Annals of cardiothoracic surgery最新文献

{"title":"Coils embolization for aortic arch lesions: technical tips.","authors":"Francesco Buia, Riccardo Nania, Maria Adriana Cocozza, Luigi Lovato, Davide Pacini, Luca Di Marco","doi":"10.21037/acs-2026-0142-aar","DOIUrl":"https://doi.org/10.21037/acs-2026-0142-aar","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 4","pages":"61"},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757773","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":"Preoperative planning for endovascular aortic arch repair.","authors":"Maciej K Kolowca","doi":"10.21037/acs-2026-0193-aar","DOIUrl":"https://doi.org/10.21037/acs-2026-0193-aar","url":null,"abstract":"<p><strong>Background: </strong>Endovascular repair of aortic arch pathology is an evolving treatment option for selected patients, particularly those at high or prohibitive risk for conventional open arch replacement. However, the complex three-dimensional anatomy of the aortic arch, high pulsatile flow, proximity of the supra-aortic vessels, and the need for durable proximal and distal sealing make these procedures technically demanding. Careful patient selection, high-quality imaging, and systematic preoperative planning are therefore essential determinants of procedural success.</p><p><strong>Methods: </strong>This article presents a structured approach to preoperative planning for endovascular aortic arch repair. The planning process includes confirmation of guideline-based indications for intervention, operative risk assessment, selection between open, hybrid, and total endovascular strategies, detailed computed tomography angiography analysis, three-dimensional reconstruction, centerline-based measurements, assessment of landing zones, supra-aortic vessels, access vessels, cerebral collateral circulation, and device-specific anatomical requirements.</p><p><strong>Results: </strong>Computed tomography angiography remains the principal imaging modality for procedural planning and should include thin-slice acquisition, appropriate contrast opacification, electrocardiogram (ECG)-gated assessment of the ascending aorta and arch, and scan coverage extending from the circle of Willis to the femoral arteries. Systematic image analysis should begin with axial source images before three-dimensional reconstruction, in order to identify thrombus, calcification, shaggy aorta, dissection, intramural hematoma, anatomical variants, and other features relevant to device implantation. Centerline and curved multiplanar reconstruction allow accurate measurements of vessel diameter, length, curvature, landing zones, and supra-aortic vessel orientation. These data guide the selection of debranching, scalloped, fenestrated, or branched endovascular strategies.</p><p><strong>Conclusions: </strong>Successful endovascular aortic arch repair depends on meticulous preoperative planning, multidisciplinary decision-making, and strict anatomical feasibility assessment. Because current arch endovascular technologies remain anatomically restrictive and device-specific, they should be applied only in carefully selected patients after comprehensive imaging analysis and comparison with available surgical alternatives.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 4","pages":"51"},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763084","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":"Frozen elephant trunk technique in redo aortic arch surgery: a step-by-step approach.","authors":"Andreas Martens, Erik Beckmann, Malakh Shrestha","doi":"10.21037/acs-2026-03-aar","DOIUrl":"https://doi.org/10.21037/acs-2026-03-aar","url":null,"abstract":"<p><p>Frozen elephant trunk (FET) is an established treatment modality for complex aortic arch and proximal descending aortic pathologies. While patients with limited life expectancy are more frequently considered for endovascular treatment options, the FET remains a sustainable platform, especially for younger post-dissection and heritable thoracic aortic disease (HTAD) patients. These patients frequently have undergone previous transsternal operations. A substantial portion require concomitant aortic root or other cardiac procedures. In this manuscript we describe our technique of redo valve sparing aortic root replacement (VSARR) and total aortic arch repair with FET implantation. Our technique combines four main technical aspects: (I) central arterial cannulation is our first option with axillary access being a secondary alternative. Femoral cannulation is only used in bail-out situations or in combination with upper body arterial access. (II) We prefer to revascularize the left subclavian artery (LSA) within the chest during the same procedure. Many alternative options exist for specific anatomical situations. Ideally, the LSA revascularization technique should not add any hypothermic circulatory arrest (HCA) time to the procedure. (III) We liberally address concomitant cardiac pathologies during the same procedure. To avoid long cardiac ischemia times in these complex cases, we employ non-cardioplegic myocardial perfusion during aortic arch repairs where ischemia times of >120 min are anticipated. (IV) During aortic arch preparation we use temporary \"flush\" retrograde cerebral perfusion (RCP) to reduce the risk of embolization to the supraaortic arteries. After aortic arch preparation bilateral or trilateral selective antegrade cerebral perfusion (SACP) is routinely initiated. The technique allows complex combined cardiac and aortic arch operations to be performed in a standardized and controlled surgical environment. FET implantation will remain an important open surgical tool in the armamentarium of complex aortic arch repair. Creating durable surgical results and minimizing surgical risks have to be the primary goals regarding surgical management.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 4","pages":"57"},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757434","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":"Brain protection in open arch surgery.","authors":"Yutaka Okita","doi":"10.21037/acs-2026-0072-aar","DOIUrl":"https://doi.org/10.21037/acs-2026-0072-aar","url":null,"abstract":"<p><p>This review outlines the history of aortic arch surgery and examines classifications of hypothermia and mechanisms of perioperative neurological injuries. Risk factors for these neurological insults are explored, as well as cerebral monitoring systems available to mitigate such injuries. Furthermore, a comparative literature analysis evaluates outcomes among deep hypothermic circulatory arrest, retrograde cerebral perfusion, and antegrade cerebral perfusion. Finally, technical considerations for cerebral perfusion delivery and contemporary trends in temperature management are discussed.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 4","pages":"48"},"PeriodicalIF":4.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758027","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":"Tricuspid valve repair in infective endocarditis.","authors":"Kristians Meidrops, Saeid Hosseini, Pēteris Stradiņš, Eduard Quintana, Carlos A Mestres","doi":"10.21037/acs-2026-1-0031-tvd","DOIUrl":"10.21037/acs-2026-1-0031-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"44"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249003","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":"Management of tricuspid regurgitation: time to adopt a lifetime perspective?","authors":"Domenico Angellotti, Jonas Lanz, Fabien Praz","doi":"10.21037/acs-2026-0062-tvd","DOIUrl":"10.21037/acs-2026-0062-tvd","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"39"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248893","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":"Tricuspid valve endocarditis in people who inject drugs: strategies to reduce mortality and recurrent infection.","authors":"Suzanne de Waha, Thilo Noack, Tobias Kister, Steffen Desch, Mateo Marín-Cuartas, Philipp Kiefer, Michael A Borger","doi":"10.21037/acs-2026-1-0008-tvd","DOIUrl":"10.21037/acs-2026-1-0008-tvd","url":null,"abstract":"<p><p>Tricuspid valve infective endocarditis (TV-IE) in people who inject drugs (PWID) has become an increasingly important clinical and public health concern, driven largely by the expanding opioid epidemic. Although PWID with TV-IE are typically young and often lack major comorbidities, they experience disproportionately high rates of mortality, reinfection, and recurrent hospitalizations. Repeated intravenous injection introduces contaminated particulate matter and pathogens into the venous circulation, promoting microbial adherence to the tricuspid valve, with <i>Staphylococcus aureus</i> including methicillin-resistant strains remaining the predominant pathogen. Clinical presentation commonly includes fever, chills, and pulmonary symptoms caused by septic emboli, while diagnostic evaluation relies on multiple blood cultures and echocardiographic assessment, complemented by computed tomography when pulmonary complications are suspected. Approximately 90% of right-sided TV-IE cases can be managed medically, highlighting the importance of optimized antimicrobial therapy tailored to the organism, disease severity, and patient-specific factors. Outpatient parenteral antibiotic therapy (OPAT) remains controversial in PWID, warranting individualized strategies to ensure treatment continuity, particularly in patients at risk of leaving the hospital before completing therapy. Surgical intervention follows standard right-sided IE criteria, with tricuspid valve repair preferred when feasible. Tricuspid valvectomy or emerging percutaneous debulking approaches may serve as adjunctive or temporizing strategies. Addiction treatment is central to improving outcomes, as ongoing injection drug use remains the strongest driver of reinfection and preventable mortality. Early involvement of addiction medicine and initiation of medication-assisted treatment can significantly improve long-term engagement. Optimal management requires a multidisciplinary approach that integrates cardiology, cardiac surgery, infectious disease, and early initiated as well as continued addiction treatment follow-up, behavioral health support, and social services to reduce reinfection risk and support recovery. This review summarizes current evidence regarding epidemiology, microbiology, clinical presentation, and management, with a focus on reducing mortality and preventing recurrent infection in PWID with TV-IE.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"35"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249013","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":"Three decades evolution of the lifetime management approach to tricuspid valve disease: a multidisciplinary European perspective from a high-volume heart valve center.","authors":"Piotr Mazur, Konstantinos Papakonstantinou, Mateo Marin-Cuartas, Charlotte Wolff, Tobias Kister, Alexey Dashkevich, David Holzhey, Holger Thiele, Michael A Borger, Philipp Kiefer, Thilo Noack","doi":"10.21037/acs-2025-1-90-tvd","DOIUrl":"10.21037/acs-2025-1-90-tvd","url":null,"abstract":"<p><strong>Background: </strong>The treatment of tricuspid valve (TV) disease has increased over the last decades. This study evaluates trends, patient characteristics, and outcomes of surgical and transcatheter TV interventions over 30 years.</p><p><strong>Methods: </strong>All consecutive adult patients undergoing TV surgery or transcatheter intervention at the Heart Center Leipzig were included in this unadjusted descriptive analysis. Patients with TV endocarditis were excluded. Surgical data covered 1996-2024, transcatheter edge-to-edge repair (T-TEER) 2016-2024, and transcatheter TV replacement (TTVR) 2021-2025. All information was obtained from the institutional database.</p><p><strong>Results: </strong>A total of 982 patients were analyzed: 450 (46%) surgical, 498 (51%) T-TEER, and 34 (3%) TTVR patients. Surgical patients were younger (67 <i>vs.</i> 79 <i>vs.</i> 81 years, respectively, P<0.001) and had fewer comorbidities than those treated interventionally. Higher-grade TR was more common in T-TEER and TTVR cohorts. Device leads crossing the TV were present in 109 (24%) surgical, 147 (30%) T-TEER, and seven (21%) TTVR patients (P=0.13). Reoperations accounted for 165 (37%) surgical cases, while prior cardiac operations were documented in 148 (30%) T-TEER and 7 (21%) TTVR patients. Surgery after T-TEER was infrequent (n=4, 1%). One-year survival was 88% after surgery, 83% after T-TEER, and 94% after TTVR (log-rank P=0.036). Among surgical patients, 335 (74%) did not require any re-hospitalizations during the first year postoperatively. Surgical reoperations showed survival comparable to primary procedures (actuarial survival at 9 years, 55% <i>vs.</i> 59%, respectively; log-rank P=0.07). Surgical TV replacement was associated with worse survival than surgical TV repair (at 9 years. 55% <i>vs.</i> 65%, respectively; log-rank P=0.03).</p><p><strong>Conclusions: </strong>Surgical TV repair yields better outcomes than replacement. Long-term survival after reoperation parallels that of primary TV surgery. Surgical and transcatheter therapies address distinct patient populations. Multidisciplinary heart team evaluation remains essential for optimal management of TV disease.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"36"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248955","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":"Innovations in transcatheter tricuspid valve interventions: what has failed, what has worked, what is coming.","authors":"Matteo Sturla, Andrea Scotti, Azeem Latib","doi":"10.21037/acs-2026-0184-tvd","DOIUrl":"10.21037/acs-2026-0184-tvd","url":null,"abstract":"<p><p>Innovation in transcatheter tricuspid valve intervention has advanced by learning from what did not work and expanding what does. Early attempts, often adapted from the mitral space, exposed practical constraints and safety tradeoffs that underscored how distinct the tricuspid valve is in anatomy, imaging, and physiology. Transcatheter edge-to-edge repair has shown improvement in symptoms, health status, and functional capacity with a favorable safety profile, when anatomy is suitable. Orthotopic transcatheter tricuspid valve replacement (TTVR) reliably abolishes regurgitation across complex anatomies, while ongoing iteration targets pacemaker rates, delivery system size, and right ventricular function. Heterotopic bicaval systems relieve venous congestion for patients unsuited to orthotopic solutions. These modalities are complementary in practice: repair is preferred when leaflet anatomy permits, TTVR is definitive when repair is unlikely to succeed, and caval approaches expand options for advanced disease. Looking ahead, the field is converging on devices and workflows that are simpler, smaller, and more anatomy-agnostic, with renewed interest in physiology-guided designs across new annuloplasty, replacement, spacer, and caval platforms. Longer-term readouts from randomized programs will test durability, right-sided remodeling, and hospitalization effects. Finally, responsible dissemination that emphasizes imaging expertise and structured pathways will be essential as access grows. Taken together, the field has moved from exploratory ideas to proven solutions and a credible near-term pipeline, positioning transcatheter therapy to deliver durable, patient-centered benefit for tricuspid regurgitation.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"34"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248837","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":"The value of preoperative risk scores prior to tricuspid valve interventions: The TRI-SCORE and beyond.","authors":"Julien Dreyfus, David Messika-Zeitoun","doi":"10.21037/acs-2026-1-0024-tvd","DOIUrl":"10.21037/acs-2026-1-0024-tvd","url":null,"abstract":"<p><p>Tricuspid regurgitation (TR) is increasingly recognized as a condition associated with poor clinical outcomes, including reduced quality of life, progressive right-sided heart failure, and increased mortality. Its heterogeneous etiologies and systemic consequences, affecting both cardiac and extracardiac organs such as the kidneys and liver, make patient management particularly challenging. Accurate risk stratification and timely intervention are therefore essential. The 2025 European Society of Cardiology and European Association for Cardio-Thoracic Surgery Guidelines acknowledge the multifaceted nature of TR and emphasize the need for evaluation in expert centers through multidisciplinary Heart Team discussions. In this context, the TRI-SCORE, initially developed to predict in-hospital mortality after isolated tricuspid valve (TV) surgery, has been incorporated into the guideline decision-making algorithm as a key risk assessment tool to support therapeutic selection. This simple eight-variable model demonstrated excellent prognostic predictive performance and has been validated across several international cohorts of patients conservatively treated or who underwent a surgical or transcatheter intervention. Compared with other surgical scores such as EuroSCORE II, Model for End-Stage Liver Disease (MELD)/MELD-XI, or the Society of Thoracic Surgeons isolated TV surgery model, the TRI-SCORE is disease-specific, simple, and offers superior predictive value. It helps identify patients most likely to benefit from intervention, providing a practical framework for integrating disease stage, procedural risk, and expected benefit. Both surgical and transcatheter therapies may improve prognosis when performed early, whereas delayed referral at advanced stages offsets their potential benefit. The systematic use of TRI-SCORE within the Heart Team can therefore refine patient selection, guide the timing of intervention, and support personalized, lifetime management of TR.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 3","pages":"33"},"PeriodicalIF":4.1,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148248926","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}