Journal of Cardiothoracic Surgery最新文献

Background: A patent ductus arteriosus (PDA) can result in pulmonary arterial hypertension (PAH) due to a left-to-right shunt. Lung transplantation (LTx) is indicated when PAH becomes refractory to medical management. We report a case of bilateral LTx (BLTx) with simultaneous aortic replacement using a donor aorta in an adult patient with PAH complicated by PDA.

Case presentation: A 27-year-old woman was referred for an LTx evaluation. At 1-year-old, she was diagnosed with a PDA. At the time of diagnosis, PDA closure was not indicated due to severe PAH, with a pulmonary vascular resistance of 33.8 Wood units. Despite receiving maximal medical therapy, her condition progressively deteriorated. She was placed on the transplant waitlist at age 27. Since left ventricular function was preserved (ejection fraction 60%) and no complex congenital heart disease was present, bilateral lung transplantation was chosen instead of heart-lung transplantation. Preoperative computed tomography revealed a giant pulmonary artery aneurysm (PAA). At 31 years of age, she underwent BLTx with simultaneous replacement of the proximal descending thoracic aorta using a donor aortic graft under cardiopulmonary bypass to enable complete excision of the ductal tissue. The giant PAA was also repaired during the same procedure. Postoperatively, she required venoarterial extracorporeal membrane oxygenation and was successfully weaned off by postoperative day 4. After an extended rehabilitation period, the patient was discharged 153 days postoperatively and remained in good health for 16 months following transplantation.

Conclusions: To our knowledge, this is the first reported case of LTx with aortic replacement using a donor aortic graft for the management of PDA. We believe this combined procedure may represent a feasible surgical strategy for adult patients with PAH complicated by PDA and warrants further investigation in future cases.

We report a novel thoracic endovascular aortic repair (TEVAR) technique for complicated type B aortic dissection requiring zone 2 landing. A 42-year-old man presented with pulseless left femoral artery. Emergency TEVAR was performed using the left subclavian artery (LSA) wall as a sealing zone to reduce the risk of endoleak. Postoperative recovery was uneventful, and the patient was discharged on day 8. CT demonstrated complete coverage of the entry tear, false lumen thrombosis, and preserved left subclavian perfusion. Follow-up CT showed favorable remodeling. This technique may be effective in patients with limited proximal sealing zones.

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.