusted odds ratio: 2.636, 95% CI, 1.143-9.095, P = .023).</p><p><strong>Conclusions: </strong>The presence of cysts in patients requiring surgery for acute type A aortic dissection may reflect the extent of aortic wall tissue degeneration.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623042","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":"Corrigendum to: Role of tricuspid valve repair in pulmonary atresia with intact ventricular septum: fresh autologous pericardium as a viable option.","authors":"","doi":"10.1093/icvts/ivaf280","DOIUrl":"10.1093/icvts/ivaf280","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"41 8","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802629","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":"Left Ventricular Failure Despite Patent Coronary Arteries in Acute Type A Aortic Dissection.","authors":"Daisuke Nakatsuka, Shun Sato, Yuichi Tara, Yasumasa Tsukamoto","doi":"10.1093/icvts/ivag204","DOIUrl":"10.1093/icvts/ivag204","url":null,"abstract":"<p><p>Severe myocardial failure after acute type A aortic dissection is usually attributed to structural coronary malperfusion. We report catastrophic global left ventricular failure despite preserved epicardial coronary anatomy, successfully bridged with durable mechanical circulatory support. A 57-year-old man presented with acute type A dissection and cardiogenic shock with extensive precordial ST-segment elevation. Emergency total arch replacement with a frozen elephant trunk was performed. Intraoperative inspection and postoperative coronary angiography confirmed patent coronary ostia and arteries. Postoperatively, venoarterial extracorporeal membrane oxygenation and a percutaneous microaxial flow pump was instituted; extracorporeal membrane oxygenation was weaned on day 4, but the patient remained pump-dependent. Perfusion imaging showed extensive fixed defects in the left coronary distribution, and durable left ventricular assist device implantation was required 6 weeks later. Severe myocardial injury can occur in acute type A aortic dissection without demonstrable fixed coronary obstruction. When dysfunction persists after successful repair, early viability assessment is essential to guide timely transition to durable mechanical circulatory support.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13431125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537539","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":"What Transesophageal Echocardiography Reveals About Intraoperative Iatrogenic Aortic Dissection.","authors":"Kazumasa Orihashi","doi":"10.1093/icvts/ivag221","DOIUrl":"10.1093/icvts/ivag221","url":null,"abstract":"<p><p>Intraoperative iatrogenic aortic dissection is a rare but potentially catastrophic complication of cardiovascular surgery. Although transoesophageal echocardiography (TEE) is considered a key diagnostic tool, its practical value and limitations are not fully appreciated. From the perspective of a TEE observer with more than 30 years of experience, only 7 cases of intraoperative iatrogenic aortic dissection were encountered. Review of these cases yielded 3 practical observations: conventional monitoring modalities may fail to detect developing dissection; the mere presence of a TEE probe does not guarantee recognition; and some forms of aortic wall injury may challenge conventional interpretations. Representative cases demonstrated that dissection can progress without immediate changes in haemodynamic variables or surgical findings, and that clinically important pathology may extend beyond the visible operative field. Additional observations suggested that intraoperative aortic wall injury may present with diverse morphologic appearances depending on the involved layer of the aortic wall. These experiences support considering proactive TEE surveillance during initiation of arterial perfusion and suggest that recognition of otherwise occult pathology may facilitate timely intervention and improve situational awareness during cardiovascular surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671492","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}