Postoperative atrial fibrillation (POAF) remains a common complication after off-pump coronary artery bypass grafting (OPCAB). We evaluated the preventive effect of short-term perioperative landiolol hydrochloride administration on POAF after OPCAB. This single-center retrospective observational study included patients who underwent elective isolated OPCAB between February 2013 and August 2018. Patients with a history of atrial fibrillation, emergency surgery, or conversion to cardiopulmonary bypass were excluded. Landiolol hydrochloride was continuously administered from the beginning of surgery until postoperative day 1. The primary endpoint was POAF occurrence. Secondary endpoints included hospital stay, perioperative complications, and healthcare insurance reimbursement points. Propensity score matching was performed to adjust baseline differences. Among eligible patients, 74 were assigned to the control group and 159 to the landiolol group. Propensity score matching generated 68 matched pairs. POAF incidence was significantly lower in the landiolol group in both the unadjusted cohort (15.7% vs. 31.1%, p = 0.01) and propensity score matched cohort (14.7% vs. 32.4%, p = 0.02). No significant differences were observed in hospital stay or major clinical outcomes, including 30-day mortality, stroke, and prolonged intubation. However, medical insurance points were significantly lower in the matched intervention group (258,460 vs. 267,904 points, p = 0.047). Short-term perioperative administration of landiolol hydrochloride was associated with a lower incidence of POAF after OPCAB without an increase in perioperative complications. While further prospective randomized studies are needed, this simplified protocol may offer a safe, feasible, and potentially cost-favorable strategy for POAF prevention after cardiac surgery.
Currently, only one method of spinal cord protection-cerebrospinal fluid (CSF) drainage - has been rated as level 1 evidence in international guidelines for thoracoabdominal aortic aneurysm surgery. However, in recent years, there has been increased attention to complications of CSF drainage, such as intracranial hemorrhage. The aim determination of the frequency and risk factors of complications of CSF drainage during operations for thoracoabdominal aortic aneurysms. A search of publications in the PubMed (Medline), Google Scholar, and Russian Science Citation Index (eLibrary) databases was conducted according to the PRISMA criteria. The ROBINS1 and ROBINS2 scales were used to assess the methodological quality of the studies. The pooled complication rate was calculated using a random-effects model (DerSimonian-Laird). Univariate (subgroup analysis) and meta-regression analyses were performed to assess the influence of the following parameters on the complication rate of CSF drainage: study type, article publication date, surgical approach, target CSF threshold pressure, CSF drainage rate, and CSF drainage method. The final analysis included 71 articles (10.798 patients) published from 1991 to 2024. In general, the methodological quality of the studies was acceptable, the risk of systematic error remained moderate. According to the meta-analysis, the incidence of all complications of CSF drainage was 11.9% (95% CI 9.7-14.1), the incidence of severe complications was 1.7% (95% CI 1.3-2.0), intracranial symptomatic hemorrhage was 1.3% (95% CI 1.0-1.7), and associated mortality was 1.1% (95% CI 0.1-3.1). High heterogeneity of studies and the absence of significant publication bias were noted. A significant increase in the incidence of complications was revealed in later publications. No differences were found in the incidence of CSF drainage complications depending on the type of publication, type of procedure, CSF pressure threshold used, drainage rate, and drainage technique. Due to the high complication rate, a careful assessment of the benefits and risks of CSF drainage is necessary. This study highlights the limitations of the available data, the high prevalence of complications associated with CSF drainage, and the need for further research to determine the true complication rate and evaluate various CSF drainage protocols.
Unilateral upper-lung field pulmonary fibrosis (upper-PF) can occur on the operative side after lung cancer surgery. It is reportedly associated with pleural effusion at 6 months post-surgery (PE-6mo), but the perioperative risk factors for PE-6mo and the cumulative incidence of upper-PF remain unclear. We retrospectively reviewed all patients with lung cancer who underwent radical surgical resection between 2008 and 2016. Perioperative characteristics were compared based on the presence of PE-6mo. The cumulative incidence of upper-PF in patients with PE-6mo was estimated using a competing risk analysis. Of the 587 patients, 160 (27.2%) had PE-6mo. Multivariate analysis identified age > 70 years, body mass index < 22, thoracotomy, lobectomy, pulmonary apical cap, and adjuvant chemotherapy as independent risk factors for PE-6mo. Among 115 patients evaluable by chest CT for 2 years, 25 (21.7%) subsequently developed upper-PF (upper-PF group), while 90 did not (non-upper-PF group). The 3-, 5-, and 10-year cumulative incidences of upper-PF were 11.5%, 16.4%, and 24.6%. The upper-PF group more commonly had prolonged pleural effusion at 2 years than the non-upper-PF group (21/25 vs. 51/90, p = 0.018). Furthermore, pleural thickening was already evident at 6 months in the upper-PF group (15/25 vs. 18/90, P < 0.001) and thereafter. For patients with pleural thickening at 6 months, the 3-, 5-, and 10-year cumulative incidences of upper-PF were 24.2%, 35.0%, and 51.8%. Prolonged pleural effusion with pleural thickening was a common phenomenon in patients who later developed upper-PF after surgery and may therefore be a strong postoperative indicator of upper-PF development.
Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinical applications have been initiated worldwide, the safe, ethical, and sustainable adoption of remote surgery requires comprehensive guidance that addresses not only technical considerations, but also clinical practice, legal responsibility, and organizational frameworks. In response to these needs, the Japan Surgical Society has developed the second edition of the Clinical Practice Guidelines for Telesurgery through a multidisciplinary, consensus-based process involving multiple surgical societies. This updated edition builds on validation and verification studies conducted since the publication of the first edition and places particular emphasis on practical implementation in real-world clinical settings, including telesurgical support and telementoring. The guidelines provide expanded, implementation-oriented recommendations covering surgeon and support staff qualifications, institutional requirements, communication network performance and cybersecurity standards, registry-based governance, and structured approaches to remote surgical mentoring. In addition, legal and ethical considerations are strengthened through the inclusion of representative informed consent documents and contractual frameworks. To enhance international applicability, content that is broadly relevant across jurisdictions is presented separately from elements specific to the Japanese regulatory environment. These guidelines aim to support the responsible global dissemination of telesurgery by promoting safety, transparency, and clinical effectiveness.
The optimal cardioplegia strategy in adult coronary artery bypass grafting (CABG) remains controversial. This study compared the efficacy of del Nido, microplegia, and St. Thomas II cardioplegic solutions for myocardial protection using clinical, biochemical, and echocardiographic parameters in isolated CABG. In this prospective single-center study, 157 adult patients undergoing isolated CABG were grouped according to cardioplegia strategy: del Nido (n = 88), microplegia (n = 32), and St. Thomas II (n = 37). Baseline demographic, laboratory, and echocardiographic characteristics were comparable. Intraoperative variables included cross-clamp (XC) and cardiopulmonary bypass (CPB) times, cardioplegia characteristics, defibrillation requirement, and vasoactive support. Postoperative assessment comprised arterial blood gas values, cardiac biomarkers, organ function tests, echocardiographic findings, clinical outcomes, and in-hospital mortality. Total cardioplegia volume and number of doses were significantly lower in the del Nido group (p < 0.001). XC time was shorter with St. Thomas II (p < 0.001), likely due to operative technique differences. Intraoperative defibrillation and adrenaline requirement were more frequent in the St. Thomas II group (p = 0.001 and p = 0.027). Postoperative arterial blood gas parameters and end-organ function were similar. The del Nido group demonstrated significantly lower 1-h troponin I, 1-h CK-MB, and 24-h troponin I levels compared with St. Thomas II (p = 0.002, p = 0.004, p = 0.013). Postoperative increases in troponin I and CK-MB were also lower with del Nido. LVEF decline was least pronounced in the microplegia group (p = 0.013). ICU and hospital stays were significantly longer with St. Thomas II (p = 0.034 and p = 0.027). Morbidity and in-hospital mortality were comparable. Del Nido cardioplegia and microplegia provide comparable and effective myocardial protection, both demonstrating superior biochemical preservation compared with St. Thomas II. Del Nido offers practical advantages without increasing morbidity or mortality.
Although neoadjuvant chemoimmunotherapy is increasingly adopted, the optimal treatment strategy for patients with clinical single-station N2 (cN2a) non-small cell lung cancer (NSCLC) remains controversial in real-world practice. We retrospectively analyzed patients with cN2a NSCLC who underwent upfront surgery between 2007 and 2022. Surgical details, pathological staging, adjuvant treatment, and outcomes were assessed. Fifty-three patients were included. Concordance between clinical and pathologic nodal status (cN2a vs. pN2a) was observed in 39.6% of patients; 35.8% were downstaged, and 24.5% were upstaged to multi-station N2 (pN2b). Median overall survival and recurrence-free survival (RFS) were 60.1 and 25.6 months. Among patients with pathologic N2 disease, recurrence or death within 1 year occurred in 42.8% of those with pN2a and 76.9% with pN2b, primarily due to distant metastases. Adjuvant chemotherapy was administered to 50.9% of the patients. In patients with pN2a, median RFS was 57.8 and 25.3 months with and without adjuvant chemotherapy, respectively (p = 0.916). In patients with pN2b, median RFS was 9.7 and 3.5 months, respectively (p = 0.104). Upfront surgery remains a feasible approach for carefully selected patients with cN2a NSCLC. However, high early recurrence rates, even after adjuvant chemotherapy, highlight the need for more effective perioperative systemic control.
Large-scale multiancestry genome-wide association studies have identified hundreds of loci associated with type 2 diabetes (T2D) and glycemic traits, yet imputed genotyping arrays limit the detection of low-frequency and rare variants. Whole-genome sequencing (WGS) offers a more complete view of genetic variation, especially across diverse populations. We analyzed high-coverage (38×) WGS data from 21,913 T2D case subjects, 61,036 control subjects, and up to 50,011 individuals with no diabetes with fasting glucose, fasting insulin, and HbA1c from the National Heart, Lung, and Blood Institute Trans-Omics for Precision Medicine Program. We performed single-variant association testing, conditional analysis, fine-mapping, and Bayesian colocalization to identify genetic signals and assess regulatory relevance in diabetes-related tissues. We identified 76 distinct association signals across 34 loci, including novel variants at DUSP9 for T2D, and ROBO1, NDN, and MYT1 for HbA1c. Fine-mapping narrowed credible sets and improved causal variant resolution. Colocalization highlighted 80 expression signals in diabetes-related tissues, linking genetic associations to functional regulatory mechanisms. Our findings demonstrate the utility of WGS to uncover novel variants in diverse populations, enhance locus resolution, and link regulatory variation to disease-relevant tissues. This work refines the genetic architecture of T2D and glycemic traits and supports precision medicine efforts targeting diverse populations. We aimed to improve understanding of the genetic architecture of type 2 diabetes and glycemic traits by leveraging whole-genome sequencing in diverse populations. Our goal was to identify novel variants, refine known loci, and link genetic signals to regulatory mechanisms through colocalization with expression quantitative trait loci. We discovered novel variants, significantly improved fine-mapping resolution, and identified 80 regulatory colocalization signals in diabetes-relevant tissues. These findings support precision medicine approaches by connecting genetic variation to functional biology in type 2 diabetes.
Public awareness and interest significantly influence research priorities and healthcare advancements. This study investigates the relationship between public interest, represented by Google Trends Relative Search Volume (RSV), and cardiothoracic research outputs over 21 years (2004 - 2024). A total of 26 conditions/surgeries representing eight topics of general cardiothoracic interest were identified from a review of various social media pages, society webpages, and hospital information bulletins. Data on the conditions were collected from Google Trends and PubMed®. RSV values were calculated annually, and publication counts were extracted for each condition. The study used R (v4.3.3) for all statistical analyses and predictive models. Trauma-related conditions and extracorporeal membrane oxygenation (ECMO) demonstrated increasing RSV and publication trends, with strong positive correlations (e.g., ECMO: r = 0.88, P < 0.0001). Conditions such as congenital cardiac anomalies (e.g., tetralogy of Fallot: r = -0.74, P < 0.0001) showed a negative correlation, with declining RSV despite ongoing research. Multiple regression revealed a significant positive relationship between RSV and publication counts when conditions were controlled (slope = 16.68, R2 = 0.8081, P < 0.0001). Feature importance analysis showed that "Condition" had a slightly greater influence than RSV on publication trends. The study demonstrates variability between public interest and research output across cardiothoracic conditions. While some conditions, such as trauma-related cases and ECMO, show alignment between public awareness and publication activity, others, including congenital anomalies, exhibit divergence.
Intraoperative mobile CT (iCT) and virtual-assisted lung mapping (VAL-MAP) are used to localize pulmonary nodules that are difficult to palpate during minimally invasive surgery. Because these techniques differ in workflow structure and timing of image acquisition, their operative time and radiation exposure may differ. We aimed to describe workflow characteristics and radiation exposure associated with newly implemented iCT and to contextualize these findings against our established VAL-MAP practice. We retrospectively reviewed 50 consecutive patients who underwent thoracoscopic wedge resection with localization between January 2024 and December 2025. Twenty-four underwent iCT-guided localization using an O-arm system, and 26 underwent VAL-MAP with bronchoscopic dye marking followed by post-mapping CT. Technique selection was based on device availability and surgeon discretion. CT dose metrics and time components related to localization were analyzed. Median CT-related dose-length product (DLP) was higher in the iCT group, primarily due to high-definition scans. When performed in standard mode with a limited scan frequency, iCT radiation exposure approximated that of post-VAL-MAP CT. Preparation CT after lateral positioning reduced repeat scans and iCT-related interruption time. Anesthesia and operative times were shorter in the VAL-MAP cohort, reflecting localization outside the operating room. Overall procedural burden appeared modestly different. Our single-center retrospective study quantified the total procedural time for VAL-MAP and iCT, finding modest differences in time and radiation exposure. These real-world data aid institutions considering these localization strategies, but do not establish superiority. Definitive comparative conclusions require future prospective evaluations controlling for nodule characteristics and cost.
Thoracic aortic aneurysm and dissection (TAAD) is a life-threatening condition for which early risk stratification and preventive strategies present critical challenges. Although genetic contributions are well established in high-risk populations, the clinical relevance of rare variants in the general population remains poorly understood. We aimed to explore the association between low-frequency homozygous minor allele genotypes in TAAD-related genes and TAAD-related mortality using a Japanese community-based cohort. We selected 14 single-nucleotide polymorphisms from genes with definitive or strong clinical validity for TAAD, based on the criterion that the frequency of individuals homozygous for the minor allele was less than 5%. Participants with any low-frequency homozygous minor allele genotypes were classified as carriers, while those without such genotypes were classified as non-carriers. The primary outcome was TAAD-related mortality, and we examined whether carrier status was associated with the risk of TAAD-related death. Among 24,478 participants, we analyzed 5,722 individuals (1,499 carriers and 4,223 non-carriers) who had genome-wide genotyping data. TAAD-related deaths were observed in 12 individuals (8 carriers and 4 non-carriers). Carriers exhibited lower survival rates compared to non-carriers. Univariate Cox model analysis showed carrier status was associated with increased TAAD-related mortality. These variants had not been previously classified as pathogenic. Low-frequency homozygous minor allele genotypes in established TAAD-related genes were associated with TAAD-related mortality in a general Japanese population. These findings should be interpreted as hypothesis-generating and are limited to mortality as the endpoint, providing population-based epidemiological evidence on the potential clinical relevance of currently unclassified variants.
Obesity has become a major determinant of outcomes across solid organ transplantation. Beyond its well-recognized metabolic and cardiovascular burden, obesity profoundly affects both immune regulation and the pharmacology of immunosuppressive therapy. Experimental evidence has established adipose tissue as an active immune organ that promotes low-grade inflammation through leptin, TNF-α, and IL-6, thereby altering alloimmune responses and impairing graft tolerance. Clinically, obesity is associated with increased surgical complications, delayed graft function, and reduced survival after kidney, liver, and thoracic organ transplantation. In parallel, obesity modifies drug disposition at every pharmacokinetic step, expanding the distribution volume for lipophilic agents such as calcineurin and mTOR inhibitors, altering CYP3A metabolism, and increasing interindividual variability in exposure. Consequently, both underexposure and toxicity remain frequent, underscoring the need for individualized therapeutic strategies. Current evidence supports the integration of therapeutic drug monitoring, pharmacogenomics, and biomarker-based approaches to refine immunosuppression intensity. This review summarizes experimental and clinical data linking obesity-induced inflammation with altered immunosuppressive pharmacology and proposes a framework for precision immunosuppression that balances efficacy, nephroprotection, and metabolic safety. Tailoring therapy to the specific immunometabolic profile of obese recipients may thus transform a major clinical challenge into an opportunity for precision transplant medicine.
Atrial fibrillation (AF) patients with cancer are frequently treated with vitamin K antagonists (VKAs). Direct oral anticoagulants (DOACs) benefit according to VKA quality has not been investigated in this high-risk population. The authors compared DOACs with VKAs on mortality, cardiovascular events (CVEs), and bleeding risk across time-in-therapeutic-range (TiTR) strata (< or ≥70%). AF patients with cancer from the nationwide Italian Survey on Anticoagulated Patients Register on oral anticoagulants were included. Propensity score matching (PSM) was performed. Results were expressed as hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality and as subdistribution HR (sHR) for CVEs and bleeding risk. Numbers-needed-to-treat (NNT) and numbers-needed-to-harm (NNH) were calculated. VKA patients were stratified by TiTR <70% or ≥70% and compared with DOACs users. A total of 1605 patients were included (median, 78 years; 44.7% women). During a mean follow-up of 729.8 days, 153 deaths, 177 CVEs, and 90 bleedings occurred. After PSM, DOACs were associated with lower all-cause mortality (HR, 0.37, p < .001) and CVEs (sHR 0.58, p = .005) and similar bleeding risk compared to VKAs. The lowest NNT was observed at 24 months (28.2 for mortality and 37.8 for CVEs), whereas NNH was not significant. DOAC use was associated with lower mortality and CVEs risk in patients with TiTR <70%, and with lower mortality, similar CVEs risk and higher risk of bleeding for a TiTR ≥70%. DOACs may reduce mortality in AF patients with cancer regardless TiTR. The use of DOACs in high-bleeding risk patients with good TiTR should be cautious.
Right ventricle-to-pulmonary artery reconstruction is essential in congenital heart surgery. In Japan, cryopreserved homograft availability is limited, necessitating alternative materials. This study systematically elucidated the status of right ventricle-to-pulmonary artery conduit use and surgeon priorities in Japan. In 2024, a web-based nationwide survey was conducted by the Japanese Society of Paediatric Cardiology and Cardiac Surgery, targeting 126 institutions. We analysed data from 2021 to 2023 regarding primary diagnoses, conduit types, and selection criteria. Responses were obtained from 52 institutions (41.2%), covering 926 cases. Handmade expanded polytetrafluoroethylene valved conduits were most frequently used (80.7%), whereas bovine jugular vein conduits (7.5%) and homografts (1.1%) were rarely employed. "Functional Durability and Performance" was the most prioritized criterion (median score: 4.00), with a median expected durability of 10 years. We concluded that in Japan, where a homograft supply system is not established, handmade expanded polytetrafluoroethylene conduits are the primary choice despite their off-label status. A significant gap exists between current performance of conduits in general and clinical expectations for durability, underscoring the need for technological advancements in conduit design.
Although neoadjuvant chemoimmunotherapy is promising for resectable stage II-III non-small cell lung cancer (NSCLC), some patients do not proceed to surgery. We aimed to investigate the clinical course and outcomes of patients whose surgery was cancelled after neoadjuvant chemoimmunotherapy. This retrospective multicentre study (CReGYT-04: Neo-Venus study) included patients with resectable clinical stage II-III NSCLC who received nivolumab neoadjuvant chemotherapy (2023-2024). Clinical characteristics were compared between a surgery-cancelled group and surgery-performed group. In the surgery-cancelled group, the reasons for surgery cancellation, salvage treatments, and effects of immune-related adverse events (irAEs) were evaluated. Among 126 patients, 11 (8.7%) did not undergo surgery. Compared with the surgery-performed group, the surgery-cancelled group had a heavier smoking history, a higher frequency of adjacent organ invasion, a greater proportion of squamous cell carcinoma histology, and more frequent Grade 3-4 irAEs. Reasons for cancelling surgery included disease progression (n = 6, 55%), patient refusal (n = 3, 27%), and irAEs (n = 2, 18%). Four (36%) patients received intensive salvage treatment (concurrent chemoradiotherapy, 3 patients; chemoimmunotherapy, 1 patient), whereas seven patients received best supportive care (n = 4) or less-intensive salvage treatment such as radiotherapy alone (n = 2) and docetaxel monotherapy (n = 1). Among the four patients in the surgery-cancelled group who developed Grade 3-4 irAEs, none received intensive salvage treatment. Intensive salvage treatment was administered to 36% of patients whose surgery was cancelled after neoadjuvant chemoimmunotherapy. These findings highlight the importance of optimising patient selection and irAE management to preserve opportunities for curative-intent treatment when adopting neoadjuvant strategies.
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Transcatheter aortic valve implantation (TAVI) is increasingly performed in younger and lower-risk patients. Since many of these patients will outlive their transcatheter heart valve (THV), redo-TAVI procedures are expected to rise in number. Yet, real-world evidence on the procedural safety and efficacy of redo-TAVI remains limited. We aimed to evaluate the 30-day procedural and clinical outcomes of redo-TAVI using the balloon-expandable SAPIEN 3 platform. The ReTAVI registry is a prospective, international study enrolling consecutive patients with a failed aortic THV undergoing redo-TAVI with a balloon-expandable SAPIEN 3 THV. Data were collected across 59 international centres. All imaging was centrally analysed, and major clinical events were adjudicated by an independent committee. â¨A total of 143 patients (median age 84 years; 40.6% female; median Society of Thoracic Surgeons risk score 7.0%) were enrolled. The predominant failing THVs were balloon-expandable SAPIEN 3 (30.1%), self-expanding CoreValve/Evolut (53.1%), and ACURATE (14.0%) platforms. The most common failure mode was isolated regurgitation (48.6%), followed by stenosis (35.2%) and a mixed pathology (16.2%). The replacement valve was successfully implanted in 95.1% of patients, with a 30-day mortality rate of 3.5%. The 30-day stroke and pacemaker implantation rates were 0.7% and 6.3%, respectively. Redo-TAVI significantly improved valve haemodynamics, with mean gradients decreasing overall (Δ=-12.0 mmHg), and a more pronounced reduction in stenotic failures (Δ=-29.0 mmHg). Coronary obstruction was observed in 1.4% of cases. Redo-TAVI with a balloon-expandable SAPIEN 3 THV platform is a safe and effective reintervention strategy across diverse failed THV types, when guided by the Heart Team, standardised procedural planning, and comprehensive imaging. gov: NCT05601453.
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Mitral valve repair (MVr) in Barlow's disease (BD) is technically demanding, requires complex repair techniques. Following a previous report including posterior mitral leaflet (PML) resection and chordal transfer plus annuloplasty applicable via minimally invasive approach, herein we present mid to long term results of patients undergoing MVr for BD with this defined repair approach. Between September 2009 and February 2021, 55 patients underwent minimally invasive MVr for BD with severe mitral regurgitation (MR), containing resection of P2-segment of PML and transfer of preserved P2-chordae to A2 with implantation of a semi-rigid open ring. Mid to long term follow-up clinical data and recent transthoracic echocardiography (TTE) results were analyzed. The initial successful repair rate was 98.2% (n = 54). 30-days mortality was 0%. Follow-up was completed in 50 patients (90.9%) with a mean of 60.2 ± 37.6 months (range; 2-127 months), while 5 patients were lost to follow-up. For patients who underwent MVr at the time of primary surgery (i.e., excluding one patient with MV replacement), the mid- to long-term survival rate after successful MVr was 92.8% at 5 years and 88.2% at 8 years. The freedom from reoperation rate and the freedom from MR ≧ grade 2 was 97.3% at 5 years and 81.3% at 8 years. There was no systolic anterior motion at follow-up. This minimally invasive repair approach combining posterior leaflet resection and chordal transfer demonstrated a high repair rate and favorable mid- to long-term outcomes in patients with BD when performed in an experienced center.
The prognostic value of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER) remains unclear. This study evaluated the MAGGIC score to predict outcomes after M-TEER in patients with functional (FMR) or degenerative mitral regurgitation (DMR) and compared its performance with conventional surgical and M-TEER-specific risk models. We analyzed 3609 patients (FMR, 71%; DMR, 29%) who underwent M-TEER in the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry. Patients were stratified into MAGGIC score tertiles. The primary outcome was all-cause death at 1 and 3 years. Secondary outcomes included cardiovascular death. Predictive performance was compared with Society of Thoracic Surgeons score, European System for Cardiac Operative Risk Evaluation II, MitraScore, and COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) score. The median age was 81 years, 55.3% were men, and median MAGGIC score was 30. In the FMR cohort, patients in tertile 3 had higher risks of all-cause death (1 year: adjusted hazard ratio [HRadj], 4.15 [95% CI, 2.34-7.36]; 3 years: HRadj, 1.83 [95% CI, 1.22-2.77]) and cardiovascular death (1 year: HRadj, 2.31 [95% CI, 1.56-3.43]; 3 years: HRadj, 1.61 [95% CI, 1.13-2.31]). In the DMR cohort, tertile 3 was associated with higher all-cause death (1 year: HRadj, 2.84 [95% CI, 1.18-6.86]; 3 years: HRadj, 2.25 [95% CI, 1.07-4.73]) and cardiovascular death at 3 years (HRadj, 3.49 [95% CI, 1.23-9.84]). The MAGGIC score demonstrated comparable or superior discrimination on the basis of the concordance index. The MAGGIC score independently predicted 1- and 3-year all-cause death after M-TEER in both FMR and DMR cohorts and cardiovascular death in the FMR cohort and at 3 years in the DMR cohort. It demonstrated comparable or superior predictive performance to conventional surgical and M-TEER-specific risk models.
Neoadjuvant immunotherapy has transformed the management of resectable non-squamous cell lung cancer (NSCLC). However, the specific arrhythmogenic potential of immune checkpoint inhibitors (ICIs) in the postoperative setting remains poorly characterized. This study aimed to isolate the independent impact of neoadjuvant immunotherapy on postoperative atrial fibrillation (POAF) and quantify its clinical consequences. We analyzed 1,610 patients undergoing anatomic lung resection for Stage II-III NSCLC between 2020 and 2025. To decouple the ICI effect from chemotherapy and eliminate selection bias, a 1:1:1 propensity score-matched (PSM) analysis based on baseline clinical and demographic characteristics was performed to create three balanced cohorts (n = 400 each, Total N = 1,200): (1) upfront surgery (Control), (2) isolated neoadjuvant chemotherapy (nCT), and (3) neoadjuvant chemo-immunotherapy (nCIT). Following PSM, all baseline cardiac risk factors achieved statistical parity (p > 0.05). A significant stepwise escalation in POAF incidence was observed: 11.5% in the Control group, 15.1% in the nCT group, and 23.5% in the nCIT group (p < 0.001). Multivariable analysis isolated the specific immunotherapy effect, revealing that the addition of ICIs independently increased POAF odds by 2.28-fold (95% CI: 1.45-3.65, p < 0.001) compared to chemotherapy alone. Clinically, POAF development in the immunotherapy cohort resulted in a significant extension of the median hospital stay (10.4 vs. 5.6 days, p < 0.001) and ICU stay (3.2 vs. 1.4 days, p < 0.001). This specific ICI effect appeared to correlate with an enhanced systemic inflammatory response and increased surgical complexity observed during hilar dissection. Modern neoadjuvant protocols suggest that the immunotherapy component contributes to a higher likelihood of POAF. Consequently, integrating careful perioperative cardiac monitoring and tailored management approaches for these patients could be beneficial in improving clinical outcomes and optimizing the use of hospital resources.