Annals of cardiothoracic surgery最新文献

{"title":"Transaxillary valve surgery in Dresden: a 99% concept.","authors":"Ali Taghizadeh-Waghefi, Sebastian Arzt, Konstantin Alexiou, Klaus Matschke, Manuel Wilbring, Utz Kappert","doi":"10.21037/acs-2026-0280-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0280-tdv","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"67"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to van Boxtel <i>et al.</i>, 'Testing errors in measuring the effective orifice diameter as a new sizing parameter of surgical valve prostheses'.","authors":"Changfu Wu, Chad Green, Salvador Marquez, Paolo Monelli, Craig Weinberg, Matthew Weston, Duke Cameron, Ajit Yoganathan, Ulrich Steinseifer","doi":"10.21037/acs-2026-0076","DOIUrl":"https://doi.org/10.21037/acs-2026-0076","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"78"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transaxillary triple valve surgery and left atrium appendage occlusion.","authors":"Erlil Mali, Michele Galeazzi, Carlo Zingaro, Alessandro D'Alfonso, Pietro Giorgio Malvindi, Marco Di Eusanio","doi":"10.21037/acs-2026-0245-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0245-tdv","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"74"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transaxillary direct-vision valve surgery: operative technique and technical principles.","authors":"Marco Di Eusanio","doi":"10.21037/acs-2026-0335-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0335-tdv","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"69"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transaxillary minimally invasive mitral valve surgery: early and mid-term outcomes in 763 patients.","authors":"Pietro Giorgio Malvindi, Francesca Spagnolo, Sara Pierdicca, Olimpia Bifulco, Jacopo Alfonsi, Mariano Cefarelli, Filippo Capestro, Alessandro D'Alfonso, Carlo Zingaro, Paolo Berretta, Marco Di Eusanio","doi":"10.21037/acs-2026-0247-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0247-tdv","url":null,"abstract":"<p><strong>Background: </strong>The transaxillary (TAxA) approach has been developed as a simplified direct-vision minimally invasive access for heart valve surgery. We report a large single-center cohort of patients undergoing TAxA minimally invasive mitral valve surgery and evaluate early safety, procedural efficacy, recovery and mid-term outcomes.</p><p><strong>Methods: </strong>Consecutive patients who underwent TAxA mitral valve surgery at the University Hospital of Marche, Ancona, Italy, between January 2017 and April 2026 were included. Mitral repair or replacement procedures were considered with or without concomitant tricuspid valve repair, atrial fibrillation ablation or left atrial appendage occlusion. Early outcomes were analyzed in the overall cohort. Mid-term survival and reoperation were assessed in patients undergoing repair for degenerative mitral regurgitation.</p><p><strong>Results: </strong>The study included 763 patients. Mitral valve repair was performed in 640 patients and replacement in 123. The repair rate was 89% in patients with mitral regurgitation and 92% in patients with degenerative mitral regurgitation. Concomitant tricuspid repair, atrial fibrillation ablation and left atrial appendage occlusion were performed in 17%, 5% and 10% of patients, respectively. Mean cardiopulmonary bypass and cross-clamp times were 103 and 63 minutes. Thirty-day mortality was 0.4%, stroke or transient ischemic attack occurred in 0.7%, and conversion to sternotomy was required in 0.7%; no conversion was due to poor exposure. Median ventilation time was 2 [interquartile range (IQR), 0-6] hours, 54% of patients were extubated in theatre and 80% were extubated within 6 hours. Median intensive care unit and hospital stays were 24 (IQR, 22-48) hours and 7 (IQR, 6-9) days. In the degenerative repair cohort, Kaplan-Meier survival was 97.0% at 5 years, and cumulative incidence of reoperation was 4.3% at 5 years.</p><p><strong>Conclusions: </strong>In this large contemporary experience, TAxA minimally invasive mitral valve surgery was associated with low early mortality and morbidity, reasonable operative times, frequent ultra fast-track extubation, and satisfactory mid-term results.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"63"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a transaxillary program in South America: lessons beyond the learning curve.","authors":"Gustavo A Orellana-Sampedro, David Maldonado, Edgar Francisco Montalvo, Luis Roberto Palma Dallan","doi":"10.21037/acs-2026-0275-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0275-tdv","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"68"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transaxillary aortic valve replacement with a sutureless valve.","authors":"Ali Taghizadeh-Waghefi, Sebastian Arzt, Konstantin Alexiou, Klaus Matschke, Manuel Wilbring, Utz Kappert","doi":"10.21037/acs-2026-0277-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0277-tdv","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"72"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery that looks like transcatheter aortic valve implantation: the transaxillary concept for minimally invasive aortic valve replacement in 1,848 consecutive patients.","authors":"Sebastian Arzt, Konstantin Alexiou, Ali Taghizadeh-Waghefi, Asen Petrov, Klaus Matschke, Utz Kappert, Manuel Wilbring","doi":"10.21037/acs-2026-0232-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0232-tdv","url":null,"abstract":"<p><strong>Background: </strong>The transaxillary (TxA) approach for minimally invasive aortic valve replacement (MICS-AVR) is a sternum-sparing technique that combines surgical valve replacement with virtually no visible scarring. We report institutional outcomes of the first 1,848 consecutive TxA MICS-AVR procedures.</p><p><strong>Methods: </strong>This retrospective single-center cohort included all consecutive patients undergoing isolated TxA MICS-AVR between January 2019 and June 2026. Patients with active endocarditis, redo surgery, or concomitant procedures were excluded. Primary endpoints were 30-day mortality and major adverse cardiac and cerebrovascular events (MACCEs). Univariable and multivariable logistic regression explored associations with adverse outcomes.</p><p><strong>Results: </strong>Mean age was 67.7±8.1 years, Society of Thoracic Surgeons Predicted Risk of Operative Mortality (STS-PROM) 1.39%±2.90%, and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) 1.65%±1.12%. TxA use among surgical treatments for isolated aortic valve disease rose from 18.8% in 2019 to 99.2% in 2025. Mean operative, cardiopulmonary bypass, and cross-clamp times were 132±34, 69±23, and 43±16 minutes. No intraoperative death occurred; 1.6% required conversion to sternotomy. Thirty-day mortality was 0.5%, and MACCE occurred in 1.6%, including stroke in 0.9% and myocardial infarction in 0.5%. In multivariable analysis, mortality associations were strongest for insulin-treated diabetes [odds ratio (OR) 8.56], left ventricular ejection fraction (LVEF) <40% (OR 8.45), and intraoperative transfusion (OR 17.86); corresponding MACCE associations included insulin-treated diabetes (OR 3.06), coronary artery disease (OR 2.46), peripheral arterial disease (OR 3.23), sternotomy conversion (OR 5.33), and transfusion (OR 5.49). These outcomes accompanied rapid institutional adoption of the technique, while operative efficiency remained favorable and the need for sternotomy conversion stayed low throughout the cohort. Given only 10 deaths and 30 MACCEs, multivariable findings should be considered exploratory and hypothesis-generating.</p><p><strong>Conclusions: </strong>Across 1,848 consecutive procedures, TxA MICS-AVR showed excellent reproducibility and safety. As long-term evidence increasingly supports surgical valve replacement in patients with extended life expectancy, TxA uniquely combines durable surgery with a cosmetic result comparable to transcatheter therapy, offering a scalable and strategically relevant platform for contemporary aortic valve care.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"64"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transaxillary access for ascending aortic and root surgery: a single-center comparison with full and partial sternotomy.","authors":"Daniel-Sebastian Dohle, Philipp Pfeiffer, Christian Keller, Edoardo Zancanaro, Ahmed Ghazy, Franz Masseli, Chris Probst, Hendrik Treede","doi":"10.21037/acs-2026-0307-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0307-tdv","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive approaches for ascending aortic and root surgery remain controversial regarding operative complexity and safety. The transaxillary (TAX) approach avoids sternotomy entirely but has not been compared with both full sternotomy (FS) and partial upper sternotomy [minimally invasive cardiac surgery (MIC)]. This study evaluates perioperative outcomes across these three access strategies.</p><p><strong>Methods: </strong>Between January 2022 and December 2025, 194 consecutive patients undergoing elective isolated ascending aortic or root surgery were retrospectively analyzed. Surgical access was FS (n=52), MIC (n=106), or TAX (n=36). TAX suitability was assessed by team consensus on electrocardiogram (ECG)-gated computed tomography (CT). Primary endpoints were in-hospital mortality, major complications [Society of Thoracic Surgeons (STS) composite], and hospital length of stay. TAX was compared with MIC after 1:2 propensity score matching. FS served as descriptive reference.</p><p><strong>Results: </strong>FS patients had higher EuroSCORE II (median 2.7 <i>vs.</i> MIC 2.2 <i>vs.</i> TAX 2.3%, P=0.006). Cardiopulmonary bypass time was longer in TAX {196 [interquartile range (IQR): 175-239] <i>vs.</i> MIC 160 [138-192] <i>vs.</i> FS 172 [140-198] min, P<0.001}, while cross-clamp time did not differ (P=0.34). In-hospital mortality was 3.8% (FS), 0% (MIC), and 0% (TAX). Major complications occurred in 26.9%, 12.3%, and 8.3% (P=0.02), and acute kidney injury (AKI) in 28.8%, 8.5%, and 2.8% (P<0.001). One stroke occurred in the FS group. In the matched cohort (34 TAX <i>vs.</i> 68 MIC), bypass time remained longer in TAX {196 [175-240] <i>vs.</i> 160 [139-190] min, P<0.001}, whereas cross-clamp time, intensive care unit (ICU) and hospital stay, major complications (5.9% <i>vs.</i> 11.8%), AKI (2.9% <i>vs.</i> 10.3%), atrial fibrillation, and wound complications did not differ significantly.</p><p><strong>Conclusions: </strong>TAX ascending aortic and root surgery was feasible in carefully selected patients, with no in-hospital mortality, no stroke, and no wound complications. In a propensity-matched comparison with partial upper sternotomy, early outcomes did not differ significantly despite longer bypass time. TAX extends the sternal-sparing concept to the aortic root and ascending aorta and warrants prospective evaluation.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"65"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT based planning for transaxillary valve surgery.","authors":"Michele Galeazzi, Erlil Mali, Paolo Berretta, Carlo Zingaro, Filippo Capestro, Marco Di Eusanio","doi":"10.21037/acs-2026-0279-tdv","DOIUrl":"https://doi.org/10.21037/acs-2026-0279-tdv","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 5","pages":"70"},"PeriodicalIF":4.1,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}