Journal of Cardiothoracic Surgery最新文献

Background: An increasing number of patients are undergoing conversion surgery owing to the rising popularity of relatively strong regimens such as immune checkpoint inhibitor (ICI)-combined chemotherapy for the treatment of unresectable esophageal or esophagogastric junction (EGJ) cancer. However, the perioperative safety of conversion surgery after ICI combined with chemotherapy remains unclear. We report two cases of postoperative immune-related adverse events (irAEs) in patients who underwent conversion surgery after the induction of ICI-combined chemotherapy.

Case presentations: Case 1: A patient with unresectable EGJ adenocarcinoma and para-abdominal aortic lymph node (LN) metastasis developed adrenal insufficiency after four courses of nivolumab + S1 + oxaliplatin (Nivo+ SOX) therapy. As significant tumor shrinkage was observed, conversion surgery was performed. While the postoperative course was uneventful, two months after surgery, hypothyroidism developed and was determined to be an irAE. Thyroid hormone replacement therapy was administered and the symptoms improved. Case 2: A patient with EGJ adenocarcinoma and extensive metastasis to mediastinal, supraclavicular, and para-aortic LNs, along with aortic invasion, also received four courses of Nivo + SOX. Hypothyroidism developed during treatment and was managed with thyroid hormone replacement therapy. Following notable tumor regression, the patient underwent conversion surgery. The patient's postoperative course was uneventful and was discharged. However, one month after surgery, the patient was readmitted with severe respiratory distress and was diagnosed with interstitial pneumonia. Intensive care with extracorporeal membrane oxygenation (ECMO) was initiated following steroid and endoxan pulse therapy, but the patient died four months after surgery.

Conclusions: The risk of irAEs should always be considered in patients receiving ICIs, even after conversion surgery. This condition should be differentiated from complications of esophagectomy and managed promptly.

Background: Coronary artery bypass graft surgery is a critical intervention for treatment of CAD. Self-care involves the knowledge and skills used daily to maintain health and self-esteem. Health literacy empowers patients to engage in health-related behaviors and perform appropriate self-care behaviors. This study aimed to assess how H-literacy and e-health literacy predict self-care in patients undergoing CABG surgery.

Methods: A cross-sectional descriptive-analytical study was conducted using convenience sampling on 192 patients who provided written informed consent. The inclusion criteria included subjects who were at least 18 years of age and underwent CABG procedure for the first time, at least one month after the operation, were free of hearing or speech impairments, no history of mental illness, ability to read and write, have access to the Internet via a mobile device. The exclusion criteria included the performance of concomitant surgical procedures concurrently with CABG surgery, such as heart valve replacement, and the occurrence of acute surgical complications, including bleeding, infection, and acute kidney failure. Data collected through four questionnaires including a demographic information questionnaire, a health literacy questionnaire, an electronic health literacy questionnaire, and a self-care questionnaire.

Results: 192 participants between ages 40 and 85, with a mean age of 63.35 ± 9.87 years, including 114 males and 184 females were studied. Notably, only 9.4% of the participants had obtained an education beyond the level of a diploma. A significant direct relationship was identified between health literacy and self-care (p < 0.001; r = 0.344), while no significant relationship was observed for e-health literacy (p = 0.255; r = 0.082). The findings of multiple linear regression indicated that health literacy had a positive influenced on self-care (coefficient = 0.92, p < 0.001), while e-health literacy did not (p < 0.059).

Conclusions: The findings indicate that health literacy is a significant predictor of self-care in coronary artery bypass graft surgery patients which highlights the need for healthcare officials to enhance public health literacy through educational initiatives.

Background: Ferroptosis, an emerging form of cell death, holds substantial promise for elucidating the etiology and improving treatment methods for cardiovascular diseases (CVDs). This work aims to comprehensively analyze cutting-edge research and future trends in CVDs, guiding research progress and the development of new therapies.

Methods: We retrieved articles and reviews related to ferroptosis in CVDs from the Web of Science Core Collection database, spanning the period from January 1, 2016, to April 22, 2025. Visualization and statistical analysis were performed using CiteSpace (6.2.R3) and VOSviewer (1.6.19) software.

Results: The bibliometric analysis of ferroptosis in CVDs reveals a significant increase in research output since 2016, with a peak in publications in 2024. China leads in publication volume, with Southern Medical University being a key contributor. The International Journal of Molecular Sciences is the most prolific journal, and authors like Zhang Jing have the highest publication counts. Research focus has shifted over time, with recent emphasis on "cardiovascular diseases," "myocardial infarction," "lipid metabolism," "autophagy," and "mitochondrial dysfunction."

Conclusions: Our bibliometric analysis reveals the rapid growth and evolving focus of ferroptosis research in CVDs, with China and the USA leading in output. Future work should prioritize developing biomarkers, multi-omics analyses, and the elucidation of specific molecular mechanisms to enhance clinical translation. Global collaboration remains key to accelerating innovation in this field.

Background: Acute kidney injury (AKI) following lung transplantation (LTx) is correlated with high mortality rates. We aimed to establish a risk-score model for AKI prediction in LTx.

Methods: We retrospectively reviewed data from the Institutional Lung Transplant Database from 2016 to 2022. The primary endpoint was to establish a risk-score model to predict AKI. The secondary endpoint was the impact of AKI on postoperative rehabilitation and survival incidence at the 1-year follow-up.

Results: Of 415 patients, 27% (n = 112) developed AKI within 48 h after LTx. Multivariable analysis revealed that body mass index, diabetes, plasma infusion, surgical time, and postoperative extracorporeal membrane oxygenation (ECMO) assistance were risk factors for AKI. This risk score was created and calibrated based on these five factors, ranging from 0 to 16 points, with the associated prediction of postoperative AKI ranging from 3 to 99% (Hosmer-Lemeshow χ² = 7.502; P = 0.484). Good discrimination was verified by developing and validating the datasets [Area Under the Curve (AUC) = 0.813 and 0.782, respectively]. Based on score distribution, patients were classified into three risk levels: low risk (0-3), moderate risk (3-7), and high risk (7-16). AKI is associated with prolonged stay length of intensive care unit and postoperative hospital (P < 0.001 and P = 0.003), and has an impact in the 3-to-6-month survival (P = 0.008 and P = 0.006).

Conclusions: A risk-score model based on perioperative variables effectively predicted the risk of AKI within 48 h after LTx. This model may be useful in early decision-making regarding AKI treatment.

Background: The "No-touch" technique has demonstrated efficacy in enhancing both short-term and long-term patency of great saphenous vein grafts (SVG) for coronary heart disease (CHD) treatment. Nevertheless, its widespread use is constrained by the method's limitations. Therefore, we modified it by using a harmonic scalpel to harvest SVG and verified its patency rate.

Methods: 156 patients who underwent coronary artery bypass grafting (CABG) were consecutively recruited between November 2018 and July 2019. Patients were allocated to 2 groups of 78 each, according to two SV harvesting techniques (modified no-touch [M group] and conventional technique [C group]). SVG samples were taken for pathological examination. This study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Tenth People's Hospital (ChiCTR1800018433). All patients underwent follow-ups for at least 2 years.

Results: The modified no-touch technique reduced graft acquisition time (P < 0.001) and the pulsatility index (PI) (P < 0.001). No difference was detected in the average flow of grafts and procedural complication rate. At 24 months, the left ventricular ejection fraction (LVEF) was higher in the M-group (P < 0.001).

Conclusions: The use of the harmonic scalpel to harvest SVG is safe and effective, and may contribute to better postoperative cardiac function recovery, as reflected by satisfactory short- and mid-term outcomes.

Objectives: The frozen elephant trunk (FET) technique during total arch replacement (TAR) in patients with acute type A aortic dissection (ATAAD) has been shown to promote favorable aortic remodeling. However, few reports have compared the morphological assessments between the conventional elephant trunk (CET) and FET procedures. Here, we investigated whether the FET technique during TAR for the patients with ATAAD could affect aortic remodeling through morphological analysis.

Methods: In total, 464 patients diagnosed with ATAAD underwent emergency ascending aorta or TAR between 2010 and 2023. We retrospectively analyzed the clinical data of 28 patients who underwent TAR and postoperative contrast-enhanced computed tomography. We assigned 28 patients to either the CET group (n = 11) or FET group (n = 17). Patient characteristics, postoperative outcomes, and aortic remodeling analysis were collected.

Results: Aortic remodeling analysis showed that the expansion rate of the true lumen (TL) in the descending thoracic aorta was significantly greater in the FET group early and 1 year after surgery. Meanwhile, the shrinkage rate of the false lumen (FL) in the descending thoracic aorta was significantly greater in the FET group early after surgery and tended to be greater in the FET group even 1 year after surgery. Remarkably, the incidence of reintervention of the descending aorta was significantly lower in the FET group.

Conclusions: The FET technique with TAR in patients with ATAAD could improve aortic remodeling through improved TL expansion and preventive FL dilatation in the descending thoracic aorta and reduce the need for surgical reintervention.