Journal of Cardiothoracic Surgery最新文献

Background: Diabetic cardiomyopathy (DCM) is a disease induced by diabetes mellitus that poses a significant threat to health, with myocardial fibrosis being one of its most prominent pathological features. This study analyses the structural frameworks and underlying connections among global research findings on myocardial fibrosis in DCM over the past two decades, and further explores future research trends.

Methods: All literature data were retrieved and downloaded from the Web of Science Core Collection database using a predefined search strategy targeting diabetic cardiomyopathy and myocardial fibrosis, encompassing publications from January 1, 2005, to December 31, 2024. This study employed the bibliometrix package in R for mathematical and statistical analyses, alongside visualization, of countries, institutions, journals, authors, keywords, references, and citation frequencies within the dataset. Journal impact factors and the Hirsch index were derived from Journal Citation Reports.

Results: Ultimately, 791 studies focusing on myocardial fibrosis in DCM were included for systematic analysis. Over the past two decades, the annual average number of publications in this field has steadily risen from 4 to 95, with the total citations of relevant literature peaking in 2018. At the global level, the United States leads in both research influence and the depth of international collaboration in this domain, while China ranks first worldwide with 490 publications. Professor Zhang Yun, a Chinese scholar, is the most influential core author in the field, Shandong University tops all institutions in terms of relevant publication output, and Cardiovascular Diabetology is the flagship journal for disseminating research findings on DCM-related myocardial fibrosis. Author keyword co-occurrence analysis identified Oxidative Stress, Inflammation, Apoptosis, and Heart Failure as high-frequency co-occurring terms. Trend and topic prediction analysis indicates that Ferroptosis is poised to emerge as a core research hotspot in this field moving forward.

Conclusion: This study systematically delineates the research characteristics and trends of myocardial fibrosis in DCM using bibliometric analysis, thereby assisting researchers in grasping the cutting-edge advances and future directions of this field.

Background: This study aims to report a case of pulmonary epithelioid hemangioendothelioma (PEH) achieving pathological complete remission following neoadjuvant treatment, thereby enhancing clinical understanding of this rare disease and providing valuable treatment insights.

Case presentation: The patient's imaging examination revealed a single large tumor on one side of the lung with lymph node metastasis. After treatment with albumin paclitaxel + carboplatin + bevacizumab, the tumor disappeared from the imaging findings, and postoperative pathology confirmed that the patient achieved pathological complete remission.

Conclusion: PEH is rare in clinical practice and is a type of malignant tumor without characteristic clinical manifestations, and the diagnosis relies on pathological and immunohistochemical examinations. Single or few lesions can be treated surgically, whereas those that cannot undergo surgery can be treated with chemotherapy and targeted therapy.

Objectives: Coronary heart disease (CHD) stands as a major cause of fatal outcomes, but current diagnostic methods often lack sensitivity or are highly invasive. The synergistic role of miR-193a-5p and VEGFB in CHD remains unclear. This study explores their combined predictive value for CHD diagnosis and prognosis.

Methods: 105 CHD and 70 non-CHD subjects were enrolled. Serum was collected to detect the abundance of miR-193a-5p and VEGFB. The diagnostic efficacy of the two was analyzed by ROC curve. The prognosis was recorded during the follow-up, and risk factors were evaluated of CHD occurrence and prognosis by logistic regression.

Results: In the serum of CHD patients, the abundance of miR-193a-5p was down-regulated, while VEGFB was up-regulated, and their expressions were significantly correlated. The AUC of miR-193a-5p and VEGFB for individual diagnosis of CHD was 0.9097 and 0.7512, which increased to 0.9415 for combined diagnosis. In the poor prognosis group, miR-193a-5p was lower and VEGFB was higher. The AUC of their combined prediction for poor prognosis was 0.9575, significantly better than individual detection. Logistic regression showed that miR-193a-5p and VEGFB were independent influencing factors for CHD occurrence and poor prognosis.

Conclusion: miR-193a-5p combined with VEGFB has high value for the diagnosis and prognostic evaluation of CHD, and is expected to become a new biomarker and potential therapeutic target for precision diagnosis and treatment of CHD.

Background: Thoracic endovascular aortic repair (TEVAR) with branch reconstruction is an alternative to open surgery for aortic arch pathologies. However, mid-term data comparing different strategies are limited. This study aimed to evaluate the mid-term outcomes of single- and double-branch TEVAR and analyze the performance of different single-branch reconstruction techniques.

Methods: We retrospectively analyzed 198 consecutive patients who underwent TEVAR for aortic arch lesions with either single-branch (n = 169) or double-branch (n = 29) reconstruction at a single center between February 2015 and December 2023. The primary endpoint was the mid-term all-cause mortality. The secondary endpoints included technical success, perioperative safety, aorta-related complications, and reintervention rates. Kaplan-Meier survival analysis, multivariable Cox regression, and Restricted Mean Survival Time (RMST) analysis were performed. The influence of age was explored using Restricted Cubic Splines (RCS), modeling age continuously.

Results: The overall technical success rate was 96.0%. The mean follow-up duration was 40.5 months. There was no significant difference in mid-term all-cause mortality between the single- and double-branch groups (Log-rank P = 0.710). Multivariable Cox regression identified older age as an independent predictor of mortality (HR 1.047 per year, 95% CI 1.012-1.084, P = 0.009) but not the number of branches reconstructed (P = 0.611). Among the single-branch techniques, RMST analysis confirmed no significant difference in mid-term survival (all pairwise P > 0.050). An inverse association between age and aorta-related complications was suggested (OR 0.957, 95% CI 0.923-0.993, P = 0.020), which most plausibly reflects selection bias and warrants confirmation in larger, multicenter studies.

Conclusion: In this single-center cohort study, single- and double-branch TEVAR yielded no statistically significant difference in mid-term survival. Age, and not the number of reconstructed branches, was the primary predictor of mortality. All single-branch techniques showed comparable mid-term survival, supporting an individualized, anatomy-driven approach. The observed inverse association between age and aorta-related complications highlights the critical role of patient selection in these complex procedures and warrants confirmation in larger, multicenter studies with standardized anatomical assessment and imaging follow-up.

Background: Anterior mediastinal hematomas following blunt chest trauma are usually not life threatening. However, in rare cases, they can cause extrapericardial tamponade, requiring urgent surgical intervention. Despite its increasing adoption in elective thoracic procedures, the use of subxiphoid uniportal video-assisted thoracoscopic surgery (SUVATS) in trauma remains scarcely reported. This case highlights a rare instance of extrapericardial tamponade caused by an anterior mediastinal hematoma, successfully managed using SUVATS in a trauma setting.

Case presentation: We report the case of a 65-year-old man who had a 4-meter fall and sustained a retrosternal hematoma and sternal fracture, as confirmed on chest computed tomography without evidence of intracardiac or major vascular injuries. Following initial hemodynamic stability, evolving hemodynamic compromise led to transthoracic echocardiography, which demonstrated right ventricular compression consistent with extrapericardial tamponade, necessitating surgical evacuation. SUVATS was performed for hematoma evacuation and hemostasis. During subsequent sternal fixation via a separate limited midline incision, thoracoscopic visualization enabled assessment of the posterior sternal surface. The patient was extubated on the day of surgery and was discharged without complications.

Conclusions: This case demonstrates the extended utility of SUVATS beyond hematoma evacuation, including its adjunctive role in sternal fixation. This minimally invasive approach provided excellent mediastinal exposure, reduced postoperative pain, and minimized respiratory complications. SUVATS may be a feasible option in selected trauma cases, including those with tamponade physiology. In trauma patients without major vascular injury, it may offer a less invasive yet effective alternative to median sternotomy, potentially improving early recovery and outcomes.

Background: Pulmonary segmentectomy is a valid alternative to lobectomy in early-stage non-small cell lung cancer (NSCLC). However, limited data are available on post-operative compensatory volume changes following segmentectomy. The aim was to clarify the temporal patterns of lobar volume changes in the residual and contralateral lung at 6 and 12 months post-segmentectomy using 3D reconstruction.

Methods: We retrospectively reviewed patients who underwent video-assisted thoracoscopic surgery (VATS) segmentectomy for early-stage NSCLC from 2017 to 2022. Pre-operative lung lobe volumes were calculated from three dimensional (3D) reconstruction (Materialize^®) and compared with volumes at 6 and 12 months post-operatively.

Results: A total of 30 patients (median age: 66, sex ratio M/F: 14/16) were included. On the right side (n = 15), median lobar volume loss reached 62.4% (p = 0.03) after upper S1 segmentectomy, 38.9% (p > 0.05) after S2 and 35.5% (p > 0.05) after S6 at 12 months. Compensatory expansion was predominant in the lower lobe for upper segmentectomies, respectively + 24.2% (p > 0.05) for S1 and + 22.2 (p > 0.05) for S2, whereas compensation in middle lobe was present for S1 segmentectomy (+ 17%, p = 0.03) and for S6 (+ 14.9%, p > 0.05). On the left side, median volume loss was 73.0% (p = 0.03) after upper trisegmentectomy, 34.8% (p > 0.05) after lingulectomy, and 37.4% (p = 0.03) after S6 resection. Compensatory expansion mainly involved the lower lobe for upper resections (+ 31.4%, p = 0.03), while the upper lobe increased by + 11.4% (p = 0.03) following lower-lobe segmentectomy. No volume difference was observed in the contralateral lobes over 12 months across resection types. Overall total lung volume was largely unchanged at 12 months across resection types, except for left S6 segmentectomy (a 6.6% decrease, p = 0.03).

Conclusion: Volume compensation mechanisms occur after VATS segmentectomy, with more pronounced volume reduction following upper-lobe resections compared to lower-lobe resections. The absence of contralateral volumetric compensation may allow subsequent compensatory responses to occur and potentially contribute to a better preservation of lung function in patients undergoing additional pulmonary resections. Characterizing these patterns is important for surgical planning and optimizing postoperative management in patients undergoing segmentectomy for early-stage NSCLC.

Background: Coronary artery bypass grafting (CABG) has been shown to reduce mortality and improve quality of life in patients with extensive coronary artery disease. However, evidence regarding its benefits in the context of acute coronary syndrome (ACS) remains limited, especially considering patient selection, graft patency and in-hospital mortality reduction. This study examines the experience of patients undergoing off-pump CABG during ACS in a high-complexity cardiology center in Argentina.

Methods: This study analyzed a single-center longitudinal prospective cohort of ACS patients undergoing off-pump CABG (OPCAB) between January 2002 and December 2022. The demographic, clinical, and surgical data were examined, focusing on major adverse cardiovascular events (MACE) and in-hospital morbidity including periprocedural AMI, reoperation for bleeding, among others. Independent risk factors for in-hospital mortality and morbidity were identified through multivariate analysis using stepwise logistic regression.

Results: Among 1,738 patients, predominantly male (85.5%), 28.3% had diabetes, and 24.2% were smokers. The average age was 64 years, with a mean ejection fraction of 55%. 6.5% of procedures were performed as emergency surgeries within 24 h of hospital admission and 3.4% required conversion to cardiopulmonary bypass. Hospital mortality was 3.5%, and multivariate analysis showed that age (OR 1.082; 95% CI: 1.036-1.129, p = 0.001) and baseline ejection fraction (OR 0.952; 95% CI: 0.924-0.981, p = 0.001) were associated with this event.

Conclusions: In our experience, OPCAB proved to be a feasible option in specialized centers with expertise, characterized by low mortality, minimal need for conversion to CPB, and high success rates in complete revascularization using arterial grafts.Age and baseline ejection fraction significantly influence hospital outcomes, although these results should be correlated with long-term randomized studies.