Juan David Niño-Calvera, Julian Senociain, Jaime Camacho, Nicolas Nunez-Ordonez, Carlos Obando, Tomas Chalela, Carlos Villa, Nestor Sandoval, Juan P. Umaña
Objective
Describe the short- and long-term outcomes of valve-sparing aortic root replacement for aortic root aneurysm repair in a lower-volume center
Methods
We included patients with aortic root aneurysm who underwent the David procedure from January 2002 to June 2024 at our institution, identified by the institutional cardiac surgery database that follows the coding guidelines of the STS. We collected data from pre-, intra-, and postoperative periods. Follow-up was performed through the outpatient clinic, government databases, and telephone interviews. The main outcomes were survival, valve regurgitation recurrence, and freedom from reoperation.
Results
150 patients were identified in 22 years. The mean age was 52 years, 81% were male, and the most frequent comorbidity was hypertension. 23 patients had Marfan syndrome and a bicuspid aortic valve. 47% of patients had severe AR, and 15% had moderate AR. 65% patients underwent elective surgery. There was concomitant aortic arch repair in 6 patients, mitral valve repair in 10 patients, and one patient required descending aorta repair. There was one perioperative death. Freedom from significant AR was 92% at 9 years, and freedom from reoperation was 90% at 8 years. There were 8 valve-related reoperations and 11 deaths in the follow-up period. Survival was 97% after 10 years.
Conclusions
Valve-sparing aortic root replacement is a safe procedure that provides outstanding short- and long-term outcomes. In the long term, AR improvement is remarkable and maintainable. In our background, the David procedure has shown favorable outcomes comparable to those reported in high-volume income centers.
{"title":"22-Year Experience With Valve-Sparing Aortic Root Replacement in a Latin American Center","authors":"Juan David Niño-Calvera, Julian Senociain, Jaime Camacho, Nicolas Nunez-Ordonez, Carlos Obando, Tomas Chalela, Carlos Villa, Nestor Sandoval, Juan P. Umaña","doi":"10.1155/jocs/3451088","DOIUrl":"https://doi.org/10.1155/jocs/3451088","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Describe the short- and long-term outcomes of valve-sparing aortic root replacement for aortic root aneurysm repair in a lower-volume center</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included patients with aortic root aneurysm who underwent the David procedure from January 2002 to June 2024 at our institution, identified by the institutional cardiac surgery database that follows the coding guidelines of the STS. We collected data from pre-, intra-, and postoperative periods. Follow-up was performed through the outpatient clinic, government databases, and telephone interviews. The main outcomes were survival, valve regurgitation recurrence, and freedom from reoperation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>150 patients were identified in 22 years. The mean age was 52 years, 81% were male, and the most frequent comorbidity was hypertension. 23 patients had Marfan syndrome and a bicuspid aortic valve. 47% of patients had severe AR, and 15% had moderate AR. 65% patients underwent elective surgery. There was concomitant aortic arch repair in 6 patients, mitral valve repair in 10 patients, and one patient required descending aorta repair. There was one perioperative death. Freedom from significant AR was 92% at 9 years, and freedom from reoperation was 90% at 8 years. There were 8 valve-related reoperations and 11 deaths in the follow-up period. Survival was 97% after 10 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Valve-sparing aortic root replacement is a safe procedure that provides outstanding short- and long-term outcomes. In the long term, AR improvement is remarkable and maintainable. In our background, the David procedure has shown favorable outcomes comparable to those reported in high-volume income centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3451088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145366454","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}
Mehmet Akif Önalan, Behzat Tüzün, Eymen Recep, Zümrüt Berra Tan Recep, Şerife Özalp, Servet Ergün, Serap Bas, Erkut Oztürk, Ali Can Hatemi
Objectives
Surgical treatment of aortic arch hypoplasia includes differences in terms of perfusion strategies. We aimed to compare the early and midterm results of isolated aortic arch reconstruction in terms of operation on antegrade cerebral perfusion (ACP) with beating heart (BH) or ACP with cardiac arrest (CA).
Methods
Medical records of 72 patients undergoing isolated aortic arch reconstruction from October 2020 to April 2024 were retrospectively reviewed. The patients were divided into two groups: Group 1 (34 patients) underwent arch reconstruction on BH and Group 2 (38 patients) underwent arch reconstruction with CA. All arch repair procedures were performed with the patch augmentation technique.
Results
The median age at surgery was 13 (interquartile range (IQR), 7–39.2) days and the median weight was 3.3 (IQR, 2.8–4) kg. Fifty-two patients (72.2%) were neonates and 20 (27.8%) were infants. Postoperative early mortality rate was 1.39% (1/34 vs. 0/38, p = 0.28). There was no statistically significant difference between two groups in terms of delayed sternal closure, intensive care unit (ICU) and hospital stays (p = 0.78, 0.54, and 0.7). Fifteen (20.8%) of the patients were extubated on the table, and fast-track extubation rate was significantly higher in the BH group (11/34 vs. 4/38, p = 0.023). The median duration of follow-up was 7.2 (IQR, 1–18.2) months and there was no late death in either group. The incidence of restenosis and reintervention was not statistically significant between the two groups (1/34 vs. 1/38, p = 0.91).
Conclusion
Both perfusion strategies were associated with satisfactory early and midterm results. Although the length of stay in the ICU and hospital were not significantly different for both groups, the fast-track extubation rate was significantly higher in the BH group.
目的主动脉弓发育不全的外科治疗包括灌注策略的差异。我们的目的是比较在心脏跳动（BH）的顺行性脑灌注（ACP）或心脏骤停（CA）的ACP手术方面，孤立主动脉弓重建的早期和中期结果。方法回顾性分析2020年10月~ 2024年4月72例主动脉弓置换术患者的临床资料。患者分为两组：第一组（34例）行BH弓重建，第二组（38例）行CA弓重建。所有的弓修复手术均采用补片增强技术。结果手术年龄中位数为13 （IQR, 7 ~ 39.2）天，体重中位数为3.3 (IQR, 2.8 ~ 4) kg，新生儿52例（72.2%），婴幼儿20例（27.8%）。术后早期死亡率为1.39% （1/34 vs. 0/38, p = 0.28）。两组患者延迟闭合胸骨、重症监护病房（ICU）和住院时间差异无统计学意义（p = 0.78、0.54和0.7）。15例（20.8%）患者在手术台上拔管，其中BH组快速通道拔管率显著高于对照组（11/34 vs. 4/38, p = 0.023）。中位随访时间为7.2 （IQR, 1-18.2）个月，两组均无晚期死亡。两组患者再狭窄和再干预发生率比较，差异无统计学意义（1/34 vs 1/38, p = 0.91）。结论两种灌注策略均可获得满意的早期和中期疗效。虽然两组在ICU和医院的住院时间无显著差异，但BH组快速通道拔管率明显高于h组。
{"title":"Beating Heart Versus Cardiac Arrest in Isolated Aortic Arch Reconstruction: A Comparative Study in Neonates and Infants","authors":"Mehmet Akif Önalan, Behzat Tüzün, Eymen Recep, Zümrüt Berra Tan Recep, Şerife Özalp, Servet Ergün, Serap Bas, Erkut Oztürk, Ali Can Hatemi","doi":"10.1155/jocs/3445014","DOIUrl":"https://doi.org/10.1155/jocs/3445014","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Surgical treatment of aortic arch hypoplasia includes differences in terms of perfusion strategies. We aimed to compare the early and midterm results of isolated aortic arch reconstruction in terms of operation on antegrade cerebral perfusion (ACP) with beating heart (BH) or ACP with cardiac arrest (CA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Medical records of 72 patients undergoing isolated aortic arch reconstruction from October 2020 to April 2024 were retrospectively reviewed. The patients were divided into two groups: Group 1 (34 patients) underwent arch reconstruction on BH and Group 2 (38 patients) underwent arch reconstruction with CA. All arch repair procedures were performed with the patch augmentation technique.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age at surgery was 13 (interquartile range (IQR), 7–39.2) days and the median weight was 3.3 (IQR, 2.8–4) kg. Fifty-two patients (72.2%) were neonates and 20 (27.8%) were infants. Postoperative early mortality rate was 1.39% (1/34 vs. 0/38, <i>p</i> = 0.28). There was no statistically significant difference between two groups in terms of delayed sternal closure, intensive care unit (ICU) and hospital stays (<i>p</i> = 0.78, 0.54, <i>a</i><i>n</i><i>d</i> 0.7). Fifteen (20.8%) of the patients were extubated on the table, and fast-track extubation rate was significantly higher in the BH group (11/34 vs. 4/38, <i>p</i> = 0.023). The median duration of follow-up was 7.2 (IQR, 1–18.2) months and there was no late death in either group. The incidence of restenosis and reintervention was not statistically significant between the two groups (1/34 vs. 1/38, <i>p</i> = 0.91).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Both perfusion strategies were associated with satisfactory early and midterm results. Although the length of stay in the ICU and hospital were not significantly different for both groups, the fast-track extubation rate was significantly higher in the BH group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3445014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145317309","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}
Caleb R. Weissman, Jessica Parker, Holliann Umana, Rima Patel, Taylor Zimmer, Justin Fanning, Charles Willekes, Stephane Leung Wai Sang, Tomasz Timek
Background
Despite the rapid growth of the elderly patients presenting for coronary artery bypass grafting (CABG), long-term outcomes for patients over 80 years of age are incompletely understood. We set out to investigate clinical outcomes and long-term survival for octogenarian CABG patients across 3 decades.
Methods
Patients aged 80 and older who underwent isolated CABG at our center between January 1991 and June 2022 (n = 1268) were evaluated in this retrospective review. Patient data were collected from the Society of Thoracic Surgeons (STS) database and electronic medical records. Long-term survival was tracked via the Michigan and National Death Indices. The primary outcomes were short- and long-term mortality.
Results
Among 1268 patients, 33.1% (n = 420) were female, with an average age of 82.5 years. Common comorbidities included hypertension (86.1%), prior myocardial infarction (45.0%), and diabetes (28.3%). In-hospital mortality was 2.9% (n = 36), and 30-day mortality was 3.1% (n = 40). Survival at 5 and 10 years was 73.3% and 33.4%, respectively. Over 3 decades, 30-day mortality rates were 3.6% (n = 10) in 1991–2000, 3.7% (n = 17) in 2001–2010%, and 2.5% (n = 13) in 2011–2022 (p = 0.49). Postoperative complications included renal failure in 6.1% (n = 78), atrial fibrillation in 33.7% (n = 427), stroke in 2.4% (n = 30), and reoperation for bleeding in 1.7% (n = 21), with no changes over time. At discharge, 61.7% (n = 604) of patients went home.
Conclusions
In selected octogenarian patients, CABG can be performed with very good perioperative outcomes and home discharge for most patients. Great majority of these elderly patients were alive 5 years after surgery.
{"title":"Three Decades of Coronary Artery Bypass Grafting in Octogenarians: Clinical Outcomes and Long-Term Survival","authors":"Caleb R. Weissman, Jessica Parker, Holliann Umana, Rima Patel, Taylor Zimmer, Justin Fanning, Charles Willekes, Stephane Leung Wai Sang, Tomasz Timek","doi":"10.1155/jocs/4809680","DOIUrl":"https://doi.org/10.1155/jocs/4809680","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the rapid growth of the elderly patients presenting for coronary artery bypass grafting (CABG), long-term outcomes for patients over 80 years of age are incompletely understood. We set out to investigate clinical outcomes and long-term survival for octogenarian CABG patients across 3 decades.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged 80 and older who underwent isolated CABG at our center between January 1991 and June 2022 (<i>n</i> = 1268) were evaluated in this retrospective review. Patient data were collected from the Society of Thoracic Surgeons (STS) database and electronic medical records. Long-term survival was tracked via the Michigan and National Death Indices. The primary outcomes were short- and long-term mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1268 patients, 33.1% (<i>n</i> = 420) were female, with an average age of 82.5 years. Common comorbidities included hypertension (86.1%), prior myocardial infarction (45.0%), and diabetes (28.3%). In-hospital mortality was 2.9% (<i>n</i> = 36), and 30-day mortality was 3.1% (<i>n</i> = 40). Survival at 5 and 10 years was 73.3% and 33.4%, respectively. Over 3 decades, 30-day mortality rates were 3.6% (<i>n</i> = 10) in 1991–2000, 3.7% (<i>n</i> = 17) in 2001–2010%, and 2.5% (<i>n</i> = 13) in 2011–2022 (<i>p</i> = 0.49). Postoperative complications included renal failure in 6.1% (<i>n</i> = 78), atrial fibrillation in 33.7% (<i>n</i> = 427), stroke in 2.4% (<i>n</i> = 30), and reoperation for bleeding in 1.7% (<i>n</i> = 21), with no changes over time. At discharge, 61.7% (<i>n</i> = 604) of patients went home.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In selected octogenarian patients, CABG can be performed with very good perioperative outcomes and home discharge for most patients. Great majority of these elderly patients were alive 5 years after surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/4809680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145317310","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}
Venous drainage is a critical aspect of peripheral cardiopulmonary bypass (CPB) management in minimally invasive cardiac surgery (MICS), particularly for superior vena cava (SVC) drainage. The most commonly used method for SVC drainage currently is percutaneous cannulation via the internal jugular vein. However, this method still faces challenges in drainage efficiency, cosmetic outcomes, and puncture-related complications. This study aimed to compare the safety, effectiveness, and cosmetic outcomes of direct SVC cannulation (SVCC) and percutaneous internal jugular vein (PIJV) for SVC drainage in MICS.
Methods
A retrospective analysis was conducted of patients who underwent MICS with CPB at the Cardiovascular Surgery Department of the First Affiliated Hospital of Jinan University and Guangdong General Hospital between January 2012 and August 2023. In this study, 499 patients underwent SVCC, and 572 patients received PIJV for SVC drainage.
Results
In the SVCC group, one central venous catheter was mistakenly fixed with a purse-string suture (0.2%). In the PIJV group, complications included neck hematoma in 11 cases (1.9%), puncture site infection in 3 cases (0.5%), and catheter failure in 1 case (0.2%). Significant differences were noted in central venous pressure (CVP) during aortic cross-clamping (p < 0.001), duration of mechanical ventilation (p = 0.049), pleural drainage volume (p = 0.001) and lactate levels at Intensive Care Unit (ICU) admission (p < 0.001) between the two groups. Additionally, lactate levels were significantly different only in the subgroup of patients weighing > 50 kg. Patients with a CVP ≤ 0 mmHg during aortic cross-clamping exhibited lower lactate levels on ICU admission than those with CVP > 0 mmHg.
Conclusion
SVCC in MICS provides an easy and safe method with minimal complications, improved venous drainage, and better cosmetic results than the PIJV method.
{"title":"Superior Vena Cava Canulation During Minimally Invasive Cardiac Surgery: A Better Choice than Percutaneous Internal Jugular Vein for Venous Drainage","authors":"Yufei Zhan, Hua Lu, Quan Shi, Shengjie Liao, Tiange Luo, Yipeng Ge, Xiaoshen Zhang","doi":"10.1155/jocs/1277604","DOIUrl":"https://doi.org/10.1155/jocs/1277604","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Backgrounds</h3>\u0000 \u0000 <p>Venous drainage is a critical aspect of peripheral cardiopulmonary bypass (CPB) management in minimally invasive cardiac surgery (MICS), particularly for superior vena cava (SVC) drainage. The most commonly used method for SVC drainage currently is percutaneous cannulation via the internal jugular vein. However, this method still faces challenges in drainage efficiency, cosmetic outcomes, and puncture-related complications. This study aimed to compare the safety, effectiveness, and cosmetic outcomes of direct SVC cannulation (SVCC) and percutaneous internal jugular vein (PIJV) for SVC drainage in MICS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis was conducted of patients who underwent MICS with CPB at the Cardiovascular Surgery Department of the First Affiliated Hospital of Jinan University and Guangdong General Hospital between January 2012 and August 2023. In this study, 499 patients underwent SVCC, and 572 patients received PIJV for SVC drainage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the SVCC group, one central venous catheter was mistakenly fixed with a purse-string suture (0.2%). In the PIJV group, complications included neck hematoma in 11 cases (1.9%), puncture site infection in 3 cases (0.5%), and catheter failure in 1 case (0.2%). Significant differences were noted in central venous pressure (CVP) during aortic cross-clamping (<i>p</i> < 0.001), duration of mechanical ventilation (<i>p</i> = 0.049), pleural drainage volume (<i>p</i> = 0.001) and lactate levels at Intensive Care Unit (ICU) admission (<i>p</i> < 0.001) between the two groups. Additionally, lactate levels were significantly different only in the subgroup of patients weighing > 50 kg. Patients with a CVP ≤ 0 mmHg during aortic cross-clamping exhibited lower lactate levels on ICU admission than those with CVP > 0 mmHg.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SVCC in MICS provides an easy and safe method with minimal complications, improved venous drainage, and better cosmetic results than the PIJV method.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/1277604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272880","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}
Ahmet Can Topcu, Fatih Yigit, Emin Onur Yerlikhan, Mustafa Mert Ozgur, Melike Turkal, Hakan Hancer, Kamile Ozeren-Topcu, Farid Gojayev, Ozgul Uzunca, Serpil Tas, Kaan Kirali
Objective
The current article describes the methods utilized during the establishment of Kosuyolu Adult Cardiac Surgery Quality Improvement Program, shares our initial experiences, and provides insights into future directions.
Methods
Through inspiration from a notable example of high-performing collaborative quality initiative, we established a surgeon-led quality improvement program by voluntary participation of senior academic and early-career surgeons. Our new program aims to improve the quality of cardiac surgical care through methods of data acquisition and analysis, internal data validation, collaborative discussions on care processes and risk-adjusted outcomes, and development and implementation of quality improvement initiatives.
Results
We observed significant baseline variations in outcome measures including perioperative blood utilization, postoperative mechanical ventilation duration, and postoperative length of stay between surgeon groups. During the first 2 years of the Kosuyolu Adult Cardiac Surgery Quality Improvement Program, there were significant overall improvements from baseline in multiarterial grafting rates among all-comer patients undergoing isolated coronary artery bypass surgery and in unadjusted re-exploration rates after all cardiac surgical procedures. However, no significant improvements were noted in perioperative blood utilization, postoperative mechanical ventilation duration and hospital and intensive care unit length of stay.
Conclusion
Surgeon-led collaborative quality improvement programs are instrumental in enhancing the quality of healthcare services provided to cardiac surgical patients.
{"title":"Establishing a Surgeon-Led Adult Cardiac Surgery Quality Improvement Program","authors":"Ahmet Can Topcu, Fatih Yigit, Emin Onur Yerlikhan, Mustafa Mert Ozgur, Melike Turkal, Hakan Hancer, Kamile Ozeren-Topcu, Farid Gojayev, Ozgul Uzunca, Serpil Tas, Kaan Kirali","doi":"10.1155/jocs/3804482","DOIUrl":"https://doi.org/10.1155/jocs/3804482","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The current article describes the methods utilized during the establishment of Kosuyolu Adult Cardiac Surgery Quality Improvement Program, shares our initial experiences, and provides insights into future directions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Through inspiration from a notable example of high-performing collaborative quality initiative, we established a surgeon-led quality improvement program by voluntary participation of senior academic and early-career surgeons. Our new program aims to improve the quality of cardiac surgical care through methods of data acquisition and analysis, internal data validation, collaborative discussions on care processes and risk-adjusted outcomes, and development and implementation of quality improvement initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We observed significant baseline variations in outcome measures including perioperative blood utilization, postoperative mechanical ventilation duration, and postoperative length of stay between surgeon groups. During the first 2 years of the Kosuyolu Adult Cardiac Surgery Quality Improvement Program, there were significant overall improvements from baseline in multiarterial grafting rates among all-comer patients undergoing isolated coronary artery bypass surgery and in unadjusted re-exploration rates after all cardiac surgical procedures. However, no significant improvements were noted in perioperative blood utilization, postoperative mechanical ventilation duration and hospital and intensive care unit length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Surgeon-led collaborative quality improvement programs are instrumental in enhancing the quality of healthcare services provided to cardiac surgical patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/3804482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272075","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}
Benedetto Del Forno, Nicolò Azzola Guicciardi, Francesca Rusconi, Gema Hernandez Ibarburu, Guido Ascione, Alessandro Verzini, Alessandro Faggi, Elisabetta Lapenna, Michele De Bonis, Francesco Maisano
Background
Patients on hemodialysis face elevated risks of cardiovascular disease, including calcified aortic valve pathology requiring replacement. The choice between biological and mechanical prostheses remains controversial, with limited evidence. This study compares early and long-term outcomes of aortic valve replacement (AVR) in hemodialysis patients.
Methods
This retrospective cohort study analyzed data from the TriNetX global health research network. Hemodialysis patients undergoing isolated AVR with either biological or mechanical prostheses were included. Propensity score matching was performed to minimize baseline differences. Early outcomes (30-day mortality, stroke, and hemorrhagic events) and long-term outcomes (survival, freedom from reintervention, stroke, and hemorrhagic events) were evaluated using Kaplan–Meier estimates and Cox proportional hazards models.
Results
Of 1101 patients, 544 received biological prostheses and 557 received mechanical prostheses from 2005 to 2021. After propensity score matching, two well-balanced groups of 427 patients each were analyzed. At 30 days, no significant differences were observed in mortality (10.5% vs. 8.4%, p = 0.270) or stroke incidence (5.1% in both, p = 0.983). At 7 years, freedom from reintervention was significantly higher in the mechanical group (91.2% vs. 80%, p = 0.025), while survival remained poor in both groups (33.2% vs. 29.9%, p = 0.351). Rates of stroke and hemorrhagic events were similar between groups.
Conclusions
There was no significant difference in long-term survival between the two groups. Prosthesis choice should be individualized, considering life expectancy, quality of life, and transplant candidacy.
背景：血液透析患者面临心血管疾病的风险增加，包括主动脉瓣钙化病理需要更换。生物假体和机械假体之间的选择仍然存在争议，证据有限。本研究比较了血液透析患者主动脉瓣置换术（AVR）的早期和长期预后。方法回顾性队列研究分析来自TriNetX全球健康研究网络的数据。接受分离AVR的血液透析患者包括生物或机械假体。进行倾向评分匹配以最小化基线差异。使用Kaplan-Meier估计和Cox比例风险模型评估早期结局（30天死亡率、卒中和出血性事件）和长期结局（生存、免于再干预、卒中和出血性事件）。结果2005 - 2021年1101例患者中，544例采用生物假体，557例采用机械假体。倾向评分匹配后，分析两组均衡的427例患者。在第30天，死亡率（10.5% vs. 8.4%, p = 0.270）和卒中发生率（两者均为5.1%,p = 0.983）无显著差异。在7年时，机械组的再干预自由度明显更高（91.2%比80%，p = 0.025），而两组的生存率仍然较差（33.2%比29.9%,p = 0.351）。两组之间中风和出血性事件的发生率相似。结论两组患者的长期生存率无显著差异。义肢的选择应个体化，考虑预期寿命、生活质量和移植候选性。
{"title":"Mechanical or Biological Aortic Valve Replacement in Hemodialysis Patients: A Propensity Score Matching Analysis With Long-Term Results From the TriNetX Global Network","authors":"Benedetto Del Forno, Nicolò Azzola Guicciardi, Francesca Rusconi, Gema Hernandez Ibarburu, Guido Ascione, Alessandro Verzini, Alessandro Faggi, Elisabetta Lapenna, Michele De Bonis, Francesco Maisano","doi":"10.1155/jocs/9329665","DOIUrl":"https://doi.org/10.1155/jocs/9329665","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients on hemodialysis face elevated risks of cardiovascular disease, including calcified aortic valve pathology requiring replacement. The choice between biological and mechanical prostheses remains controversial, with limited evidence. This study compares early and long-term outcomes of aortic valve replacement (AVR) in hemodialysis patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study analyzed data from the TriNetX global health research network. Hemodialysis patients undergoing isolated AVR with either biological or mechanical prostheses were included. Propensity score matching was performed to minimize baseline differences. Early outcomes (30-day mortality, stroke, and hemorrhagic events) and long-term outcomes (survival, freedom from reintervention, stroke, and hemorrhagic events) were evaluated using Kaplan–Meier estimates and Cox proportional hazards models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1101 patients, 544 received biological prostheses and 557 received mechanical prostheses from 2005 to 2021. After propensity score matching, two well-balanced groups of 427 patients each were analyzed. At 30 days, no significant differences were observed in mortality (10.5% vs. 8.4%, <i>p</i> = 0.270) or stroke incidence (5.1% in both, <i>p</i> = 0.983). At 7 years, freedom from reintervention was significantly higher in the mechanical group (91.2% vs. 80%, <i>p</i> = 0.025), while survival remained poor in both groups (33.2% vs. 29.9%, <i>p</i> = 0.351). Rates of stroke and hemorrhagic events were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>There was no significant difference in long-term survival between the two groups. Prosthesis choice should be individualized, considering life expectancy, quality of life, and transplant candidacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9329665","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145271861","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}
Ahmad Makhdoum, Muhammed Suleman, Bhavendra Singh, Hatim Al-Raddadi, Leah Wall, Kandace Forsyth, Dominic Parry, Iqbal Jaffer, Ali Alsagheir, Victor Chu, Warkaa Shamkhani, Adel Dyub, Richard Whitlock, Tej Sheth
Background
The feasibility of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) after surgical aortic valve replacement (SAVR) and the impact of aortic root enlargement (ARE) remain unclear. This study assesses the anatomical feasibility of Viv TAVR post-SAVR, with and without ARE through detailed pre- and postoperative gated CT scans.
Methods
We analyzed 62 patients undergoing SAVR (n = 31) or SAVR + ARE (n = 31) between September 2022 and May 2024. Pre- and postoperative gated CT scans were used to measure annular area, sinus of Valsalva (SOV) dimensions, coronary heights, and virtual valve-to-coronary (VTC) and valve-to-sinotubular junction (VTSTJ) distances. High-risk ViV-TAVR anatomy was defined as VTC < 4 mm or VTSTJ < 2 mm. Four enlargement techniques were used (Y-Incision, Manouguian, Nicks and replacement of the coronary sinus).
Results
Female patients were more prevalent in the SAVR + ARE group (61% vs. 19.4%, p < 0.001). Preoperatively and compared to the SAVR cohort, SAVR + ARE had a smaller annular area-derived diameter (23 ± 2 mm vs. 26.8 ± 2.2 mm, p < 0.001) and SOV dimensions (28.8 ± 2 vs. 32.8 ± 3.6, p ≤ 0.001) and, both cohorts had coronary heights of ≥ 14 mm. Postoperatively, both groups had a significant reduction in coronary heights by at least 7–9 mm (p < 0.001). On the contrary, the SOV dimension increased significantly by +3 mm in the SAVR + ARE group (< 0.001), while it decreased numerically in the SAVR-only cohort (0.07). Similarly, the majority of both groups were considered low risk for future ViV TAVR (SAVR: 24/31, 74%) and (SAVR + ARE: 22/31, 71%), while 22.6% (7/31) of SAVR and 29% (9/31) of SAVR + ARE were considered anatomically high risk.
Conclusion
While most patients who had SAVR, with or without ARE, were anatomically feasible for ViV TAVR, postoperative CT scans identified high-risk anatomy in approximately 25% of cases. Pre- and post-SAVR CT imaging offers insights into surgical planning and lifetime management of aortic valve disease.
手术主动脉瓣置换术（SAVR）后经导管瓣内置换术（ViV-TAVR）的可行性和主动脉根部扩大（ARE）的影响尚不清楚。本研究通过详细的术前和术后门控CT扫描，评估了savr后带ARE和不带ARE的Viv TAVR的解剖学可行性。方法我们分析了2022年9月至2024年5月期间接受SAVR （n = 31）或SAVR + ARE （n = 31）的62例患者。术前和术后门控CT扫描用于测量环形面积，Valsalva窦（SOV）尺寸，冠状动脉高度，虚拟瓣膜到冠状动脉（VTC）和瓣膜到窦管交界处（VTSTJ）的距离。高危ViV-TAVR解剖定义为VTC <； 4mm或VTSTJ <； 2mm。采用了四种扩大技术（y形切口、Manouguian、切口和冠状窦置换术）。结果女性患者在SAVR + ARE组中更为普遍（61%比19.4%,p < 0.001）。术前与SAVR组相比，SAVR + ARE组的环状面积衍生直径更小（23±2mm vs. 26.8±2.2 mm, p < 0.001）， SOV尺寸更小（28.8±2 vs. 32.8±3.6,p≤0.001），两组的冠状动脉高度均≥14 mm。术后两组冠状动脉高度均显著降低至少7 - 9mm （p < 0.001）。相反，在SAVR + ARE组中，SOV尺寸显著增加了+3 mm (< 0.001)，而在仅SAVR组中，SOV尺寸减少了数值（0.07）。同样，两组中大多数人被认为是未来ViV TAVR的低风险（SAVR: 24/31, 74%）和（SAVR + ARE: 22/31, 71%），而22.6%（7/31）的SAVR和29%（9/31）的SAVR + ARE被认为是解剖学上的高风险。结论：虽然大多数SAVR患者，无论有无ARE，在解剖上都是可行的，但术后CT扫描发现约25%的病例存在高危解剖。术前和术后的CT成像为主动脉瓣疾病的手术计划和终身管理提供了见解。
{"title":"Feasibility of Transcatheter Aortic Valve Replacement After Surgical Aortic Valve Replacement With and Without Aortic Root Enlargement, Gated CT Study","authors":"Ahmad Makhdoum, Muhammed Suleman, Bhavendra Singh, Hatim Al-Raddadi, Leah Wall, Kandace Forsyth, Dominic Parry, Iqbal Jaffer, Ali Alsagheir, Victor Chu, Warkaa Shamkhani, Adel Dyub, Richard Whitlock, Tej Sheth","doi":"10.1155/jocs/9518444","DOIUrl":"https://doi.org/10.1155/jocs/9518444","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The feasibility of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) after surgical aortic valve replacement (SAVR) and the impact of aortic root enlargement (ARE) remain unclear. This study assesses the anatomical feasibility of Viv TAVR post-SAVR, with and without ARE through detailed pre- and postoperative gated CT scans.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 62 patients undergoing SAVR (<i>n</i> = 31) or SAVR + ARE (<i>n</i> = 31) between September 2022 and May 2024. Pre- and postoperative gated CT scans were used to measure annular area, sinus of Valsalva (SOV) dimensions, coronary heights, and virtual valve-to-coronary (VTC) and valve-to-sinotubular junction (VTSTJ) distances. High-risk ViV-TAVR anatomy was defined as VTC < 4 mm or VTSTJ < 2 mm. Four enlargement techniques were used (Y-Incision, Manouguian, Nicks and replacement of the coronary sinus).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Female patients were more prevalent in the SAVR + ARE group (61% vs. 19.4%, <i>p</i> < 0.001). Preoperatively and compared to the SAVR cohort, SAVR + ARE had a smaller annular area-derived diameter (23 ± 2 mm vs. 26.8 ± 2.2 mm, <i>p</i> < 0.001) and SOV dimensions (28.8 ± 2 vs. 32.8 ± 3.6, <i>p</i> ≤ 0.001) and, both cohorts had coronary heights of ≥ 14 mm. Postoperatively, both groups had a significant reduction in coronary heights by at least 7–9 mm (<i>p</i> < 0.001). On the contrary, the SOV dimension increased significantly by +3 mm in the SAVR + ARE group (< 0.001), while it decreased numerically in the SAVR-only cohort (0.07). Similarly, the majority of both groups were considered low risk for future ViV TAVR (SAVR: 24/31, 74%) and (SAVR + ARE: 22/31, 71%), while 22.6% (7/31) of SAVR and 29% (9/31) of SAVR + ARE were considered anatomically high risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While most patients who had SAVR, with or without ARE, were anatomically feasible for ViV TAVR, postoperative CT scans identified high-risk anatomy in approximately 25% of cases. Pre- and post-SAVR CT imaging offers insights into surgical planning and lifetime management of aortic valve disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9518444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224024","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}
Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar
<p><b>Background:</b> The extracardiac Fontan procedure, a palliative intervention for single-ventricle physiology, is associated with significant thromboembolism and bleeding risks. Warfarin has been the standard anticoagulant, but its limitations have prompted exploration of nonvitamin K oral anticoagulants, such as rivaroxaban.</p><p><b>Objective:</b> To compare the safety and efficacy of rivaroxaban vs. warfarin as postoperative anticoagulation in pediatric patients following the extracardiac Fontan procedure, focusing on thromboembolic events, bleeding complications, and treatment adherence.</p><p><b>Methods:</b> This retrospective cohort study included 369 pediatric patients (aged 3–17 years) who underwent the extracardiac Fontan procedure at a single center from 2015 to 2022, selected from 412 cases reviewed, with 43 excluded due to incomplete follow-up or comorbidities. Patients received either warfarin (<i>n</i> = 177) or rivaroxaban (<i>n</i> = 192) for anticoagulation. Baseline characteristics, including age, sex, body weight, and pulmonary artery pressure, were comparable between groups. Anticoagulation was initiated on postoperative Day 1 per institutional protocol, excluding aspirin to standardize thromboembolism prevention due to high risk in nonanticoagulated patients. Warfarin was titrated to an international normalized ratio (INR) of 2.0–3.0, while rivaroxaban was dosed per European Medicines Agency guidelines. Outcomes included thromboembolic events (graft thrombosis, pulmonary embolism, and transient ischemic attacks [TIAs]), major and minor bleeding, mortality, and treatment discontinuation over a mean follow-up of 5 years. TIAs were defined per American Heart Association guidelines as transient neurological dysfunction lasting less than 24 h without infarction on neuroimaging. Statistical analyses used Fisher’s exact test, Kaplan–Meier survival analysis, and multivariable logistic regression, with <i>p</i> < 0.05 indicating significance; the study was designed to detect a 3% difference in major bleeding. The limited number of thromboembolic events resulted in wide confidence intervals, limiting precision in between-group comparisons.</p><p><b>Results:</b> Thromboembolic events occurred in 5.1% (<i>n</i> = 9) of warfarin patients and 2.1% (<i>n</i> = 4) of rivaroxaban patients (OR = 2.5, 95% CI: 0.8–8.2). Major bleeding was significantly higher with warfarin (3.4%, n = 6; 4 intracranial and 2 gastrointestinal) than rivaroxaban (0.5%, n = 1; gastrointestinal; OR = 7.0, 95% CI: 1.2–40.8). Minor bleeding rates were 9.0% (warfarin) vs. 5.7% (rivaroxaban). Two warfarin-related deaths (intracranial hemorrhage and systemic embolism post-TIA) were recorded; none occurred with rivaroxaban. Treatment discontinuation was higher with warfarin (5.1% vs. 0.5%).</p><p><b>Conclusions:</b> Rivaroxaban demonstrated a superior safety profile compared to warfarin, with significantly lower major bleeding rates, no associated mortality, and imp
{"title":"Comparative Safety and Efficacy of Rivaroxaban Versus Warfarin in Pediatric Patients Following the Fontan Procedure: A Retrospective Cohort Study","authors":"Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar","doi":"10.1155/jocs/7805401","DOIUrl":"https://doi.org/10.1155/jocs/7805401","url":null,"abstract":"<p><b>Background:</b> The extracardiac Fontan procedure, a palliative intervention for single-ventricle physiology, is associated with significant thromboembolism and bleeding risks. Warfarin has been the standard anticoagulant, but its limitations have prompted exploration of nonvitamin K oral anticoagulants, such as rivaroxaban.</p><p><b>Objective:</b> To compare the safety and efficacy of rivaroxaban vs. warfarin as postoperative anticoagulation in pediatric patients following the extracardiac Fontan procedure, focusing on thromboembolic events, bleeding complications, and treatment adherence.</p><p><b>Methods:</b> This retrospective cohort study included 369 pediatric patients (aged 3–17 years) who underwent the extracardiac Fontan procedure at a single center from 2015 to 2022, selected from 412 cases reviewed, with 43 excluded due to incomplete follow-up or comorbidities. Patients received either warfarin (<i>n</i> = 177) or rivaroxaban (<i>n</i> = 192) for anticoagulation. Baseline characteristics, including age, sex, body weight, and pulmonary artery pressure, were comparable between groups. Anticoagulation was initiated on postoperative Day 1 per institutional protocol, excluding aspirin to standardize thromboembolism prevention due to high risk in nonanticoagulated patients. Warfarin was titrated to an international normalized ratio (INR) of 2.0–3.0, while rivaroxaban was dosed per European Medicines Agency guidelines. Outcomes included thromboembolic events (graft thrombosis, pulmonary embolism, and transient ischemic attacks [TIAs]), major and minor bleeding, mortality, and treatment discontinuation over a mean follow-up of 5 years. TIAs were defined per American Heart Association guidelines as transient neurological dysfunction lasting less than 24 h without infarction on neuroimaging. Statistical analyses used Fisher’s exact test, Kaplan–Meier survival analysis, and multivariable logistic regression, with <i>p</i> < 0.05 indicating significance; the study was designed to detect a 3% difference in major bleeding. The limited number of thromboembolic events resulted in wide confidence intervals, limiting precision in between-group comparisons.</p><p><b>Results:</b> Thromboembolic events occurred in 5.1% (<i>n</i> = 9) of warfarin patients and 2.1% (<i>n</i> = 4) of rivaroxaban patients (OR = 2.5, 95% CI: 0.8–8.2). Major bleeding was significantly higher with warfarin (3.4%, n = 6; 4 intracranial and 2 gastrointestinal) than rivaroxaban (0.5%, n = 1; gastrointestinal; OR = 7.0, 95% CI: 1.2–40.8). Minor bleeding rates were 9.0% (warfarin) vs. 5.7% (rivaroxaban). Two warfarin-related deaths (intracranial hemorrhage and systemic embolism post-TIA) were recorded; none occurred with rivaroxaban. Treatment discontinuation was higher with warfarin (5.1% vs. 0.5%).</p><p><b>Conclusions:</b> Rivaroxaban demonstrated a superior safety profile compared to warfarin, with significantly lower major bleeding rates, no associated mortality, and imp","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/7805401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224296","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}
Baiqing Huang, Yirou Ma, Haiyang Wang, Wenli Wang, Xisheng Wang
Background: Coronary artery bypass grafting (CABG) is a cornerstone therapy for coronary heart disease (CHD), but vein graft failure (VGF) caused by neointimal hyperplasia remains a major clinical challenge. Vascular smooth muscle cell (VSMC) proliferation and migration are central to this pathology, yet the regulatory role of circular RNAs (circRNAs) in VGF remains unclear. This study aimed to identify circRNAs driving VSMC dysfunction and explore their mechanisms in vein graft stenosis.
Methods: A murine jugular vein-carotid artery bypass grafting model was established. RNA sequencing identified differentially expressed circRNAs in stenotic veins versus controls. Functional validation included circRNA knockdown/overexpression in VSMCs, proliferation (CCK-8, PCNA staining), migration (Transwell), apoptosis (TUNEL, cleaved caspase-3/Bcl-2), and mechanistic studies (qPCR, FISH). Bioinformatics tools predicted circRNA-miRNA interactions. Data were analyzed using ANOVA and t-tests (SPSS 27.0).
Results: Circ-Myh4_un770 was significantly upregulated in stenotic veins (log2FC > 2, p < 0.001). Knockdown of circ-Myh4_un770 suppressed VSMC proliferation (37% reduction, p < 0.01) and migration (52% reduction, p < 0.05), while promoting apoptosis (2.1-fold increase in cleaved caspase-3, p < 0.01). Conversely, circ-Myh4_un770 overexpression exacerbated VSMC dysfunction. Bioinformatic prediction and expression analyses support an interaction between circ-Myh4_un770 and miR-3593-5p (65% reduction, p < 0.01). miR-3593-5p overexpression phenocopied circ-Myh4_un770 knockdown effects, inhibiting proliferation (41% reduction, p < 0.05) and migration (48% reduction, p < 0.05).
Conclusions: Our study demonstrates that circ-Myh4_un770 contributes to VSMC dysfunction in vein graft stenosis through interaction with miR-3593-5p. These findings suggest that modulating the circ-Myh4_un770/miR-3593-5p axis could represent a strategy to attenuate pathological vascular remodeling. While further validation of direct RNA interactions (e.g., luciferase assays) and human tissue studies are required, our data highlight the potential translational relevance of circ-Myh4_un770 and miR-3593-5p in VGF management.
{"title":"Circ-Myh4_un770 Regulates VSMC Proliferation and Migration via miR-3593-5p in Vein Graft Stenosis: A Mechanism for Vascular Remodeling","authors":"Baiqing Huang, Yirou Ma, Haiyang Wang, Wenli Wang, Xisheng Wang","doi":"10.1155/jocs/4874721","DOIUrl":"https://doi.org/10.1155/jocs/4874721","url":null,"abstract":"<p><b>Background:</b> Coronary artery bypass grafting (CABG) is a cornerstone therapy for coronary heart disease (CHD), but vein graft failure (VGF) caused by neointimal hyperplasia remains a major clinical challenge. Vascular smooth muscle cell (VSMC) proliferation and migration are central to this pathology, yet the regulatory role of circular RNAs (circRNAs) in VGF remains unclear. This study aimed to identify circRNAs driving VSMC dysfunction and explore their mechanisms in vein graft stenosis.</p><p><b>Methods:</b> A murine jugular vein-carotid artery bypass grafting model was established. RNA sequencing identified differentially expressed circRNAs in stenotic veins versus controls. Functional validation included circRNA knockdown/overexpression in VSMCs, proliferation (CCK-8, PCNA staining), migration (Transwell), apoptosis (TUNEL, cleaved caspase-3/Bcl-2), and mechanistic studies (qPCR, FISH). Bioinformatics tools predicted circRNA-miRNA interactions. Data were analyzed using ANOVA and <i>t</i>-tests (SPSS 27.0).</p><p><b>Results:</b> Circ-Myh4_un770 was significantly upregulated in stenotic veins (log2FC > 2, <i>p</i> < 0.001). Knockdown of circ-Myh4_un770 suppressed VSMC proliferation (37% reduction, <i>p</i> < 0.01) and migration (52% reduction, <i>p</i> < 0.05), while promoting apoptosis (2.1-fold increase in cleaved caspase-3, <i>p</i> < 0.01). Conversely, circ-Myh4_un770 overexpression exacerbated VSMC dysfunction. Bioinformatic prediction and expression analyses support an interaction between circ-Myh4_un770 and miR-3593-5p (65% reduction, <i>p</i> < 0.01). miR-3593-5p overexpression phenocopied circ-Myh4_un770 knockdown effects, inhibiting proliferation (41% reduction, <i>p</i> < 0.05) and migration (48% reduction, <i>p</i> < 0.05).</p><p><b>Conclusions:</b> Our study demonstrates that circ-Myh4_un770 contributes to VSMC dysfunction in vein graft stenosis through interaction with miR-3593-5p. These findings suggest that modulating the circ-Myh4_un770/miR-3593-5p axis could represent a strategy to attenuate pathological vascular remodeling. While further validation of direct RNA interactions (e.g., luciferase assays) and human tissue studies are required, our data highlight the potential translational relevance of circ-Myh4_un770 and miR-3593-5p in VGF management.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/4874721","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146430","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}
Ye In Christopher Kwon, Yeseo Kwon, Michelle Burmistrova, David T. Zhu, Alan Lai, Andrew Min-Gi Park, Dean Zhang, David J. Ramsey, Michael P. Robich, Ahmet Kilic, Josue Chery, Vigneshwar Kasirajan, Zubair A. Hashmi
Ophthalmic complications during a major cardiac surgery are rare but may have serious consequences. Patients requiring intraoperative support from a cardiopulmonary bypass machine have an increased risk of developing ocular adverse effects because of significant hemodynamic alterations involving the systemic and ocular vasculature. Ocular conditions experienced by patients undergoing cardiac surgery range from corneal abrasions to retinal artery occlusions or ischemic optic neuropathies. Postoperative vision loss may also occur because of cerebrovascular pathologies, such as stroke, pituitary apoplexy, or even cortical blindness. Here, we review perioperative ophthalmic complications encountered in cardiac surgery patients to guide clinicians in their diagnosis and management.
{"title":"Protecting Sight During Cardiac Surgery: Mechanisms, Risks, and Management of Perioperative Ocular Complications","authors":"Ye In Christopher Kwon, Yeseo Kwon, Michelle Burmistrova, David T. Zhu, Alan Lai, Andrew Min-Gi Park, Dean Zhang, David J. Ramsey, Michael P. Robich, Ahmet Kilic, Josue Chery, Vigneshwar Kasirajan, Zubair A. Hashmi","doi":"10.1155/jocs/5176617","DOIUrl":"https://doi.org/10.1155/jocs/5176617","url":null,"abstract":"<p>Ophthalmic complications during a major cardiac surgery are rare but may have serious consequences. Patients requiring intraoperative support from a cardiopulmonary bypass machine have an increased risk of developing ocular adverse effects because of significant hemodynamic alterations involving the systemic and ocular vasculature. Ocular conditions experienced by patients undergoing cardiac surgery range from corneal abrasions to retinal artery occlusions or ischemic optic neuropathies. Postoperative vision loss may also occur because of cerebrovascular pathologies, such as stroke, pituitary apoplexy, or even cortical blindness. Here, we review perioperative ophthalmic complications encountered in cardiac surgery patients to guide clinicians in their diagnosis and management.</p>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/5176617","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145101583","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号