Annals of cardiothoracic surgery最新文献

{"title":"Don't fix what's not broken: tricuspid valve repair in the mitral patient.","authors":"Marc Gillinov, Tarek Malas, Per Wierup, Lars G Svensson","doi":"10.21037/acs-2025-tvd-0123","DOIUrl":"10.21037/acs-2025-tvd-0123","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"24"},"PeriodicalIF":4.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687711","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":"Transcatheter and surgical management of tricuspid valve disease: multidisciplinary lifetime management considerations.","authors":"Suzanne de Waha, Thilo Noack, Tobias Kister, Steffen Desch, Mateo Marín-Cuartas, Philipp Kiefer, Michael A Borger","doi":"10.21037/acs-2025-1-74-tvd","DOIUrl":"10.21037/acs-2025-1-74-tvd","url":null,"abstract":"<p><p>Tricuspid valve disease (TVD) has long been underrecognized compared with left-sided valvular disorders, yet it represents a major determinant of cardiovascular morbidity and mortality. Tricuspid regurgitation (TR), the predominant manifestation of TVD, is being recognized with increasing frequency as populations age and the burden of left-sided heart disease rises. While mild TR is often physiological, moderate and severe TR are associated with adverse outcomes, independent of left ventricular function or pulmonary pressures. Secondary TR, driven by right atrial or right ventricular remodeling, constitutes the majority of cases, whereas primary TR due to intrinsic valvular pathology is less frequent. Cardiac implantable electronic device (CIED)-related TR represents a distinct and increasingly prevalent mechanism that often requires dedicated management considerations. Historically, management of TVD has often been delayed until the onset of advanced right heart failure or end-organ dysfunction, resulting in poor outcomes. Contemporary evidence emphasizes the importance of early recognition, precise etiologic characterization, and timely intervention within a multidisciplinary framework. Surgical repair, particularly annuloplasty, remains the reference standard in suitable candidates, offering durable results when performed before irreversible right ventricular remodeling develops. Transcatheter tricuspid valve interventions have expanded therapeutic options for high-risk or inoperable patients, demonstrating symptomatic and hemodynamic improvement in early studies. Optimal management of TVD follows a lifetime approach, integrating multimodality imaging, risk stratification, and individualized treatment strategies. General physicians and cardiologists play a key role in early detection, while coordinated collaboration among imaging specialists, electrophysiologists, heart failure experts, interventional cardiologists, cardiac surgeons, and anesthesiologists is essential for comprehensive care. Ultimately, a patient-centered lifetime management strategy initiated early and adapted to disease progression offers the best opportunity to preserve right heart function, improve survival, and maintain quality of life in patients with TVD.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 2","pages":"18"},"PeriodicalIF":4.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147687726","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":"Robotic degenerative mitral valve repair: an evolution.","authors":"Daniel J Romary, Hallie L Jefferson, Kevin E Hodges","doi":"10.21037/acs-2025-dmv-0175","DOIUrl":"10.21037/acs-2025-dmv-0175","url":null,"abstract":"<p><p>Robotic mitral valve repair (RMVr) has advanced considerably since its introduction at the turn of the millennium. Surgical techniques and technological innovations have addressed many of the limitations of early RMVr procedures. Today, RMVr is recognized as a safe, effective, and adaptable approach to degenerative mitral valve disease, with applications extending to commonly associated conditions such as atrial fibrillation and tricuspid valve disease. Patient selection criteria are now more rigorously defined, and robotic surgical teams are expanding the scope of practice to include increasingly complex cases. This review summarizes the evolution of RMVr techniques, current patient selection strategies, modern outcomes, and training considerations for surgeons and teams. We outline our institutional approach to RMVr and highlight key components for surgeons seeking to establish new programs or expand existing ones.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"4"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155744","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":"Robotic chordae shortening in mitral valve repair.","authors":"Ling-Yi Wei, Jen-Wei Chen, Nai-Kwan Chou, Yi-Chia Wang, Chi-Hsiang Huang, Hsi-Yu Yu, Nai-Hsin Chi","doi":"10.21037/acs-2025-dmv-0135","DOIUrl":"10.21037/acs-2025-dmv-0135","url":null,"abstract":"<p><strong>Background: </strong>Cusp-level chordae shortening was largely abandoned after suboptimal durability in the sternotomy era. We postulated that the enhanced visualization and wristed instrumentation of totally endoscopic robotic mitral repair could enable precise shortening with durable hemodynamics and acceptable peri-operative risk.</p><p><strong>Methods: </strong>We retrospectively analyzed 523 consecutive degenerative mitral regurgitation (MR) repairs performed robotically at the National Taiwan University Hospital (January 2012-November 2024). Chordae shortening was used in 68 patients (13%; 46 primary, 22 adjunct) and compared with 455 contemporaneous repairs without shortening.</p><p><strong>Results: </strong>Baseline characteristics and operative times were similar [cross‑clamp 74±27 <i>vs.</i> 75±25 min; cardiopulmonary bypass (CPB) 120±30 <i>vs.</i> 120±25 min]. All shortening cases achieved successful repair without conversion or valve replacement. At discharge, none/trace MR was more frequent after shortening (95.6% <i>vs.</i> 93.4%); no patient in the shortening group had ≥ moderate MR. Early events were low: 30-day mortality 0% <i>vs.</i> 0.2%, stroke 0% <i>vs.</i> 0.2%, renal failure 1.5% <i>vs.</i> 1.8%, and reoperation for bleeding 1.5% <i>vs.</i> 0%. Reintubation (2.9% <i>vs.</i> 0%) and new-onset atrial fibrillation (33.8% <i>vs.</i> 13.6%) were more common with shortening, yet median ventilation time was comparable, and resource use favored shortening [intensive care unit (ICU) stay 19±28 <i>vs.</i> 27±25 h; hospital stay 7.0±2.9 <i>vs.</i> 9.5±2.7 days]. Follow-up echocardiography (median, 3.6 years) showed sustained competence: 92% of shortening patients remained MR-free. Ten-year freedom from ≥ moderate MR was 95.6% with shortening <i>vs.</i> 94.5% without (log-rank P=0.66).</p><p><strong>Conclusions: </strong>Robotic chordae shortening adds negligible operative time, shortens ICU and hospital stay, and delivers long-term valve competence equivalent to contemporary robotic repairs relying on chordal transfer or neochordae. Although new-onset atrial fibrillation was more frequent, other adverse events were rare. The robotic platform appears to overcome historical limitations of chordae shortening, restoring this tissue‑preserving option for anterior leaflet prolapse in degenerative mitral disease.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"7"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155792","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":"My approach to Barlow's disease.","authors":"Patrick M McCarthy","doi":"10.21037/acs-2025-dmv-0183","DOIUrl":"10.21037/acs-2025-dmv-0183","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"16"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155544","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":"Surgical management of the anterior leaflet in mitral valve repair: the legacy of Professor Alain Carpentier.","authors":"Gilles Dreyfus, Jérôme Jouan","doi":"10.21037/acs-2025-dmv-0154","DOIUrl":"10.21037/acs-2025-dmv-0154","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"9"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155731","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":"Patient selection in robotic mitral valve surgery.","authors":"Marc Gillinov, Tarek Malas, Daniel J P Burns, Stephanie L Mick, Per Wierup","doi":"10.21037/acs-2025-dmv-0114","DOIUrl":"10.21037/acs-2025-dmv-0114","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"13"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155816","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":"Intraoperative transesophageal echocardiography: the roadmap for successful mitral valve repair.","authors":"Anand R Mehta, Nelson Burbano-Vera","doi":"10.21037/acs-2025-dmv-10","DOIUrl":"10.21037/acs-2025-dmv-10","url":null,"abstract":"<p><p>Intraoperative transesophageal echocardiography (TEE) is crucial in defining a real-time imaging guide for a successful surgical repair of degenerative mitral valve (MV) disease. Three-dimensional TEE enhances the echocardiographer's ability to delineate and communicate the pathology more precisely. It is an invaluable tool in guiding peripheral cannulation for minimally invasive and robot-assisted surgical valve repairs and is critical in determining the adequacy of repair and associated complications. As an imaging modality, TEE is an indispensable aid during mitral valve repair (MVR).</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"3"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155867","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":"Lessons learned during my 25 years as Dr. Carpentier's echocardiographer.","authors":"Alain Berrebi","doi":"10.21037/acs-2025-dmv-08","DOIUrl":"10.21037/acs-2025-dmv-08","url":null,"abstract":"<p><p>My collaboration with Professor Carpentier began in the early 1990s and was to continue for more than 25 years. Ours was a unique relationship based on mutual respect and unwavering trust: he liked to introduce me as \"the justice of the peace\", a symbol of the power of partnership. The lessons I learned during my 25 years with Professor Carpentier could be summarized in four key messages: understanding the surgeon's needs based upon the pathophysiological triad and functional approach, establishing a dedicated two-dimensional (2D)/three-dimensional (3D) intra-operative echo protocol in a common language, participating in evolution and evaluation of mitral valve reconstruction and transmitting knowledge to younger generations by education: \"give to be given\". I owe my entire professional career to him. Beyond that, we have forged an unbreakable bond, a relationship that is not only scientific but also deeply human. This filial bond will last forever.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"2"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155935","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":"Chord transfer and leaflet management for Barlow's valve repair.","authors":"Patrick M McCarthy","doi":"10.21037/acs-2026-dmv-01","DOIUrl":"10.21037/acs-2026-dmv-01","url":null,"abstract":"<p><p>Barlow's disease is one of the most challenging phenotypes of degenerative mitral valve pathology, characterized by excessive leaflet tissue, diffuse prolapse, elongated chordae, and annular dilation. Successful repair requires restoration of physiologic leaflet motion and stable coaptation and prevents systolic anterior motion. This manuscript describes an algorithmic approach for Barlow's valve repair centered on chord transfer and leaflet management. Chord transfer utilizes normally functioning secondary chords as support for prolapsing leaflet segments. By mobilizing and reattaching these chords to areas of excess height or unsupported leaflet tissue, balanced leaflet motion can be restored. The technique is detailed step-by-step, including identification of abnormal chordal structures, selection of appropriate chords and precise re-implantation to restore coaptation geometry. Additional leaflet management strategies to address Barlow's disease include cleft closure, assessing and correcting areas of asymmetry, smoothing of irregular edges. Operative images and descriptions illustrate how to safely execute these modifications while preserving leaflet integrity and subvalvular architecture. This approach aims to simplify and standardize repair with a reliable method to repair a complex Barlow's valve without use of artificial neochord implantation.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"14"},"PeriodicalIF":4.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155892","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}