S. C. Sung, H. Kim, and K. H. Choi, “Modification of the Senning procedure in the double-switch operation: The triangular double-door technique,” Journal of Cardiac Surgery 2020 Sep; 35(9): 2347–2349, https://doi.org/10.1111/jocs.14763.
In the article titled “Modification of the Senning procedure in the double-switch operation: The triangular double-door technique,” there was an error in the affiliation, the institutional affiliations for authors Si Chan Sung, Hyungtae Kim, and Kwang Ho Choi were incomplete.
The following affiliation should be added for Si Chan Sung, Hyungtae Kim, and Kwang Ho Choi authors:
“Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan-si, Republic of Korea.”
We apologize for this error.
S. C. Sung， H. Kim， K. H. Choi，“双开关手术中Senning程序的改进：三角双门技术”，《心脏外科杂志》2020年9月；35(9): 2347-2349, https://doi.org/10.1111/jocs.14763.In《双开关操作中森宁程序的修改：三角双门技术》一文中的隶属关系存在错误，作者成时灿、金亨泰、崔光浩的机构隶属关系不完整。对于Si Chan Sung、Hyungtae Kim和Kwang Ho Choi的作者，应添加以下从属关系：“大韩民国梁山市釜山国立大学梁山医院医学学院生物医学科学与技术融合研究所胸外科和心血管外科。”我们为这个错误道歉。
{"title":"Correction to “Modification of the Senning procedure in the double-switch operation: The triangular double-door technique”","authors":"","doi":"10.1155/jocs/9803237","DOIUrl":"https://doi.org/10.1155/jocs/9803237","url":null,"abstract":"<p>S. C. Sung, H. Kim, and K. H. Choi, “Modification of the Senning procedure in the double-switch operation: The triangular double-door technique,” <i>Journal of Cardiac Surgery</i> 2020 Sep; 35(9): 2347–2349, https://doi.org/10.1111/jocs.14763.</p><p>In the article titled “Modification of the Senning procedure in the double-switch operation: The triangular double-door technique,” there was an error in the affiliation, the institutional affiliations for authors Si Chan Sung, Hyungtae Kim, and Kwang Ho Choi were incomplete.</p><p>The following affiliation should be added for Si Chan Sung, Hyungtae Kim, and Kwang Ho Choi authors:</p><p>“Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, <b>School of Medicine, Pusan National University</b>, Yangsan-si, Republic of Korea.”</p><p>We apologize for this error.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9803237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. H. Choi, H. Kim, S. C. Sung, H. D. Lee, H. Ko, and J.-H. Byun, “Effectiveness of posterior aortopexy for the left pulmonary vein obstruction between the left atrium and the descending aorta,” Journal of Cardiac Surgery 2021 Aug; 36(8): 2644–2650, https://doi.org/10.1111/jocs.15596.
In the article titled “Effectiveness of posterior aortopexy for the left pulmonary vein obstruction between the left atrium and the descending aorta,” there was an error in the affiliation, the institutional affiliations for authors Kwang Ho Choi, Hyungtae Kim, and Si Chan Sung were incomplete.
The following affiliation should be added for Kwang Ho Choi, Hyungtae Kim, and Si Chan Sung authors:
“Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Yangsan-si, Republic of Korea.”
We apologize for this error.
崔国辉，金国辉，成三成，李国栋，高国辉，j - h。Byun，“后主动脉固定术治疗左心房与降主动脉之间的左肺静脉阻塞的有效性”，《心脏外科杂志》2021年8月；36(8): 2644-2650, https://doi.org/10.1111/jocs.15596.In题为“后主动脉置入术治疗左心房与降主动脉之间的左肺静脉阻塞的有效性”的文章在隶属关系中存在错误，作者Kwang Ho Choi， Hyungtae Kim和Si Chan Sung的机构隶属关系不完整。对于Kwang Ho Choi、Hyungtae Kim和Si Chan Sung的作者，应添加以下从属关系：“大韩民国梁山市釜山国立大学梁山医院医学学院生物医学科学与技术融合研究所胸心血管外科。”我们为这个错误道歉。
{"title":"Correction to “Effectiveness of posterior aortopexy for the left pulmonary vein obstruction between the left atrium and the descending aorta”","authors":"","doi":"10.1155/jocs/9802504","DOIUrl":"https://doi.org/10.1155/jocs/9802504","url":null,"abstract":"<p>K. H. Choi, H. Kim, S. C. Sung, H. D. Lee, H. Ko, and J.-H. Byun, “Effectiveness of posterior aortopexy for the left pulmonary vein obstruction between the left atrium and the descending aorta,” <i>Journal of Cardiac Surgery</i> 2021 Aug; 36(8): 2644–2650, https://doi.org/10.1111/jocs.15596.</p><p>In the article titled “Effectiveness of posterior aortopexy for the left pulmonary vein obstruction between the left atrium and the descending aorta,” there was an error in the affiliation, the institutional affiliations for authors Kwang Ho Choi, Hyungtae Kim, and Si Chan Sung were incomplete.</p><p>The following affiliation should be added for Kwang Ho Choi, Hyungtae Kim, and Si Chan Sung authors:</p><p>“Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, <b>School of Medicine, Pusan National University</b>, Yangsan-si, Republic of Korea.”</p><p>We apologize for this error.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9802504","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lean A. Al Saqer, Louisa Anita Fox, Ana Maria Soler Castells, Antonia Gerontati, Mohamad Bashir, Niraj S. Kumar, Wael I. Awad
Background
Bleeding into mediastinal and pleural cavities is common after cardiac surgery. Retained blood syndrome (RBS) refers to the need for further interventions to remove blood, blood clot, or bloody fluid from around the heart and lungs. The aim of this study was to ascertain the incidence of RBS following cardiac surgery at our center and evaluate ensuing outcomes.
Methods
We conducted a retrospective analysis of all patients who underwent cardiac surgery between September 2017 and February 2018, with follow-up completed in February 2022. The primary endpoint was the incidence of RBS secondary endpoints including postoperative survival at 30 days, 6 months, and 5 years, incidence of postoperative atrial fibrillation (POAF), acute kidney injury (AKI), surgical site infection (SSI), and prolonged length of stay in intensive therapy unit (ITU) (> 72 h) and hospital (> 10 days).
Results
A total of 1002 patients underwent surgery during the study period, of whom 12.7% (127/1002) developed RBS. Mortality was higher among RBS patients compared with non-RBS patients at 30 days, 6 months, and 5 years (11.9% vs. 2.5% (p < 0.001), 18.1% vs. 4.2% (p = 0.001), and 19.0% vs, 8.9% (p < 0.001), respectively). The incidence of all secondary endpoints was also higher among RBS patients: POAF (33.9% vs. 20.8%, p < 0.001), AKI (38.6% vs. 17.9%, p < 0.001), SSI (11.8% vs. 2.1%, p < 0.001), prolonged ITU stay (61.4% vs. 31.4%, p < 0.001), and prolonged hospital stay (51.2% vs. 19.7%, p < 0.001).
Conclusions
The incidence of RBS following cardiac surgery is high and is associated with increased mortality and morbidity. Implementing interventions to minimize bleeding and reduce retained blood volume postcardiac surgery may improve patient outcomes.
{"title":"Retained Blood Syndrome Is Associated With High Mortality and Morbidity After Cardiac Surgery","authors":"Lean A. Al Saqer, Louisa Anita Fox, Ana Maria Soler Castells, Antonia Gerontati, Mohamad Bashir, Niraj S. Kumar, Wael I. Awad","doi":"10.1155/jocs/5567661","DOIUrl":"https://doi.org/10.1155/jocs/5567661","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bleeding into mediastinal and pleural cavities is common after cardiac surgery. Retained blood syndrome (RBS) refers to the need for further interventions to remove blood, blood clot, or bloody fluid from around the heart and lungs. The aim of this study was to ascertain the incidence of RBS following cardiac surgery at our center and evaluate ensuing outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of all patients who underwent cardiac surgery between September 2017 and February 2018, with follow-up completed in February 2022. The primary endpoint was the incidence of RBS secondary endpoints including postoperative survival at 30 days, 6 months, and 5 years, incidence of postoperative atrial fibrillation (POAF), acute kidney injury (AKI), surgical site infection (SSI), and prolonged length of stay in intensive therapy unit (ITU) (> 72 h) and hospital (> 10 days).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1002 patients underwent surgery during the study period, of whom 12.7% (127/1002) developed RBS. Mortality was higher among RBS patients compared with non-RBS patients at 30 days, 6 months, and 5 years (11.9% vs. 2.5% (<i>p</i> < 0.001), 18.1% vs. 4.2% (<i>p</i> = 0.001), and 19.0% vs, 8.9% (<i>p</i> < 0.001), respectively). The incidence of all secondary endpoints was also higher among RBS patients: POAF (33.9% vs. 20.8%, <i>p</i> < 0.001), AKI (38.6% vs. 17.9%, <i>p</i> < 0.001), SSI (11.8% vs. 2.1%, <i>p</i> < 0.001), prolonged ITU stay (61.4% vs. 31.4%, <i>p</i> < 0.001), and prolonged hospital stay (51.2% vs. 19.7%, <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The incidence of RBS following cardiac surgery is high and is associated with increased mortality and morbidity. Implementing interventions to minimize bleeding and reduce retained blood volume postcardiac surgery may improve patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5567661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145739393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Arammash, Axel Gomez, William Carroway, Jay Patel, Yuvraj Mahadeshwar, Shiv Verma, Elaine E. Tseng, Marko T. Boskovski
Background
There is mounting evidence of the long-term benefits of multiple versus single arterial grafts (MAG vs. SAG) during coronary artery bypass grafting (CABG). However, the adoption of MAG has been low in nonfederal institutions as reported by the Society of Thoracic Surgeons Database, and adoption and results from lower volume federal institutions have rarely been reported. Here, we report our long-term clinical outcomes of MAG in a veteran population.
Methods
We collected data on 521 consecutive CABG patients from 2013 to 2023. The decision for MAG was at the discretion of the operating surgeon with use of skeletonized bilateral internal mammary arteries (BIMAs) when applicable and procedures included both on-pump and off-pump CABG. The Fisher exact test was used to compare categorical variables, and the Wilcoxon rank sum test was used to compare continuous variables. A Mann–Kendall statistical test was used to test the trend of MAG use over time, and a Cox proportional hazards model was used to compare mortality between the groups after adjusting for confounders.
Results
Our patients had a mean (SD) age of 67.3 (7.2) years with 2.72 (0.68) diseased coronary vessels. Over the course of the study, 58% of the patients received MAG. There was a significant increase of MAG over time (p = 0.03), with 0% prior to 2013, 69.1% by 2015, and settling at 80.0% utilization in 2022. Patients who received MAG had a lower prevalence of chronic kidney disease and history of myocardial infarction. Patients who received MAG received significantly more total bypass grafts. Right internal mammary artery was utilized 69.4% and radial artery 32.9% of the time in MAG cases. There were no differences in short-term mortality or sternal wound infections between the two groups. However, there was improved long-term mortality seen as early as 5 years with MAG.
Conclusions
In a lower-volume federal center, there was a significant increase in MAG utilization over time and improved long-term survival for patients receiving MAG than SAG with no differences in short-term mortality or sternal wound infection.
背景越来越多的证据表明，在冠状动脉旁路移植术（CABG）中，多动脉与单动脉移植（MAG vs. SAG）的长期益处。然而，据胸外科学会数据库报道，MAG在非联邦机构的采用率很低，而在规模较小的联邦机构的采用率和结果很少有报道。在这里，我们报告了退伍军人群体MAG的长期临床结果。方法收集2013 - 2023年连续521例CABG患者的资料。MAG的决定由外科医生酌情决定，在适用的情况下使用骨架化的双侧乳腺内动脉（BIMAs），手术包括有泵和无泵CABG。分类变量比较采用Fisher精确检验，连续变量比较采用Wilcoxon秩和检验。采用Mann-Kendall统计检验检验MAG使用随时间的变化趋势，采用Cox比例风险模型在调整混杂因素后比较两组之间的死亡率。结果患者平均（SD）年龄为67.3（7.2）岁，冠脉病变血管2.72（0.68）条。在研究过程中，58%的患者接受了MAG治疗，随着时间的推移，MAG的使用率显著增加（p = 0.03）， 2013年之前为0%，2015年为69.1%，到2022年稳定在80.0%。接受MAG治疗的患者有较低的慢性肾脏疾病患病率和心肌梗死史。接受MAG的患者接受了更多的全旁路移植。右乳内动脉占69.4%，桡动脉占32.9%。两组在短期死亡率和胸骨伤口感染方面没有差异。然而，早在接受MAG治疗5年后，长期死亡率就有所改善。结论：在一个小容量的联邦中心，随着时间的推移，MAG的使用率显著增加，接受MAG治疗的患者的长期生存率比接受SAG治疗的患者有所改善，短期死亡率和胸骨伤口感染没有差异。
{"title":"Multiple Versus Single Arterial Grafts in Coronary Artery Bypass Grafting Among Veterans","authors":"Mohammad Arammash, Axel Gomez, William Carroway, Jay Patel, Yuvraj Mahadeshwar, Shiv Verma, Elaine E. Tseng, Marko T. Boskovski","doi":"10.1155/jocs/3134321","DOIUrl":"https://doi.org/10.1155/jocs/3134321","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is mounting evidence of the long-term benefits of multiple versus single arterial grafts (MAG vs. SAG) during coronary artery bypass grafting (CABG). However, the adoption of MAG has been low in nonfederal institutions as reported by the Society of Thoracic Surgeons Database, and adoption and results from lower volume federal institutions have rarely been reported. Here, we report our long-term clinical outcomes of MAG in a veteran population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected data on 521 consecutive CABG patients from 2013 to 2023. The decision for MAG was at the discretion of the operating surgeon with use of skeletonized bilateral internal mammary arteries (BIMAs) when applicable and procedures included both on-pump and off-pump CABG. The Fisher exact test was used to compare categorical variables, and the Wilcoxon rank sum test was used to compare continuous variables. A Mann–Kendall statistical test was used to test the trend of MAG use over time, and a Cox proportional hazards model was used to compare mortality between the groups after adjusting for confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our patients had a mean (SD) age of 67.3 (7.2) years with 2.72 (0.68) diseased coronary vessels. Over the course of the study, 58% of the patients received MAG. There was a significant increase of MAG over time (<i>p</i> = 0.03), with 0% prior to 2013, 69.1% by 2015, and settling at 80.0% utilization in 2022. Patients who received MAG had a lower prevalence of chronic kidney disease and history of myocardial infarction. Patients who received MAG received significantly more total bypass grafts. Right internal mammary artery was utilized 69.4% and radial artery 32.9% of the time in MAG cases. There were no differences in short-term mortality or sternal wound infections between the two groups. However, there was improved long-term mortality seen as early as 5 years with MAG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a lower-volume federal center, there was a significant increase in MAG utilization over time and improved long-term survival for patients receiving MAG than SAG with no differences in short-term mortality or sternal wound infection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3134321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to examine the outcomes of cardiovascular surgery in Jehovah’s witnesses (JWs) according to surgical urgency (elective vs. emergency), investigate the relationship between surgical urgency and postoperative anemia progression, and determine the impact of postoperative anemia on overall mortality.
Methods
JW patients undergoing cardiovascular surgery were categorized into elective (n = 35) and emergency (n = 7) groups. Baseline characteristics, intraoperative data, postoperative complications, and all-cause mortality were compared. Postoperative hemoglobin (Hb) trends were analyzed using linear mixed-effects models. Survival analysis, including multivariable Cox proportional hazards regression, identified independent risk factors for mortality.
Results
Emergent cases had lower preoperative Hb (12.2 [11.3–12.3] vs. 13.5 [12.2–14.4] g/dL, p = 0.024) and higher incidence of acute type A aortic dissection (85.7% vs. 2.9%) than elective cases. Perioperative Hb levels were significantly lower in emergent patients demonstrating higher rates of 30-day mortality (42.9% vs. 2.9%, p = 0.011). Survival analysis showed a significant difference favoring the elective group (p = 0.003). Cox proportional hazards analysis revealed that emergency surgery (HR, 4.01 and 95% confidence interval [CI], 1.13–14.19) and the lowest postoperative Hb level (HR, 0.66 and 95% CI, 0.45–0.98) were shown to be independent predictors of postoperative mortality.
Conclusions
Emergency cardiovascular surgery in JWs is associated with significantly poorer outcomes, including higher mortality and more severe postoperative anemia, compared with elective procedures. Severe postoperative anemia is an independent predictor of postoperative mortality. These findings underscore the critical need for intensified patient blood management strategies, even in emergent settings, to mitigate risks in this vulnerable patient population.
方法将JW例心血管手术患者分为择期组（n = 35）和急诊组（n = 7）。比较基线特征、术中数据、术后并发症和全因死亡率。术后血红蛋白（Hb）趋势分析采用线性混合效应模型。生存分析，包括多变量Cox比例风险回归，确定了死亡率的独立危险因素。结果急诊患者术前Hb（12.2[11.3-12.3]对13.5 [12.2 - 14.4]g/dL, p = 0.024）低于择期患者，急性A型主动脉夹层发生率（85.7%对2.9%）高于择期患者。急诊患者围手术期Hb水平显著降低，30天死亡率较高（42.9% vs. 2.9%, p = 0.011）。生存分析显示择期组有显著差异（p = 0.003）。Cox比例风险分析显示，急诊手术（HR, 4.01, 95%可信区间[CI]， 1.13-14.19）和术后最低Hb水平（HR, 0.66, 95% CI, 0.45-0.98）是术后死亡率的独立预测因素。结论：与选择性手术相比，JWs的急诊心血管手术预后明显较差，包括更高的死亡率和更严重的术后贫血。术后严重贫血是术后死亡率的独立预测因子。这些发现强调，即使在紧急情况下，也迫切需要加强患者血液管理策略，以减轻这一弱势患者群体的风险。
{"title":"Impact of Surgical Urgency on Outcomes and Postoperative Anemia in Jehovah’s Witnesses Undergoing Cardiovascular Surgery","authors":"Tsuyoshi Yamabe, Kenichiro Noguchi, Naomi Imai, Shogo Matsui, Chishio Arai, Daisuke Hama, Takashi Ota, Tohru Asai","doi":"10.1155/jocs/9190618","DOIUrl":"https://doi.org/10.1155/jocs/9190618","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to examine the outcomes of cardiovascular surgery in Jehovah’s witnesses (JWs) according to surgical urgency (elective vs. emergency), investigate the relationship between surgical urgency and postoperative anemia progression, and determine the impact of postoperative anemia on overall mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>JW patients undergoing cardiovascular surgery were categorized into elective (<i>n</i> = 35) and emergency (<i>n</i> = 7) groups. Baseline characteristics, intraoperative data, postoperative complications, and all-cause mortality were compared. Postoperative hemoglobin (Hb) trends were analyzed using linear mixed-effects models. Survival analysis, including multivariable Cox proportional hazards regression, identified independent risk factors for mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Emergent cases had lower preoperative Hb (12.2 [11.3–12.3] vs. 13.5 [12.2–14.4] g/dL, <i>p</i> = 0.024) and higher incidence of acute type A aortic dissection (85.7% vs. 2.9%) than elective cases. Perioperative Hb levels were significantly lower in emergent patients demonstrating higher rates of 30-day mortality (42.9% vs. 2.9%, <i>p</i> = 0.011). Survival analysis showed a significant difference favoring the elective group (<i>p</i> = 0.003). Cox proportional hazards analysis revealed that emergency surgery (HR, 4.01 and 95% confidence interval [CI], 1.13–14.19) and the lowest postoperative Hb level (HR, 0.66 and 95% CI, 0.45–0.98) were shown to be independent predictors of postoperative mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency cardiovascular surgery in JWs is associated with significantly poorer outcomes, including higher mortality and more severe postoperative anemia, compared with elective procedures. Severe postoperative anemia is an independent predictor of postoperative mortality. These findings underscore the critical need for intensified patient blood management strategies, even in emergent settings, to mitigate risks in this vulnerable patient population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9190618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hashem Abdel Kader, Panagiotis G. Kyriazis, Prakash P. Punjabi
Background
Saphenous vein grafts (SVGs) remain widely used in coronary artery bypass grafting (CABG). This study examines the role of wall shear stress (WSS) and graft geometry on SVG patency and evaluates the potential of computational fluid dynamics (CFD) as an assessment tool post-CABG.
Methods
A systematic search was conducted in PubMed, Cochrane Library, Scopus and EMBASE using the terms ‘wall shear stress’, ‘geometry’, ‘computational fluid dynamics’ and ‘saphenous vein graft patency’. From 374 articles, 82 met the inclusion criteria, focussing on WSS and/or graft geometry in relation to SVG patency in coronary disease. Studies limited to qualitative findings or animal models were excluded, narrowing the selection to 64 eligible articles.
Results
Adverse WSS conditions were linked to pronounced intimal hyperplasia, atherosclerosis and graft failure. Geometrical factors influencing SVG patency included graft diameter, target coronary diameter (> 2.0 mm), graft wall thickness (> 1.5 mm), curvature at the graft-host junction and anastomotic angles exceeding 15–20°. CFD-based evaluations of SVG patency aligned with existing literature findings.
Discussion
The interplay between SVG patency, WSS and graft geometry is well documented. CFD offers a promising modality for in-depth graft analysis by gauging geometry and flow dynamics. By delivering objective information, CFD can equip surgeons with the tools to optimise strategies and thereby enhance CABG patient outcomes.
{"title":"Evaluation of Saphenous Vein Graft Patency Using Wall Shear Stress and Geometry Post Coronary Artery Bypass Graft Surgery","authors":"Hashem Abdel Kader, Panagiotis G. Kyriazis, Prakash P. Punjabi","doi":"10.1155/jocs/5602643","DOIUrl":"https://doi.org/10.1155/jocs/5602643","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Saphenous vein grafts (SVGs) remain widely used in coronary artery bypass grafting (CABG). This study examines the role of wall shear stress (WSS) and graft geometry on SVG patency and evaluates the potential of computational fluid dynamics (CFD) as an assessment tool post-CABG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed, Cochrane Library, Scopus and EMBASE using the terms ‘wall shear stress’, ‘geometry’, ‘computational fluid dynamics’ and ‘saphenous vein graft patency’. From 374 articles, 82 met the inclusion criteria, focussing on WSS and/or graft geometry in relation to SVG patency in coronary disease. Studies limited to qualitative findings or animal models were excluded, narrowing the selection to 64 eligible articles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adverse WSS conditions were linked to pronounced intimal hyperplasia, atherosclerosis and graft failure. Geometrical factors influencing SVG patency included graft diameter, target coronary diameter (> 2.0 mm), graft wall thickness (> 1.5 mm), curvature at the graft-host junction and anastomotic angles exceeding 15–20°. CFD-based evaluations of SVG patency aligned with existing literature findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The interplay between SVG patency, WSS and graft geometry is well documented. CFD offers a promising modality for in-depth graft analysis by gauging geometry and flow dynamics. By delivering objective information, CFD can equip surgeons with the tools to optimise strategies and thereby enhance CABG patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5602643","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145521707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tristan W. Dorey, Loryn J. Bohne, Ali Fatehi Hassanabad, Kaylene Duttchen, Stephen B. Wilton, Rosaleen Chun
Background
Postoperative atrial fibrillation (POAF) occurs in roughly one-third of patients undergoing cardiac surgery, increasing mortality, morbidity, and healthcare costs. Frailty, a syndrome of physiological decline, is associated with poor outcomes after cardiac surgery. The link between frailty and POAF has not been clearly established.
Methods
A systematic search of PubMed and EMBASE was conducted up to January 2025 for studies reporting preoperative frailty scores and POAF rates postcardiac surgery. Transcatheter aortic valve replacement (TAVR) studies were assessed separately. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) for frail vs. nonfrail patients were calculated using a random-effect model.
Results
Eighteen studies involving 9098 patients (undergoing coronary artery bypass, surgical valve replacement, or both) were included. Meta-analysis indicated that frailty was associated with a higher risk of POAF (RR 1.20; 95% CI 1.08–1.33, p = 0.0008). Subgroup analyses showed consistent frailty effects across different patient ages, study designs, surgery types, and sample sizes. Notably, POAF risk was higher in studies using clinical frailty scales (RR 1.33; 95% CI 1.15–1.54, p < 0.0001) compared to those using surrogate imaging/lab-based methods (RR 1.10; 95% CI 0.92–1.33, p = 0.24) though comparison between subgroups did not reach statistical significance (p = 0.08). In 3 studies for patients undergoing TAVR, there was no association between frailty and POAF (RR 1.24; 95% CI 0.81–1.88, p = 0.32).
Conclusion
This meta-analysis underscores the association between frailty and increased POAF risk in cardiac surgery patients, highlighting the need for comprehensive clinical frailty assessments in preoperative evaluations to identify high-risk patients and optimize perioperative management.
背景：大约三分之一的心脏手术患者发生术后心房颤动（POAF），增加了死亡率、发病率和医疗费用。虚弱是一种生理机能下降的综合征，与心脏手术后不良预后相关。虚弱和POAF之间的联系还没有明确确立。方法系统检索PubMed和EMBASE，检索截至2025年1月的报告术前虚弱评分和心脏手术后POAF发生率的研究。经导管主动脉瓣置换术（TAVR）研究被单独评估。使用随机效应模型计算体弱与非体弱患者的合并风险比（rr）和95%置信区间（ci）。结果纳入18项研究，涉及9098例患者（接受冠状动脉搭桥术、手术瓣膜置换术或两者兼而有之）。荟萃分析显示，虚弱与POAF的高风险相关（RR 1.20; 95% CI 1.08-1.33, p = 0.0008）。亚组分析显示，在不同的患者年龄、研究设计、手术类型和样本量中，虚弱效应是一致的。值得注意的是，使用临床虚弱量表的研究中，POAF风险高于使用替代成像/实验室方法的研究（RR 1.33; 95% CI 1.15-1.54, p < 0.0001），但亚组间比较无统计学意义（p = 0.08）。在3项针对TAVR患者的研究中，虚弱和POAF之间没有相关性（RR 1.24; 95% CI 0.81-1.88, p = 0.32）。结论：本荟萃分析强调了心脏手术患者虚弱与POAF风险增加之间的关联，强调了术前评估中需要进行全面的临床虚弱评估，以识别高危患者并优化围手术期管理。
{"title":"The Relationship Between Frailty and Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis","authors":"Tristan W. Dorey, Loryn J. Bohne, Ali Fatehi Hassanabad, Kaylene Duttchen, Stephen B. Wilton, Rosaleen Chun","doi":"10.1155/jocs/1336346","DOIUrl":"https://doi.org/10.1155/jocs/1336346","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Postoperative atrial fibrillation (POAF) occurs in roughly one-third of patients undergoing cardiac surgery, increasing mortality, morbidity, and healthcare costs. Frailty, a syndrome of physiological decline, is associated with poor outcomes after cardiac surgery. The link between frailty and POAF has not been clearly established.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed and EMBASE was conducted up to January 2025 for studies reporting preoperative frailty scores and POAF rates postcardiac surgery. Transcatheter aortic valve replacement (TAVR) studies were assessed separately. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) for frail vs. nonfrail patients were calculated using a random-effect model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighteen studies involving 9098 patients (undergoing coronary artery bypass, surgical valve replacement, or both) were included. Meta-analysis indicated that frailty was associated with a higher risk of POAF (RR 1.20; 95% CI 1.08–1.33, <i>p</i> = 0.0008). Subgroup analyses showed consistent frailty effects across different patient ages, study designs, surgery types, and sample sizes. Notably, POAF risk was higher in studies using clinical frailty scales (RR 1.33; 95% CI 1.15–1.54, <i>p</i> < 0.0001) compared to those using surrogate imaging/lab-based methods (RR 1.10; 95% CI 0.92–1.33, <i>p</i> = 0.24) though comparison between subgroups did not reach statistical significance (<i>p</i> = 0.08). In 3 studies for patients undergoing TAVR, there was no association between frailty and POAF (RR 1.24; 95% CI 0.81–1.88, <i>p</i> = 0.32).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This meta-analysis underscores the association between frailty and increased POAF risk in cardiac surgery patients, highlighting the need for comprehensive clinical frailty assessments in preoperative evaluations to identify high-risk patients and optimize perioperative management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/1336346","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vladimir Pichugin, Alexandr Volvach, Anna Deryugina, Victor Selemir, Stepan Domnin, Sergey Fedorov, Darya Danilova, Artem Starshov, Roman Trofimov
Background/Aim
The present study investigates the effects of isolated administration of nitric oxide (NO) and molecular hydrogen (H2), as well as their combined delivery into the gas supply line of the cardiopulmonary bypass (CPB) circuit. The primary objective is to evaluate their impact on antioxidant activity, biomarkers of myocardial injury, and clinical outcomes in patients undergoing cardiac surgery.
Materials and Methods
A total of 123 patients undergoing cardiac surgery with CPB were enrolled in the study and randomly assigned to four groups. Group 1 (n = 30) served as the control and received standard CPB without gas supplementation. Group 2 (n = 33) received isolated nitric oxide (NO) administration at a concentration of 40 ppm via the CPB circuit. Group 3 (n = 30) was administered molecular hydrogen (H2) at 1.2 ppm in isolation. Group 4 (n = 30) received a combined supply of NO (40 ppm) and H2 (1.2 ppm) through the CPB gas line. The following parameters were assessed: the intensity of lipid peroxidation processes (LPPs), erythrocyte aggregation, and intracellular adenosine triphosphate (ATP) concentrations. The level of cardiac troponin I (cTnI) after surgery was investigated. Clinical outcomes were registered.
Results
Statistically significant lower levels of diene and triene conjugates, Schiff bases in Group 3 (H2) and Group 4 (NO + H2) during CPB were revealed. A decrease in the aggregation of the researched groups was revealed in comparison with the control group. The concentration of ATP was increased in Groups 3 and 4 relatives to the control, in which ATP was reduced. Statistically significant lower levels of cTnI after surgery in Group 2 and Group 4 were registered. No postoperative complications were noted in Groups 2 and 4. A statistically important drop in both the amount of time that ventilation was administered and the duration spent in the intensive care unit (ICU) was registered in Group 4 compared with Group 2.
Conclusion
The combined administration of nitric oxide and molecular hydrogen during CPB resulted in a statistically significant reduction in lipid peroxidation activity and erythrocyte aggregation, as well as decreased postoperative levels of cTnI. These effects contributed to enhanced myocardial protection, accelerated postoperative recovery, and reduced duration of ICU stay, underscoring the clinical ef
{"title":"Enhanced Organ Protection During Cardiopulmonary Bypass in Cardiac Surgery: Synergistic Effects of Nitric Oxide and Hydrogen Therapy","authors":"Vladimir Pichugin, Alexandr Volvach, Anna Deryugina, Victor Selemir, Stepan Domnin, Sergey Fedorov, Darya Danilova, Artem Starshov, Roman Trofimov","doi":"10.1155/jocs/6749229","DOIUrl":"https://doi.org/10.1155/jocs/6749229","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aim</h3>\u0000 \u0000 <p>The present study investigates the effects of isolated administration of nitric oxide (NO) and molecular hydrogen (H<sub>2</sub>), as well as their combined delivery into the gas supply line of the cardiopulmonary bypass (CPB) circuit. The primary objective is to evaluate their impact on antioxidant activity, biomarkers of myocardial injury, and clinical outcomes in patients undergoing cardiac surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>A total of 123 patients undergoing cardiac surgery with CPB were enrolled in the study and randomly assigned to four groups. Group 1 (<i>n</i> = 30) served as the control and received standard CPB without gas supplementation. Group 2 (<i>n</i> = 33) received isolated nitric oxide (NO) administration at a concentration of 40 ppm via the CPB circuit. Group 3 (<i>n</i> = 30) was administered molecular hydrogen (H<sub>2</sub>) at 1.2 ppm in isolation. Group 4 (<i>n</i> = 30) received a combined supply of NO (40 ppm) and H<sub>2</sub> (1.2 ppm) through the CPB gas line. The following parameters were assessed: the intensity of lipid peroxidation processes (LPPs), erythrocyte aggregation, and intracellular adenosine triphosphate (ATP) concentrations. The level of cardiac troponin I (cTnI) after surgery was investigated. Clinical outcomes were registered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Statistically significant lower levels of diene and triene conjugates, Schiff bases in Group 3 (H<sub>2</sub>) and Group 4 (NO + H<sub>2</sub>) during CPB were revealed. A decrease in the aggregation of the researched groups was revealed in comparison with the control group. The concentration of ATP was increased in Groups 3 and 4 relatives to the control, in which ATP was reduced. Statistically significant lower levels of cTnI after surgery in Group 2 and Group 4 were registered. No postoperative complications were noted in Groups 2 and 4. A statistically important drop in both the amount of time that ventilation was administered and the duration spent in the intensive care unit (ICU) was registered in Group 4 compared with Group 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combined administration of nitric oxide and molecular hydrogen during CPB resulted in a statistically significant reduction in lipid peroxidation activity and erythrocyte aggregation, as well as decreased postoperative levels of cTnI. These effects contributed to enhanced myocardial protection, accelerated postoperative recovery, and reduced duration of ICU stay, underscoring the clinical ef","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6749229","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roslan Aslannif, Si Ling Soh, Yee Sin Tey, Am Haris Norhaliza, Teo Jassie, Lynne Murray Rowina, Kee Soon Chong, Kian Boon Wong, Dillon Jeswant, Mohamed Yunus Alwi, Mohd Ghazi Azmee
Background/Purpose
Bicuspid aortic valves (BAV) are a common cause of surgical aortic valve replacement (SAVR). This study aims to evaluate medium-term (5-year) outcomes, echocardiographic changes, and predictors of mortality in bicuspid SAVR patients, with a focus on preoperative and postoperative echocardiographic parameters, including strain measurements.
Methods
A retrospective cohort of 448 bicuspid SAVR patients from 2015–2021 was analyzed. Preoperative echocardiograms were obtained within 1 month before surgery, with follow-up at 6 months. Parameters assessed included standard measurements (e.g., stroke volume index [SVi], ejection fraction [EF], flow rate, and pressure gradients) and advanced strain metrics (e.g., global longitudinal strain [GLS], left atrial reservoir strain [LArS], and right ventricular free wall strain [RVFWS]). Mortality data were collected via national registry, with a median follow-up of 54.2 months.
Results
The median age was 59 years; 68.5% were male. The 30-day and 5-year mortality rates were 3.6% and 18.3%, respectively, both lower than the overall SAVR cohort. Preoperative parameters such as lower SVi (p = 0.027), EF (p = 0.045), flow rate (p = 0.027), and reduced strain measures (LArS, p < 0.001; LAcS, p = 0.013; RVFWS, p = 0.005) correlated with worse outcomes. Postoperative reductions in EF and SVi were observed, but only the change in mean pressure gradient (meanPG) was associated with 5-year mortality. Higher absolute LArS independently predicted improved survival (p < 0.001). Multivariate analysis identified hypertension, elevated urea, longer hospital stays, and higher preoperative LArS as independent predictors of mortality.
Conclusions
Bicuspid SAVR patients exhibit favorable medium-term survival, with 5-year mortality at 18.3%. Absolute preoperative LArS are a key independent predictor of outcomes, alongside clinical factors such as hypertension and urea levels. The reduction in meanPG postsurgery correlates with better long-term survival, emphasizing the importance of comprehensive echocardiographic assessment in risk stratification and management.
背景/目的双尖瓣主动脉瓣（BAV）是外科主动脉瓣置换术（SAVR）的常见原因。本研究旨在评估双尖瓣SAVR患者的中期（5年）预后、超声心动图变化和死亡率预测因素，重点关注术前和术后超声心动图参数，包括应变测量。方法对2015-2021年448例双尖瓣SAVR患者进行回顾性队列分析。术前1个月内进行超声心动图检查，术后6个月随访。评估的参数包括标准测量（如卒中容积指数[SVi]、射血分数[EF]、流速和压力梯度）和高级应变测量（如总纵向应变[GLS]、左心房储液池应变[LArS]和右心室游离壁应变[RVFWS]）。死亡率数据通过国家登记收集，中位随访时间为54.2个月。结果中位年龄59岁；68.5%为男性。30天和5年死亡率分别为3.6%和18.3%，均低于总体SAVR队列。术前参数如较低的SVi （p = 0.027）、EF （p = 0.045）、流速（p = 0.027）和减小的应变测量（LArS, p < 0.001; LAcS, p = 0.013； RVFWS, p = 0.005）与较差的预后相关。观察到术后EF和SVi的降低，但只有平均压力梯度（meanPG）的变化与5年死亡率相关。较高的绝对LArS独立预测了生存率的提高（p < 0.001）。多变量分析发现高血压、尿素升高、住院时间较长和术前LArS较高是死亡率的独立预测因素。结论双尖瓣SAVR患者中期生存率较好，5年死亡率为18.3%。与高血压和尿素水平等临床因素一起，绝对术前LArS是预后的关键独立预测因素。术后平均pg的降低与较好的长期生存相关，强调了全面超声心动图评估在风险分层和管理中的重要性。
{"title":"Bicuspid Surgical Aortic Valve Replacement: Anatomical Insight, Medium Term 5 Years Outcomes, and Predictors of Mortality: An Echocardiographic Study","authors":"Roslan Aslannif, Si Ling Soh, Yee Sin Tey, Am Haris Norhaliza, Teo Jassie, Lynne Murray Rowina, Kee Soon Chong, Kian Boon Wong, Dillon Jeswant, Mohamed Yunus Alwi, Mohd Ghazi Azmee","doi":"10.1155/jocs/6619189","DOIUrl":"https://doi.org/10.1155/jocs/6619189","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Purpose</h3>\u0000 \u0000 <p>Bicuspid aortic valves (BAV) are a common cause of surgical aortic valve replacement (SAVR). This study aims to evaluate medium-term (5-year) outcomes, echocardiographic changes, and predictors of mortality in bicuspid SAVR patients, with a focus on preoperative and postoperative echocardiographic parameters, including strain measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort of 448 bicuspid SAVR patients from 2015–2021 was analyzed. Preoperative echocardiograms were obtained within 1 month before surgery, with follow-up at 6 months. Parameters assessed included standard measurements (e.g., stroke volume index [SVi], ejection fraction [EF], flow rate, and pressure gradients) and advanced strain metrics (e.g., global longitudinal strain [GLS], left atrial reservoir strain [LArS], and right ventricular free wall strain [RVFWS]). Mortality data were collected via national registry, with a median follow-up of 54.2 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age was 59 years; 68.5% were male. The 30-day and 5-year mortality rates were 3.6% and 18.3%, respectively, both lower than the overall SAVR cohort. Preoperative parameters such as lower SVi (<i>p</i> = 0.027), EF (<i>p</i> = 0.045), flow rate (<i>p</i> = 0.027), and reduced strain measures (LArS, <i>p</i> < 0.001; LAcS, <i>p</i> = 0.013; RVFWS, <i>p</i> = 0.005) correlated with worse outcomes. Postoperative reductions in EF and SVi were observed, but only the change in mean pressure gradient (meanPG) was associated with 5-year mortality. Higher absolute LArS independently predicted improved survival (<i>p</i> < 0.001). Multivariate analysis identified hypertension, elevated urea, longer hospital stays, and higher preoperative LArS as independent predictors of mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bicuspid SAVR patients exhibit favorable medium-term survival, with 5-year mortality at 18.3%. Absolute preoperative LArS are a key independent predictor of outcomes, alongside clinical factors such as hypertension and urea levels. The reduction in meanPG postsurgery correlates with better long-term survival, emphasizing the importance of comprehensive echocardiographic assessment in risk stratification and management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/6619189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pooya Eini, Peyman Eini, Homa Serpoush, Mohammad Rezayee, Jason Tremblay
Background
Aortic dissection is a life-threatening condition requiring rapid and accurate diagnosis. Machine learning (ML) models have shown promise in enhancing diagnostic performance using imaging modalities, but their pooled efficacy remains unclear. This systematic review and meta-analysis evaluates the diagnostic accuracy of ML models for detecting aortic dissection.
Methods
Following PRISMA guidelines, we searched PubMed, Scopus, Embase, Web of Science, and ProQuest up to March 10, 2025, identifying 775 articles. After removing duplicates, 358 articles were screened, 28 underwent full-text review, and 21 studies were included, with 18 providing sufficient metrics for meta-analysis. The MIDAS module in Stata was used to pool sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) for the best-performing models, assessed via a bivariate mixed-effects model. Risk of bias was evaluated using PROBAST + AI.
Results
The 21 studies included 261,477 patients (mean age 58.74 years, 66.67% male), predominantly from China (11 studies). Imaging modalities included CT angiography (10 studies) and noncontrast/contrast-enhanced CT (five studies). The best models (18 studies, 7957 positive, 41,852 negative cases) achieved a pooled sensitivity of 0.92 (95% CI: 0.87–0.96), a specificity of 0.95 (95% CI: 0.91–0.98), and an AUROC of 0.98 (95% CI: 0.96–0.99). Deep learning models (DenseNet121, Attention U-Net) predominated. Moderate to substantial heterogeneity in both pooled sensitivity (I2 = 64.85%) and specificity (I2 = 62.87%), likely due to diverse ML algorithms and imaging protocols, was identified.
Conclusions
ML models show strong diagnostic performance for detecting aortic dissection, highlighting their promise for clinical use. However, the standardization of methodologies is essential to reduce variability and promote broader clinical implementation.
{"title":"Machine Learning Applications in the Diagnosis and Prediction of Aortic Dissection: A Systematic Review and Meta-Analysis","authors":"Pooya Eini, Peyman Eini, Homa Serpoush, Mohammad Rezayee, Jason Tremblay","doi":"10.1155/jocs/3328006","DOIUrl":"https://doi.org/10.1155/jocs/3328006","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Aortic dissection is a life-threatening condition requiring rapid and accurate diagnosis. Machine learning (ML) models have shown promise in enhancing diagnostic performance using imaging modalities, but their pooled efficacy remains unclear. This systematic review and meta-analysis evaluates the diagnostic accuracy of ML models for detecting aortic dissection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we searched PubMed, Scopus, Embase, Web of Science, and ProQuest up to March 10, 2025, identifying 775 articles. After removing duplicates, 358 articles were screened, 28 underwent full-text review, and 21 studies were included, with 18 providing sufficient metrics for meta-analysis. The MIDAS module in Stata was used to pool sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) for the best-performing models, assessed via a bivariate mixed-effects model. Risk of bias was evaluated using PROBAST + AI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 21 studies included 261,477 patients (mean age 58.74 years, 66.67% male), predominantly from China (11 studies). Imaging modalities included CT angiography (10 studies) and noncontrast/contrast-enhanced CT (five studies). The best models (18 studies, 7957 positive, 41,852 negative cases) achieved a pooled sensitivity of 0.92 (95% CI: 0.87–0.96), a specificity of 0.95 (95% CI: 0.91–0.98), and an AUROC of 0.98 (95% CI: 0.96–0.99). Deep learning models (DenseNet121, Attention U-Net) predominated. Moderate to substantial heterogeneity in both pooled sensitivity (<i>I</i><sup>2</sup> = 64.85%) and specificity (<i>I</i><sup>2</sup> = 62.87%), likely due to diverse ML algorithms and imaging protocols, was identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ML models show strong diagnostic performance for detecting aortic dissection, highlighting their promise for clinical use. However, the standardization of methodologies is essential to reduce variability and promote broader clinical implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3328006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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