ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

IntroductionMalignant pericardial effusion (MPE) is uncommon in advanced-stage cancer. However, MPE can result in a life-threatening condition such as cardiac tamponade. Surgical drainage is routinely recommended as a rapid and effective treatment for this disease. This study aims to investigate the overall outcome after pleuropericardial window surgery in patients with MPE.MethodThis study enrolled 148 patients with MPE who underwent pleuropericardial window surgery from 1990 to 2020. The patients were grouped based on their history of lung cancer or nonlung cancer. A Kaplan-Meier survival analysis was performed to compare the two groups of patients. Depending on the variable type, the chi-square test, t test, or the Mann-Whitney U test was used to compare the two groups in terms of intraoperative and postoperative outcomes. Cox regression analysis was performed to demonstrate the mortality risk.ResultsA total of 148 patients underwent pleuropericardial window surgery during the study period; 92 patients had lung cancer, and 56 patients had nonlung cancer. In the subgroup analysis, there was no difference in age, underlying disease, or surgical approach. With regard to intraoperative outcomes, no differences were observed in hospital stay or postoperative complications. The Kaplan-Meier survival analysis revealed that patients with nonlung cancer survived longer than those with lung cancer did (p = .001).ConclusionPleuropericardial window surgery is a safe and effective procedure with acceptable postoperative outcomes. Among patients who have undergone this surgery, the presence of lung cancer, as compared with nonlung cancer, worsened their survival rate.

This systematic review and meta-analysis aimed to evaluate sex-based differences in surgical outcomes among patients with infective endocarditis (IE). A comprehensive search of three major medical databases identified ten studies encompassing 16,763 patients who underwent valvular surgery for IE. Of these, 70.8% were male (n = 11,873), and 29.2% were female (n = 4890). Female patients were generally older at the time of surgery. The most common causative pathogen was Staphylococcus aureus (28.4%), followed by Streptococcus (22.5%) and Enterococcus (4.1%). Females demonstrated lower aortic valve involvement (risk ratio [RR]: 0.80, 95% confidence interval [CI]: 0.67-0.96) but higher mitral valve involvement (RR: 1.30, 95% CI: 1.17-1.45, p < 0.001). They also had a reduced prevalence of Streptococcus (RR: 0.89, 95% CI: 0.81-0.98, p = 0.02) and Enterococcus (RR: 0.71, 95% CI: 0.62-0.82, p = 0.03) infections and a lower risk of abscess formation (RR: 0.87, 95% CI: 0.76-0.99, p = 0.03) compared to males. There was a significant difference in the in-hospital mortality between female and male patients (RR: 1.30, 95% CI: 1.04-1.61, p = 0.02). No significant sex-related differences were observed in the duration of hospitalization. However, significant sex-related differences were observed in the incidence of postoperative stroke (RR: 1.10, 95% CI: 1.02-1.20, p = 0.02). In summary, female patients undergoing surgery for IE face a higher risk of both in-hospital mortality and postoperative stroke compared to males, underscoring clinically meaningful sex-based disparities in short-term surgical outcomes. These findings emphasize the need for further studies to clarify these observations. (PROSPERO Registration: CRD42024602013).

The frozen elephant trunk (FET) procedure has emerged as a transformative approach for complex aortic arch pathology, addressing limitations of conventional elephant trunk procedures, including the need for second-stage operations with interval mortality, inability to expand the true lumen in dissections and lack of distal anastomotic support.Our experience with over 200 procedures demonstrates FET technique evolution and refinement, achieving 13.8% overall mortality. Presenting pathologies were diverse, predominantly aneurysmal disease and acute or chronic dissections. Most utilised Thoraflex Hybrid, though the Jotec E-vita prosthesis has been increasingly used recently. Critical technical advancements include bilateral axillary artery cannulation, which has dramatically reduced neurological complications, including paraplegia and recurrent laryngeal nerve injury, compared to historical series. It also made the procedure technically less complex and more reproducible. In selected cases, we have also adopted a beating heart strategy to reduce the cardiac ischaemic time once the proximal aortic repair has been completed. The beating heart strategy demonstrated a tendency for reduced post-operative adrenaline requirements without compromising outcomes.Frozen elephant trunk demands advanced perfusion strategies, proactive spinal cord protection and meticulous surgical technique but reduces the need for future open repair, facilitating endovascular interventions. Our experience demonstrates that FET represents a paradigm shift toward comprehensive single-stage treatment of complex aortic arch pathology with acceptable outcomes when performed in high-volume centres by experienced multidisciplinary teams.

ObjectivePectus excavatum and, less commonly, pectus carinatum are congenital chest wall deformities. These may be associated with kyphoscoliosis, pulmonary, and cardiac diseases. However, the incidence of concomitant cardiac disease in patients with pectus deformities is not well-documented. There is no consensus on the optimal age for repair, the most effective technique, or whether a simultaneous or staged approach is preferable. This study presents our experience with combined pectus and cardiac surgery.MethodsThirteen patients (aged 6-32 years) with pectus deformities and concurrent cardiac disease underwent surgery between 2016 and 2024. Eleven had pectus excavatum, one had a mixed deformity, and one had Pouter chest wall deformity. Seven had Marfan syndrome, one had Noonan syndrome, and three had mitral valve regurgitation requiring Bentall and/or valve replacement. The patient with Pouter chest wall deformity had right ventricular outflow tract (RVOT) stenosis, pulmonary valve stenosis, and a patent foramen ovale. Another had a failed Ravitch repair with a right coronary artery to RVOT fistula.ResultsThere was no mortality. All patients were extubated within 72 h, except one requiring reintubation for seven days due to COVID-19 pneumonia. Patients' characteristics are summarized in Table 1. One patient with a previous failed Ravitch repair required bilateral costochondral fixation. Pectus repair outcomes were excellent in 11 patients, while two children developed postoperative pectus carinatum.ConclusionThe choice between simultaneous or staged repair remains debated. Our experience suggests the modified open Nuss procedure is preferable for concomitant pectus and cardiac surgery, except when infeasible.

Anomalous aortic origin of a coronary artery (AAOCA) represents a rare yet clinically significant congenital anomaly associated with myocardial ischemia and sudden cardiac death, particularly in young individuals. Advances in multimodality imaging have enabled earlier detection and precise anatomical delineation, shifting the paradigm from incidental diagnosis to proactive management. This review synthesizes contemporary understanding of AAOCA pathophysiology, diagnostic strategies, and surgical management. The mechanisms of ischemia-slit-like ostium, intramural course, acute take-off angles, and interarterial compression-underscore the condition's dynamic nature. Diagnostic evaluation integrates anatomical imaging with computed tomography or cardiac magnetic resonance and functional assessment through perfusion testing to identify ischemia. Surgical intervention is indicated for high-risk anatomy or documented perfusion defects. Unroofing and coronary reimplantation remain the mainstays of therapy, while ostioplasty, pulmonary artery translocation, and coronary artery bypass grafting are reserved for anatomically or technically specific scenarios. Successful AAOCA management requires individualized surgical planning grounded in anatomical precision and physiologic understanding. Long-term surveillance with multimodality imaging and stress testing is essential, as residual or delayed complications-such as restenosis, fibrosis, or aortic insufficiency-may occur. With accurate diagnosis, meticulous surgical execution, and disciplined follow-up, most patients achieve excellent outcomes. The era of AAOCA as a mysterious postmortem diagnosis is ending; it is now a surgically correctable entity when addressed proactively and precisely.

IntroductionSurgical revascularization through coronary artery bypass is a widely accepted approach for treating diseases affecting multiple coronary vessels. While the standard approach uses a single arterial graft combined with vein grafts, using numerous arterial grafts may improve long-term outcomes. Although supported by observational data and guideline recommendations, the broader adoption of multiple arterial grafting has been limited due to a lack of definitive randomized trial evidence and uncertainties in specific patient subgroups.MethodsA systematic review and meta-analysis were conducted to compare long-term survival in patients receiving multiple versus single arterial grafts during coronary artery bypass surgery. Twenty-seven studies (including one randomized trial) involving more than one million patients were included. The primary outcome was long-term all-cause mortality. Hazard ratios with 95% confidence intervals were pooled using a random-effects model. Subgroup analyses were performed based on age, sex, diabetes status, graft conduit type, extent of arterial revascularization, and left ventricular function. Meta-regression examined the impact of patient characteristics.ResultsMultiple arterial grafting was associated with a significant reduction in long-term mortality compared to single arterial grafting. The pooled hazard ratio indicated an approximate 20% relative reduction in mortality. This survival benefit was consistent across all evaluated subgroups. Meta-regression did not identify any patient characteristic that significantly altered the benefit of multiple arterial grafting. No significant publication bias was detected.ConclusionMultiple arterial grafting is associated with improved long-term survival in coronary artery bypass surgery. These findings support the broader implementation of this strategy in suitable patients while emphasizing the need for individualized surgical decision-making.

BackgroundSurgical repair of complete atrioventricular septal defect (CAVSD) has evolved substantially, with early mortality markedly reduced over the past decades. However, achieving durable left atrioventricular valve (LAVV) competence and preserving left ventricular outflow tract (LVOT) geometry remain critical determinants of long-term success.MethodsThis review summarizes the anatomical principles, operative details, and clinical outcomes of the Nunn-modified single-patch ("Australian") technique for CAVSD repair.ResultsThe Australian technique-characterized by direct approximation of bridging leaflets to the septal crest without a ventricular patch-demonstrates superior preservation of LVOT architecture and promotes symmetrical LAVV coaptation. Contemporary series report >90% freedom from LAVV reoperation and >97% freedom from LVOT obstruction at 10-15 years, outperforming traditional repairs in multiple institutional and multicenter cohorts. These advantages are consistent across a wide spectrum of ventricular septal defect sizes and patient ages, provided anatomical prerequisites are met.ConclusionsBy minimizing prosthetic material and restoring native leaflet geometry, the Australian Repair achieves excellent long-term valve competence and reoperation-free survival. It should be considered a first-line option in appropriately selected CAVSD patients, particularly where durable LAVV function and LVOT integrity are paramount.

BackgroundThere is conflicting evidence on the adverse impact of pulmonary hypertension (PH) on outcomes following cardiac surgery for rheumatic heart disease (RHD). This study aimed to evaluate the influence of PH severity on in-hospital mortality and early outcomes after valve surgery in patients with RHD.MethodsIn this prospective observational study, 152 patients with RHD undergoing valve surgery were categorized into three groups based on estimated systolic pulmonary artery pressure on echocardiography: no or mild PH (<45 mmHg), moderate PH (45-59 mmHg), and severe PH (≥60 mmHg). The primary endpoint was in-hospital all-cause mortality and major morbidity; the secondary endpoint was 30-day readmission.ResultsIn-hospital all-cause mortality was 3.3% (n = 5), with no statistically significant difference among severe (4.8%), moderate (3.2%), and no/mild PH (0%) groups (p = 0.518). ICU stay was significantly longer in patients with severe PH (p = 0.042). There was no significant difference in mortality based on predominant valve lesion (mitral stenosis or regurgitation) across PH groups (p = 0.625, p = 0.172). The 30-day readmission rate was 12.5%, with no significant variation across PH categories (p = 0.194).ConclusionThe severity of PH did not significantly impact early postoperative outcomes or in-hospital mortality following valve surgery for RHD. These findings support the feasibility and safety of surgical intervention even in patients with severe PH and provide a critical foundation for future studies in Yemen.

Unicuspid aortic valve (UAV) is a rare congenital defect. Compared with valve replacement, aortic valve repair is a better potential strategy to achieve a low rate of valve-related events and an enhanced quality of life. We herein report two cases of aortic valve repair for UAV accompanied by aneurysm of the ascending aorta. By retaining the free margin tissue and forming a neocommissure to the side of the left lateral commissure that is 180 degrees opposite and the same height, we were able to achieve bicuspidization of the UAV. A glutaraldehyde-treated autologous pericardium patch was placed along the cusp connection to the annulus to expand the aortic cusp. During the follow-up period of over 4 years, the patients showed no signs of aortic regurgitation or significant stenosis.

IntroductionThe optimal extent of aortic arch intervention for acute type A aortic dissection (ATAAD) remains uncertain. Total arch replacement with a frozen elephant trunk (TAR + FET) prolongs circulatory-arrest time, whereas hybrid arch repair (HAR)-supra-aortic debranching in combination with antegrade endovascular stent grafting-reduces ischemic time but may increase the risk of late reintervention.ObjectiveThis study aims to compare mid-term survival and freedom from reintervention after HAR versus TAR in ATAAD.MethodsPubMed, Embase, and Scopus were searched from their inception to May 2025. Kaplan-Meier Curves were digitized, and individual-participant data were reconstructed with a validated algorithm. Pooled hazard ratios (HR) were derived from a one-stage flexible parametric model; robustness was assessed with two-stage random-effects meta-analysis, leave-one-out tests.ResultsFive propensity-matched studies (n = 697; 338 HAR, 359 TAR) met inclusion criteria. Hybrid arch repair shortened cardiopulmonary bypass and avoided circulatory arrest time. Five-year survival was 86.5% for HAR versus 76.2% for TAR (log-rank p < 0.001). Hybrid arch repair provided a significant early-to-mid-term survival advantage over TAR in ATAAD (HR 0.46 (95% CI 0.31-0.69; p < 0.001)), corresponding to about 6 months of survival benefit at 5 years. Hybrid arch repair was associated with greater likelihood of early reintervention (HR 4.07, 95% CI 0.55-30.34).ConclusionHybrid arch repair offers a significant early-to-mid-term survival advantage over TAR in ATAAD. In patients requiring aortic arch replacement, HAR may be favored over TAR/FET, while extensive TAR/FET procedures are reserved for anatomically unsuitable cases.