ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

The conventional primary-secondary classification of spontaneous pneumothorax fails to capture the complexity encountered during thoracoscopic surgery, where CT imaging often misses subtle apical scarring, early emphysematous changes, or fibrotic, noncompliant lung tissue. To provide a more operative-relevant clinical framework, we hereby propose the PLEX Classification, based on Pattern of lung abnormality, Location of leak and lung reserve, Extent of disease, and eXpected surgical complexity and surgical outcome. This system categorizes pneumothorax into four different variants: Type I (apical vulnerability pneumothorax), Type II (multibullous pneumothorax), Type III (emphysematous pneumothorax), and Type IV (fibrotic lung pneumothorax). Applied to 710 surgeries, PLEX demonstrated a clear gradient of increasing surgical difficulty and complications from Type I to Type IV. PLEX offers a pragmatic, surgically actionable system for planning, communication, as well as outcome prediction.

BackgroundRobotic-assisted mitral valve surgery (RAMVS) has emerged as an alternative to conventional minimally invasive mitral valve surgery (MIMVS). However, previous studies have been limited by small sample sizes, heterogeneous techniques and reliance on unmatched or indirectly compared cohorts, resulting in inconclusive evidence. This meta-analysis focuses exclusively on propensity-matched studies to provide a more robust comparison of RAMVS and MIMVS.MethodsA comprehensive literature search was performed to identify propensity-matched studies comparing RAMVS and MIMVS. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0. Subgroup analyses, including mitral valve repair only, non-isolated mitral valve surgery and MIMVS via right minithoracotomy, were conducted to explore heterogeneity.ResultsEight studies comprising 3352 patients were included, with 1578 (47.1%) undergoing RAMVS. The RAMVS was associated with a shorter hospital stay (MD -1.8 days; 95% CI -3.0 to -0.5; p = 0.006) but significantly longer cardiopulmonary bypass time (MD 21.8 min; 95% CI 0.8-42.9; p = 0.04), and higher odds of conversion to sternotomy (OR 2.9; 95% CI 1.6-5.4; p = 0.0007) and re-exploration for bleeding (OR 1.86; 95% CI 1.1-3.2; p = 0.02). Intensive care unit stay, operative time and postoperative complications were comparable. All subgroup analyses consistently showed higher conversion rates with RAMVS.ConclusionThe RAMVS offers potential recovery benefits but at the cost of greater intraoperative complexity. Careful patient selection and technical expertise are essential to maximise outcomes.

Acute type A aortic dissection is a life-threatening condition that requires urgent surgical intervention. This article presents our institutional approach, offering a systematic, step-by-step guide to surgical management. Key aspects include preoperative preparation, intraoperative monitoring, arterial cannulation strategies, management of malperfusion, cardiopulmonary bypass, myocardial and cerebral protection, and reconstruction of the aortic root, arch, coronary artery, and left subclavian artery. The use of the frozen elephant trunk technique with hybrid devices is described in detail. Operative photographs, echocardiography, and computed tomography angiography are incorporated to support technical understanding and clinical practice.

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.

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.

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.

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.

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).

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.

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.