Pub Date : 2026-01-27DOI: 10.1016/j.athoracsur.2026.01.008
Carlos A Mestres, Elena Sandoval
{"title":"Reoperative coronary artery surgery: Yesterday, today, tomorrow, it will always be there. But experience counts, we know.","authors":"Carlos A Mestres, Elena Sandoval","doi":"10.1016/j.athoracsur.2026.01.008","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.01.008","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-27DOI: 10.1016/j.athoracsur.2026.01.007
Aakash M Shah, Dawn S Hui
{"title":"Not your grandfather's aortic dissection.","authors":"Aakash M Shah, Dawn S Hui","doi":"10.1016/j.athoracsur.2026.01.007","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.01.007","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced three cerebral infarctions and underwent thoracoscopic left atrial appendage closure (LAAC). Transthoracic echocardiography on postoperative day 5 revealed free-floating thrombus in the left atrium, prompting emergency surgical removal and tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall leading to thrombus formation. Concomitant severe tricuspid regurgitation may have contributed to atrial stasis. In patients with markedly impaired atrial hemodynamics, concomitant tricuspid valve repair at LAAC may help mitigate the risk of thrombus formation.
{"title":"Large Free-Floating Left Atrial Thrombus following Incomplete Thoracoscopic Closure of the Left Atrial Appendage.","authors":"Motoki Nagatsuka, Tohru Asai, Kenichiro Noguchi, Daisuke Hama, Chishio Arai, Kunihiko Shimizu","doi":"10.1016/j.athoracsur.2026.01.009","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.01.009","url":null,"abstract":"<p><p>A 79-year-old man with permanent atrial fibrillation and cardiomyopathy had previously received an implantable cardioverter-defibrillator. Despite anticoagulation, he had experienced three cerebral infarctions and underwent thoracoscopic left atrial appendage closure (LAAC). Transthoracic echocardiography on postoperative day 5 revealed free-floating thrombus in the left atrium, prompting emergency surgical removal and tricuspid valve repair. Incomplete exclusion of the appendage was identified as a key procedural pitfall leading to thrombus formation. Concomitant severe tricuspid regurgitation may have contributed to atrial stasis. In patients with markedly impaired atrial hemodynamics, concomitant tricuspid valve repair at LAAC may help mitigate the risk of thrombus formation.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.athoracsur.2025.12.046
Andrea Amabile, Johannes Bonatti
{"title":"The Annus Mirabilis of Robotics in Cardiac Surgery.","authors":"Andrea Amabile, Johannes Bonatti","doi":"10.1016/j.athoracsur.2025.12.046","DOIUrl":"10.1016/j.athoracsur.2025.12.046","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.athoracsur.2025.12.047
Shinya Yokoyama
{"title":"Can the Eustachian Valve Become a Pitfall in Congenital Heart Defect Repair Surgery?","authors":"Shinya Yokoyama","doi":"10.1016/j.athoracsur.2025.12.047","DOIUrl":"10.1016/j.athoracsur.2025.12.047","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.athoracsur.2025.12.045
Hande İştar
{"title":"An Uncommon Variant of Left Atrioventricular Valve Morphology in Atrioventricular Canal Defect: Double-Orifice Configuration.","authors":"Hande İştar","doi":"10.1016/j.athoracsur.2025.12.045","DOIUrl":"10.1016/j.athoracsur.2025.12.045","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-23DOI: 10.1016/j.athoracsur.2025.12.048
G Chad Hughes, Edward P Chen
{"title":"Prophylactic Proximal Aortic Surgery in 2026: Risks of Hypothermic Circulatory Arrest and the Limits of Diameter-Based Decisions.","authors":"G Chad Hughes, Edward P Chen","doi":"10.1016/j.athoracsur.2025.12.048","DOIUrl":"10.1016/j.athoracsur.2025.12.048","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1016/j.athoracsur.2025.12.043
Albert J Pedroza, Y Joseph Woo
{"title":"A Top-Down Approach to Perfusing the Dissected Aorta.","authors":"Albert J Pedroza, Y Joseph Woo","doi":"10.1016/j.athoracsur.2025.12.043","DOIUrl":"10.1016/j.athoracsur.2025.12.043","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21DOI: 10.1016/j.athoracsur.2025.12.042
Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar
Background: Tunnel-type left ventricular outflow tract obstruction (LVOTO) in children requires extensive resection of long-segment fibromuscular narrowing and is traditionally treated with Konno or modified Konno procedures, which involve right ventriculotomy and may risk right ventricular dysfunction and conduction injury.
Methods: Between 2012 and 2023, 26 children (mean age 5.4 ± 1.3 years; 34.6% with prior septal myectomy) underwent repair of tunnel-type LVOTO using a combined transaortic and right atrial approach at three tertiary centers. The operation consisted of transaortic exposure, controlled creation of an iatrogenic membranous ventricular septal defect to access deep obstructive tissue, bidirectional resection via the aortic root and right atrium, and patch closure of the septal defect from the right atrium.
Results: There was no early or late mortality. The mean left ventricular-aortic gradient decreased from 67.6 ± 11.9 mm Hg preoperatively to 15.8 ± 5.0 mm Hg at last follow-up (p < 0.0001). Freedom from reoperation at 5 years was 96.2%, with one patient (3.8%) reoperated for aortic insufficiency. Right bundle branch block occurred in 23.1% of patients, but no complete heart block was observed. Right ventricular systolic function showed only modest reductions from baseline. CONCLUSİONS: A transaortic and right atrial, right ventricle-sparing approach can achieve durable relief of tunnel-type LVOTO in children while preserving right ventricular function and avoiding right ventriculotomy, and may represent a useful alternative to modified Konno repair.
背景：儿童隧道型左心室流出道梗阻（LVOTO）需要广泛切除长段纤维肌肉狭窄，传统上采用Konno或改良的Konno手术治疗，这涉及到右心室切开术，可能存在右心室功能障碍和传导损伤的风险。方法：2012年至2023年间，26名儿童（平均年龄5.4±1.3岁，34.6%既往有间隔肌切除术）在三个三级中心经主动脉和右心房联合入路行隧道型LVOTO修复术。手术包括经主动脉暴露，控制医源性膜性室间隔缺损的形成以进入深部阻塞性组织，通过主动脉根和右心房双向切除，以及从右心房对室间隔缺损进行补片封闭。结果：无早期和晚期死亡。平均左心室-主动脉梯度由术前67.6±11.9 mm Hg降至末次随访时的15.8±5.0 mm Hg （p < 0.0001）。5年后再次手术成功率为96.2%，其中1例（3.8%）因主动脉功能不全再次手术。23.1%的患者发生右束支传导阻滞，但未见完全的心脏传导阻滞。右心室收缩功能仅较基线有轻微下降。CONCLUSİONS：经主动脉和右心房，保留右心室入路可以持久缓解儿童隧道型LVOTO，同时保留右心室功能并避免右心室切开术，可能是改良的Konno修复的有用替代方案。
{"title":"Transaortic and Right Atrial Approach for Pediatric Tunnel-Type Left Ventricular Outflow Tract Obstruction: An Alternative to Modified Konno.","authors":"Mustafa Kemal Avşar, Yasin Güzel, İbrahim Özgür Önsel, Barış Kırat, İlker Kemal Yücel, Cenap Zeybek, Deniz Yorgancılar","doi":"10.1016/j.athoracsur.2025.12.042","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.12.042","url":null,"abstract":"<p><strong>Background: </strong>Tunnel-type left ventricular outflow tract obstruction (LVOTO) in children requires extensive resection of long-segment fibromuscular narrowing and is traditionally treated with Konno or modified Konno procedures, which involve right ventriculotomy and may risk right ventricular dysfunction and conduction injury.</p><p><strong>Methods: </strong>Between 2012 and 2023, 26 children (mean age 5.4 ± 1.3 years; 34.6% with prior septal myectomy) underwent repair of tunnel-type LVOTO using a combined transaortic and right atrial approach at three tertiary centers. The operation consisted of transaortic exposure, controlled creation of an iatrogenic membranous ventricular septal defect to access deep obstructive tissue, bidirectional resection via the aortic root and right atrium, and patch closure of the septal defect from the right atrium.</p><p><strong>Results: </strong>There was no early or late mortality. The mean left ventricular-aortic gradient decreased from 67.6 ± 11.9 mm Hg preoperatively to 15.8 ± 5.0 mm Hg at last follow-up (p < 0.0001). Freedom from reoperation at 5 years was 96.2%, with one patient (3.8%) reoperated for aortic insufficiency. Right bundle branch block occurred in 23.1% of patients, but no complete heart block was observed. Right ventricular systolic function showed only modest reductions from baseline. CONCLUSİONS: A transaortic and right atrial, right ventricle-sparing approach can achieve durable relief of tunnel-type LVOTO in children while preserving right ventricular function and avoiding right ventriculotomy, and may represent a useful alternative to modified Konno repair.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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