Annals of cardiothoracic surgery最新文献

{"title":"Mind the gap: transcatheter edge to edge repair <i>vs.</i> surgical repair in degenerative mitral regurgitation.","authors":"Saibal Kar, Saro Avedikian","doi":"10.21037/acs-2025-dmv-11","DOIUrl":"10.21037/acs-2025-dmv-11","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"11"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155929","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":"Mathematical modeling for predicting the optimal size of ring annuloplasty in the repair of degenerative mitral valves.","authors":"Laura Besola, Giosuè Salvatore Falcetta, Alessandro Fiocco, Chiara Mangifesta, Giacomo Ravenni, Michele Celiento, Danilo Ruggiero, Edoardo Merella, Federico Giorgi, Andrea Colli","doi":"10.21037/acs-2025-dmv-0158","DOIUrl":"10.21037/acs-2025-dmv-0158","url":null,"abstract":"<p><strong>Background: </strong>During mitral valve repair (MVRe), the sizing of the prosthetic ring/band often depends more on the surgeon's experience than objective methodology. The study aims to validate a mathematical approach based on transthoracic echocardiography to predict the optimal ring size in a surgical cohort.</p><p><strong>Methods: </strong>Patients who underwent MVRe between July 2021 and July 2023 were retrospectively evaluated. Pre-operative echocardiography data were collected [including pre-operative coaptation length (CL0), anteroposterior (AP) diameter, anterior mitral leaflet (AML) length, posterior mitral leaflet (PML) length]. A dedicated formula was developed to predict the postoperative AP (pAP) diameter, ensuring a CL of 8 mm, according to the literature. Based on the calculated pAP, the optimal ring size was selected using the manufacturer's ring charts. A linear regression study tested the consistency between the predicted and implanted sizes.</p><p><strong>Results: </strong>Fifty-four patients were included; six implanted a Flexible Band, 17 a Semirigid Band, and 31 a Semirigid Ring. In linear regression, there was an acceptable correlation between predicted/implanted sizes (r=0.589; P<0.001). Overall, the only factor influencing concordance was ring type. When analyzing the single ring groups, we found that correlation was impacted by ring type with an optimal correlation for Semirigid Rings (r=0.745, P<0.001), good for Semirigid Bands (r=0.659, P=0.004), and poor for Flexible Bands.</p><p><strong>Conclusions: </strong>The proposed method is reliable in predicting the optimal ring size, with a CL >8 mm; however, the test's ability is influenced by the type of ring. Further studies are needed to validate the formula in a larger population and investigate its use in transcatheter annuloplasty.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"8"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156023","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 mitral valve surgery: the future is now.","authors":"Vinay Badhwar","doi":"10.21037/acs-2025-dmv-0170","DOIUrl":"10.21037/acs-2025-dmv-0170","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"12"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155804","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":"Tackling MAC and other complex mitral valve repair scenarios through the lens of robotics.","authors":"Didier F Loulmet, Ali Hage","doi":"10.21037/acs-2025-dmv-0164","DOIUrl":"10.21037/acs-2025-dmv-0164","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"10"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155760","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":"Neochords: how to best use them and when not to use them.","authors":"Tirone E David","doi":"10.21037/acs-2025-dmv-0168","DOIUrl":"10.21037/acs-2025-dmv-0168","url":null,"abstract":"","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"15"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155601","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":"Outcomes of robotic repair for the degenerative mitral valve: a systematic review and meta-analysis.","authors":"Aditya Eranki, Liam Munir, David Downes, Connor Debs, Kruthajn Rajesh, Benjamin Muston, Dominic Ng, Ashley Wilson-Smith, Aashray Gupta, Martin Misfeld","doi":"10.21037/acs-2025-dmv-12","DOIUrl":"10.21037/acs-2025-dmv-12","url":null,"abstract":"<p><strong>Background: </strong>Robotic mitral valve repair (RMVr) provides a minimally invasive option for degenerative mitral regurgitation (MR), yet durability signals and patient outcomes remain heterogeneously reported. This current systematic review and meta-analysis aims to summarize survival and freedom from reoperation following RMVr in degenerative disease.</p><p><strong>Methods: </strong>Five databases were searched from inception through July 2025 for studies reporting RMVr outcomes in degenerative disease. Cohorts with mixed etiologies without separable data were excluded. Short-term mortality (<30 days) was the primary outcome, while mid- to long-term survival and freedom from reoperation were presented using Kaplan-Meier curves. Secondary endpoints included relevant morbidity outcomes and reoperation rates. Meta-regression analysis examined associations between cohort size and adverse outcomes and assessed temporal trends in RMVr technique.</p><p><strong>Results: </strong>Following independent screening, 15 studies were selected, including 11,432 patients. Pooled mean follow-up was 60.9 months (clinical) and 20.0 months (echocardiographic). Kaplan-Meier overall survival at 1, 3, 5 and 10 years was 98.9%, 98.7%, 97.4% and 92.3%, respectively. At 1, 3 and 5 years, freedom from reoperation was 97.7%, 96.0% and 96.0%, while freedom from recurrent ≥2+ MR was 98.3%, 95.8% and 95.8%. Pooled short-term (<30 days) mortality was 1.3% [95% confidence interval (CI): 1.1-1.4%]. Postoperative morbidity was low, with cerebrovascular accident (CVA) in 1.4% and acute kidney injury (AKI) in 1.3%. Reoperation for bleeding and valve dysfunction occurred in 2.3% and 2.2% of patients, respectively. Pooled mean intensive care unit (ICU) stay was 1.2 days and hospital length of stay (LOS) was 6.0 days. Meta-regression suggested increasing adoption of neochordae techniques over time (P=0.015). Heterogeneity was high for several parameters, reflecting differences in study design, surgeon experience, and follow-up duration.</p><p><strong>Conclusions: </strong>In degenerative mitral disease, RMVr demonstrates low short-term mortality and complications, with favorable mid- to long-term durability, including high freedom from recurrent moderate-to-severe MR and reoperation. These findings support RMVr as an effective and durable surgical approach to degenerative mitral pathology, underscoring the need for prospective, standardized studies with robust echocardiographic follow-up and case-mix adjustment.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"1"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155784","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":"Mitral valve surgery and maze procedure: the Korean experience in rheumatic versus degenerative disease.","authors":"Joon Young Kim, Hong Rae Kim, Jae-Suk Yoo, Joon Bum Kim, Sung-Ho Jung, Jae Won Lee, Ho Jin Kim","doi":"10.21037/acs-2025-dmv-0157","DOIUrl":"10.21037/acs-2025-dmv-0157","url":null,"abstract":"<p><strong>Background: </strong>In Korea, rheumatic mitral valve (MV) disease remains relatively prevalent compared with Western countries. Given this demographic profile, we aimed to evaluate long-term rhythm and clinical outcomes of surgical ablation of atrial fibrillation (AF) during MV surgery in patients with degenerative versus rheumatic MV disease, using the data from the nation's highest-volume center.</p><p><strong>Methods: </strong>We retrospectively analyzed consecutive patients with AF who underwent MV surgery with concomitant surgical ablation between 2001 and 2020 at a high-volume center in Korea. Patients were categorized by MV etiology (rheumatic <i>vs.</i> degenerative). The primary outcome was AF recurrence after a 3-month blanking period. Secondary outcomes included all-cause mortality, stroke, and permanent pacemaker (PPM) implantation. The probability of AF recurrence was estimated using logistic regression with generalized estimating equations, and competing risk models were used to assess stroke and PPM implantation.</p><p><strong>Results: </strong>Among 1,872 patients (mean age 58.7±11.5 years; 56.9% women), 1,157 (61.8%) had rheumatic MV disease, and 715 (38.2%) had degenerative disease. Compared with patients with degenerative disease, those with rheumatic disease were younger, more often female, had more persistent AF, larger left atrial dimensions, and a higher likelihood of undergoing MV replacement. The adjusted probability of AF recurrence at 3, 5, and 10 years was 23.6%, 28.6%, and 40.1%, respectively, and did not significantly differ between rheumatic and degenerative groups (10-year: 39.8% <i>vs.</i> 40.6%; P=0.746). Rheumatic etiology was not associated with an increased risk of death (P=0.518), stroke (P=0.520), or PPM implantation (P=0.052).</p><p><strong>Conclusions: </strong>In a contemporary Korean cohort, surgical ablation during MV surgery provided sustained rhythm control and favorable clinical outcomes in patients with both degenerative and rheumatic disease. Given the continued burden of rheumatic heart disease in Korea, these findings support the routine application of surgical ablation during MV surgery, regardless of underlying etiology.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"5"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155938","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 mitral repair in echocardiographically symmetrical and asymmetrical Barlow's disease.","authors":"Piotr Suwalski, Michał Pasierski, Jakub Brączkowski, Małgorzata Żurawska, Janina Finke, Zofia Głowniak, Mariusz Kowalewski, Jakub Staromłyński, Maciej Bartczak, Piotr Szymański, Robert Gil, Radosław Smoczyński","doi":"10.21037/acs-2025-dmv-fs-0121","DOIUrl":"10.21037/acs-2025-dmv-fs-0121","url":null,"abstract":"<p><strong>Background: </strong>Robotic mitral valve repair for mitral regurgitation (MR) is increasingly popular due to shorter hospital stays, reduced perioperative pain, and faster recovery. Barlow's disease is a significant subset of primary MR due to its complex repair requirements. This study presents our surgical and short-term outcomes for patients with Barlow's disease treated using the da Vinci Xi robotic system.</p><p><strong>Methods: </strong>Since adopting robotic surgery in June 2021, all consecutive patients diagnosed with Barlow's disease through September 2023 were included. Based on preoperative echocardiography, patients were classified into two groups: \"symmetrical\", involving bileaflet prolapse and a central regurgitant jet, and \"asymmetrical\", with single-leaflet prolapse and eccentric regurgitation.</p><p><strong>Results: </strong>Thirty-six patients with Barlow's disease underwent robotic surgery during the study period. Repair success was 100%, with no conversions required. No significant differences were found in baseline characteristics between the prolapse types. Annuloplasty alone was sufficient for the symmetrical group, whereas asymmetrical cases required neochord loops, reflected by shorter aortic cross-clamp (190 <i>vs.</i> 151 min; P=0.034) and aortic cross-clamp (121 <i>vs.</i> 89 min; P=0.003) durations in the symmetrical group. During a median follow-up of 7.5 months, there were no deaths or reinterventions. Additionally, no cases of progression to ≥ moderate MR were observed during the median echocardiographic follow-up of 5.3 months.</p><p><strong>Conclusions: </strong>Robotic repair of Barlow's disease is safe, feasible, and yields excellent short-term outcomes. For patients with symmetrical prolapse, annuloplasty alone provides effective repair.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"15 1","pages":"6"},"PeriodicalIF":3.1,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12884181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146155826","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":"Early and late outcomes of mitral valve surgery in the setting of mitral annular calcification: a systematic review with narrative synthesis.","authors":"Ali Hage, Anjolaoluwa Ajai, Caroline A Snyder, Justin T Wang, Fadi Hage, Michael W A Chu","doi":"10.21037/acs-2025-mac-0166","DOIUrl":"10.21037/acs-2025-mac-0166","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular calcification (MAC) is a degenerative calcific pathology of the mitral valve (MV) associated with MV dysfunction and poor patient outcomes. The pathophysiologic complexity of MAC presents unique challenges for surgical management. In this systematic review, we summarize the heterogenous approaches to MV surgery for MAC and assess early and late outcomes of each approach.</p><p><strong>Methods: </strong>A systematic literature search was performed in the PubMed, EMBASE, and Web of Science databases. Three reviewers independently selected relevant studies through a sequential three-step review process. Based on included descriptions of intraoperative methods, each study was categorized as either a \"MAC Respect\" or \"MAC Resect\" intervention. Quantitative data were collected, aggregated across all studies, and analyzed by surgical approach.</p><p><strong>Results: </strong>Our initial search yielded 635 unique studies, of which 19 studies met inclusion criteria for quantitative data extraction. Based on the operative approach, two cohorts of \"MAC Respect\" (N=550) and \"MAC Resect\" (N=487) were created. Baseline characteristics were similar; the median patient age and proportion of female patients were 71.5 years and 66.4% in the \"Respect\" group and 70.3 years and 54.9% in the \"Resect\" group, respectively. A median of 26.9% of patients in the \"Resect\" group and 12.5% in the \"Resect\" group were classified as New York Heart Association (NYHA) class III or IV. \"Respect\" studies had a median cardiopulmonary bypass time of 156 minutes, while \"Resect\" studies had a median time of 181.5 minutes. The median intensive care unit stay was two days for the \"Respect\" group and 3.5 days for the \"Resect\" group. Ranges of complication rates largely overlapped between groups. Thirty-day, one-year, and long-term mortality rates were 0-25%, 0-44%, and 0-27% in the \"Respect\" group and 0-14%, 0-18%, and 0-50% in the \"Resect\" group.</p><p><strong>Conclusions: </strong>Surgical intervention remains the gold-standard for management of MAC-related MV dysfunction; however, there is no standardized consensus for the optimal surgical approach. This systematic review evaluates the advantages, disadvantages, and outcomes of several approaches to MAC surgical intervention. Our findings underscore the heterogeneous presentation of MAC and the associated complications to avoid in order to improve patient outcomes.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"407-422"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740466","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":"Clinical and echocardiographic outcomes of patients with mitral annular calcification undergoing mitral valve surgery: a 10-year single center experience.","authors":"Rahul Kanade, Jack Gosden, Jonathan Roland, Mohamed Aly, Maximilian Reisinger, Mateusz Kachel, Luigi Pirelli, Koji Takeda, Michael Argenziano, Hiroo Takayama, Arnar Geirsson, Chunhui Wang, Paul Kurlansky, Isaac George","doi":"10.21037/acs-2025-mac-0173","DOIUrl":"10.21037/acs-2025-mac-0173","url":null,"abstract":"<p><strong>Background: </strong>Mitral annular calcification (MAC) is a chronic and degenerative process, affecting the mitral valve annulus. MAC complicates the decision over the appropriate surgical approach to mitral valve disease. Distorted valvular anatomy increases surgical risk and therefore requires careful patient selection. Here, we report our single-center experience performing mitral valve surgery in the setting of MAC over a 10-year period.</p><p><strong>Methods: </strong>This is a 10-year retrospective analysis of 172 patients with MAC. Sixty-seven patients underwent MAC severity scoring using a 10-point system based on computed tomography (CT). The primary outcome was 30-day mortality, readmission, reoperation, stroke, prolonged ventilation, renal failure and deep sternal infection. Secondary analyses stratified MAC by underlying mitral disease type as well as evaluated outcomes by CT severity score. Patients without MAC undergoing mitral valve replacement surgery during the same time period served as controls.</p><p><strong>Results: </strong>The 30-day mortality was significantly higher in MAC patients compared with non-MAC (9.9% <i>vs.</i> 4.2%, P<0.001), as were rates of stroke (4.7% <i>vs.</i> 1.6%, P=0.036), prolonged ventilation (33.1% <i>vs.</i> 21.1%, P<0.001), and renal failure (8.7% <i>vs.</i> 4.3%, P=0.008). Resource utilization was also greater, with longer intensive care unit (ICU) hours {118 [interquartile range (IQR), 58.2-254] <i>vs.</i> 72.3 (IQR, 41.0-141.5) hours, P<0.001}, postoperative length of stay [10 (IQR, 7-22) <i>vs.</i> 8 (IQR, 6-13) days, P<0.001], and total hospitalization [12 (IQR, 8-28) <i>vs.</i> 10 (IQR, 6-17) days, P=0.001].</p><p><strong>Conclusions: </strong>MAC complicates mitral valve surgery, with significant differences seen in survival stroke, renal failure, prolonged ventilatory support, and ICU and hospital length of stay. Careful evaluation of surgical risk and patient selection is warranted in patients with MAC.</p>","PeriodicalId":8067,"journal":{"name":"Annals of cardiothoracic surgery","volume":"14 6","pages":"472-481"},"PeriodicalIF":3.1,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740483","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}