The dimensions of the aorta play a crucial role in cardiovascular health, serving as a determinant of normalcy and a marker for pathological conditions such as aortic aneurysms and dissections. Extensive research has been conducted on the ascending aortic dimensions in the Western population, which forms the basis of the current aortic surgical guidelines. However, there remains a paucity of data specifically focused on the Indian population, which is essential for accurate diagnosis, risk stratification, and management of aortic diseases in the Indian context. This paper aims to describe the general aortic size distribution in the general Indian population. To study the aortic size in the Indian general population, we included all consecutive individuals who underwent a computed tomography (CT) scan between January 2022 and December 2022. Patients under the age of 18 years, those with cardiovascular comorbidities, and those with any aortic segment measuring > 45 mm were excluded from the analysis. The maximum aortic diameters were measured at predefined levels (aortic root, ascending aorta, aortic arch, proximal descending aorta, and the abdominal aorta). Our study comprised 891 individuals with a mean age of 51.9 years, of which 41.5% were female. The mean ascending aortic diameter of all subjects was 29.3 ± 3.9 mm and was significantly smaller in women (28.7 ± 4.0 mm) as compared to men (29.8 ± 3.8 mm), even after correcting for age, body mass index (BMI), and body surface area (BSA). The proportion of subjects with an ascending aorta < 3.5 cm was 93.5%, that of subjects with 3.5-3.9 cm was 6.2%, and that of subjects with 4.0-4.4 cm was 0.3%. The general aortic dimension in the Indian population is deceptively small, most commonly < 3.5 cm. The ascending aorta is significantly smaller in the female population, also after correcting for age, BMI, and BSA. This study provides evidence to question current recommendations in the aortic guidelines for surgical intervention at 5-5.5 cm for the Indian population and whether a distinction should be made for the female patients. The online version contains supplementary material available at 10.1007/s12055-025-02173-6.
Data on outcome for robotic coronary artery bypass grafting (CABG) is sparse. The aim of this study was to compare clinical outcomes between conventional and robotic-assisted CABG. This was a single-center retrospective study comparing conventional and robotic-assisted CABG between January 2024 and October 2024. Baseline patient characteristics, intra-operative details, and post-op outcomes were compared between 2488 conventional and 136 robotic procedures. Propensity matching was done for age, gender, comorbid illness, and operative characteristics. Learning curve was analyzed using a cumulative sum (CUSUM) chart. One hundred and thirty-two propensity-matched pairs were compared. Before matching, the conventional CABG group had a higher frequency of females and diabetes mellitus, and a slightly higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 risk score, while ejection fraction was marginally higher in the robotic surgery group. After matching, the groups were comparable in terms of demographic details, clinical presentation, comorbid illness, and laboratory parameters. The duration of surgery, ventilation duration, and the number of distal anastomoses were higher in the conventional group before matching. After matching, the difference persisted for ventilation duration alone. Patients in the robotic-assisted CABG group had a lower incidence of arrhythmia (5.3% versus (vs.) 18.2%; p < 0.001). There was no difference in other post-op outcomes (renal complications, post-op myocardial infarction, extracorporeal membrane oxygenation (ECMO) requirement, and mortality). CUSUM analysis showed achievement of learning at the 86th patient, proficiency at the 114th patient, and competency by the 136th patient (R 2 0.88). Our study demonstrates that robotic-assisted CABG is a feasible and effective approach in appropriately selected patients. Long-term outcomes, particularly graft patency and completeness of revascularization, require further investigation before definitive conclusions can be drawn regarding its superiority over conventional CABG. Robotic CABG is a promising alternative to conventional techniques with potential clinical benefits and should form part of the surgical armamentarium. The online version contains supplementary material available at 10.1007/s12055-025-02123-2.
Congenital heart disease (CHD) presents a major health challenge in India. Wide variations exist in the burden of CHD across published studies. Pooling data from published evidence and analyzing factors associated with these variations can provide robust estimates and insights for policymakers and healthcare providers. A systematic literature search was done in PubMed, Embase, Cochrane Library, CINAHL, and Web of Science from inception to August 2023. Two independent reviewers screened studies, extracted data, and evaluated the risk of bias using the Joanna Briggs Institute (JBI) Critical Appraisal tool. This study was registered with International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023469773). A total of 33 studies were included in the systematic review, with 32 studies eligible for meta-analysis. The CHD event rates varied widely across the studies, ranging from 0.67 per 1000 to 40.28 per 1000. The pooled incidence of CHD was 10.10 per 1000 live births (95% confidence interval (CI), 4.52-15.68). These studies predominantly assessed CHD shortly after birth or within a defined time window. The pooled prevalence of CHD among children was 9.61 per 1000 (95% CI, 6.18-13.05). These studies included cross-sectional assessments from school-based, hospital-based, and community-based screening of children in older age groups. Subgroup analyses revealed variations by population group, ranging from 7.44 per 1000 in school-based screenings to 14.00 per 1000 in fetal screening. A time trend analysis revealed 6.65/1000 (95% CI, 1.01 to 12.29) (1980-2000) to 11.47/1000 (95% CI, 5.65 to 17.30) (2016-2022). These findings highlight substantial variation in the burden of CHD reported across the studies, partially attributed to methodological heterogeneity. A nationwide longitudinal database with uniform methodology is essential to the accurate assessment of the burden, changing epidemiological profile, and clinical outcomes. The online version contains supplementary material available at 10.1007/s12055-026-02181-0.
In ST-elevation myocardial infarction (STEMI), timely reperfusion via percutaneous coronary intervention (PCI) reduces mortality but is limited by microvascular injury (MVI), including microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), which drive adverse cardiac remodeling. This study evaluates the incidence of MVO and IMH, their combined effects, and associations with hyperglycemia, inflammation, and left ventricular (LV) dysfunction after successful non-surgical revascularization of STEMI. A single-center cohort of 60 STEMI patients (2019-2020) underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) 48 ± 6 h post-infarction to assess MVI. Patients were classified into four groups: no MVI, isolated MVO, isolated IMH, and combined MVO + IMH. For some analyses, patients were also dichotomized into MVI-present versus MVI-absent groups to facilitate comparison of functional and biochemical outcomes. LV function was evaluated via echocardiography (days 7 and 90). Biomarkers were analyzed at admission and day 7. MVI occurred in 68.3% of patients: isolated MVO (16.7%), isolated IMH (15%), and combined MVO + IMH (36.7%). Combined MVO + IMH correlated with larger infarct size, prolonged ischemia, and higher admission glucose. C-reactive protein (CRP) levels on day 7 were elevated in isolated MVO (59.8 [9.1-75.9] mg/L) and MVO + IMH (32.8 [4-55.6] mg/L) versus no-MVI (4.6 [2.9-12.7] mg/L). LV ejection fraction (LVEF) was significantly lower in MVO + IMH groups (p < 0.05). Admission glucose inversely correlated with day 7 LVEF (r = -0.43, p < 0.0001). Combined MVO and IMH was associated with a more unfavorable remodeling pattern and subtle LV dysfunction, which may be exaggerated by hyperglycemia and inflammation. Elevated CRP links MVO to systemic inflammation, while IMH reflects mechanical capillary damage. These findings emphasize the need for early glycemic control, anti-inflammatory strategies, and imaging-guided risk stratification to mitigate microvascular injury and improve outcomes in STEMI. AMI-Acute Myocardial Infarction; IMH-Intramyocardial Hemorrhage: MVO-Microvascular Obstruction.Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage. The online version contains supplementary material available at 10.1007/s12055-025-02082-8.
If patients with bicuspid aortic valve (BAV) stenosis are high-risk candidates for traditional open-heart surgery, they can be treated with transcatheter aortic valve replacement (TAVR). The purpose of this study is to understand the effects of balloon-expandable valves (BEVs) and self-expandable valves (SEVs) as they are used in TAVR on patients with BAV stenosis. We searched the databases PubMed, Embase, Cochrane, and ScienceDirect from their inception until January 2025. An odds ratio (OR) and corresponding 95% confidence interval (CI) were determined for every outcome, with statistical significance at p-value < 0.05. Random-effects models were used for studies with high heterogeneity (I 2 > 50%), and fixed-effects models for low heterogeneity (I 2 ≤ 50%). Nine observational studies were included. There was no significant difference found for the following outcomes: procedural death, 30-day mortality, 1-year all-cause mortality, annulus rupture, acute kidney injury, stroke, and moderate/severe paravalvular leak between BEV and SEV.Still, having a BEV was associated with a lower risk of needing a pacemaker or requiring second valve surgery. From this analysis, it seems that BEVs may provide better results than SEVs in terms of reducing the need for a pacemaker and a second valve in patients with BAV stenosis treated with TAVR. The number of deaths and serious complications was about the same for the two valves. Additional randomized controlled trials are needed to study both the lasting effects and the factors that shape these results. CRD420251003387. The online version contains supplementary material available at 10.1007/s12055-025-02111-6.
Adjuvant procedures to treat persistent long-standing atrial fibrillation (AF) in patients undergoing mitral valve surgery are known to improve postoperative outcomes. Traditionally, the Cox-Maze operation has had outstanding long-term outcomes, but it is not widely employed because of its intricacy and lengthy learning curve. Pulmonary vein isolation (PVI) using the cut-and-sew technique and excision of the left atrial appendage (LAA) can be a simpler alternative adjuvant procedure in mitral valve surgery patients. A prospective observational study was conducted from January 2020 to December 2024, involving patients requiring mitral valve procedures with persistent long-standing AF on anti-arrhythmic treatment. Adjuvant PVI and LAA excision were carried out in all these patients for treating this AF. The mean follow-up period of the patients was 48.7 ± 7 months to assess their return to normal sinus rhythm (NSR). This study observed that PVI by cut-and-sew technique achieved NSR in 96.4% at 6 months follow-up. A significant mean difference was found between preoperative and postoperative left atrial (LA) diameter of 1.0778 ± 0.3804 cm. Re-exploration for bleeding, thromboembolic events, and postoperative anti-arrhythmic drug requirement or permanent pacemaker implantation were nil. The cut-and-sew PVI with LAA excision is a safe, effective, and cost-efficient technique for AF treatment in mitral valve surgery. It creates a transmural lesion that forms a scar and is a permanent, reliable stopgap for ectopic electrical impulses. Our findings support its feasibility, especially in resource-limited settings, though larger studies are needed for further validation.
Autoimmune carditis in children is uncommon and often overlooked, particularly in regions where rheumatic fever is endemic. We report the case of a 12-year-old girl who presented with progressive dyspnea, orthopnea, and intermittent fever, ultimately found to have a superior vena cava (SVC)-type sinus venosus atrial septal defect (SV-ASD) with partial anomalous pulmonary venous connection (PAPVC). Her condition was compounded by severe mitral, aortic, and tricuspid regurgitation; moderate pulmonary regurgitation; and moderate pericardial effusion. Laboratory testing suggested an autoimmune inflammatory process, and rapid clinical decline with impending cardiac tamponade necessitated urgent pericardial drainage. Immunosuppressive therapy with corticosteroids, hydroxychloroquine, and mycophenolate mofetil was initiated for presumed autoimmune pancarditis, followed by surgical repair consisting of SV-ASD closure with the Warden technique, rerouting of anomalous pulmonary veins, and multivalvular repair. Histopathology confirmed fibrinous pericarditis with chronic inflammation. The patient improved significantly after surgery, with resolution of pulmonary hypertension and stable mild residual valvular disease. At 1 year, she remained asymptomatic with normalized inflammatory markers. This case highlights how autoimmune inflammation superimposed on congenital heart disease can accelerate hemodynamic compromise and underscores the importance of early recognition, timely immunosuppression, and individualized surgical planning to prevent irreversible cardiovascular damage.
The heart has long occupied a unique position at the intersection of mythology, philosophy, and medicine. In ancient Greek thought, it was regarded not merely as an anatomical structure but as the seat of emotion, intelligence, and vitality. This article traces the evolving conceptualization of the heart from its mythopoetic roots in Hellenic mythology and literature to its re-interpretation within early philosophical discourse and proto-medical frameworks. Through an interdisciplinary approach, we explore how symbolic understandings of the heart informed early medical theories, culminating in the foundational works of Hippocrates, Aristotle, and Galen. We further examine the enduring metaphorical significance of the heart in modern cardiology, particularly in psychosomatic and neurocardiological models that echo ancient intuitions. By uncovering the layered genealogy of cardiac symbolism and function, this study highlights how historical perspectives continue to influence contemporary clinical paradigms. Ultimately, the heart remains not merely a biological organ but a palimpsest of cultural meanings, bridging the domains of myth, medicine, and metaphysical thought.
Tracheobronchial injuries (TBI) are rare but potentially life-threatening complications of esophagectomy, with significant morbidity and mortality. This narrative review examined the incidence, risk factors, diagnostic methods, and management strategies for TBI following esophagectomy. A PubMed search was conducted for relevant studies published between 1978 and 2024 using terms related to tracheal injury and esophagectomy. Forty-five articles met the inclusion criteria. The incidence of TBI ranged from 0.4 to 3.5% in transhiatal esophagectomy (THE) and 0 to 2.67% in transthoracic esophagectomy (TTE). Identified risk factors included dense tumor adhesions, neoadjuvant chemoradiation, blunt esophageal dissection, and double-lumen endotracheal tube use. Diagnosis was primarily via bronchoscopy and imaging. Small, stable injuries were managed conservatively, while larger defects required surgical repair, often with muscle flap or synthetic reinforcement. Early intraoperative recognition and repair are key to improving outcomes, but mortality is high in cases of delayed diagnosis. This review emphasizes the importance of meticulous surgical technique, vigilant intraoperative monitoring, and individualized treatment strategies to minimize complications in high-risk patients.
In India, myocardial infarction (MI) is a significant cause of mortality related to cardiovascular diseases. Timely diagnosis is critical for addressing this issue. While prior studies have concentrated on digital electrocardiogram (ECG) data, the presence of noise and artifacts in paper electrocardiogram is not well addressed in the literature. So, it is important to incorporate a more diverse range of data to understand the intricacies involved in MI diagnosis comprehensively. This paper proposes an approach for MI and non-MI classification and cardiac rhythm classification using ECG. Modified versions of GoogleNet-Gated Recurrent Unit (GRU) and ResNet50- Bidirectional Long Short-Term Memory (BiLSTM) models were utilized for MI/non-MI and cardiac rhythm classification, respectively. Three different datasets (PTB-XL (dataset 1), ECG images of cardiac patients' data samples (dataset 2), and hospital paper ECG (dataset 3) were used for training the datasets, and final testing was done on digitized hospital paper ECG. The proposed model achieved 88.8% accuracy on the PTB-XL dataset for MI/non-MI classification but showed performance disparity on dataset 3 test data. After a training-retraining process on datasets 2 and 3 and testing on dataset 3 test data, the model showed an accuracy of 92.50% with a balanced performance. For five-class cardiac rhythm classification, the proposed model attained 93.50% accuracy. Retraining models on diverse datasets enhances generalization to real-world scenarios. The study's findings emphasize the importance of incorporating various data sources to improve model robustness and reliability in clinical applications. The developed application facilitates the seamless integration of digitization and classification processes for enhanced diagnostic accuracy.
This meta-analysis compared peri-procedural and short-term outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in severe bicuspid aortic valve (BAV) stenosis, addressing TAVR's debated efficacy in this context. A systematic search of PubMed, ScienceDirect, and Embase up to January 2025. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with the I2 statistic, with p < 0.05 as significant. 9 observational studies and 1 randomized controlled trial with 148,771 patients (TAVR: 16,584; SAVR: 132,187) were included. TAVR showed lower odds of acute kidney injury (OR = 0.58, 95% CI: 0.35-0.97; p = 0.04), major bleeding (OR = 0.29, 95% CI: 0.12-0.69; p = 0.005), and pulmonary complications (OR = 0.44, 95% CI: 0.34-0.57; p < 0.00001) versus SAVR. However, TAVR increased risks of paravalvular leak (OR = 2.15, 95% CI: 1.20-3.88; p = 0.01) and permanent pacemaker implantation (OR = 2.08, 95% CI: 1.39-3.10; p = 0.0004). No significant differences were noted in in-hospital mortality (OR = 1.04, 95% CI: 0.56-1.94; p = 0.89), stroke (OR = 1.05, 95% CI: 0.86-1.28; p = 0.65), or vascular complications (OR = 0.67, 95% CI: 0.18-2.52; p = 0.55). TAVR reduces risks of acute kidney injury, major bleeding, and pulmonary complications in BAV stenosis but raises paravalvular leak and pacemaker implantation risks compared to SAVR. Mortality and stroke rates are similar. TAVR may suit selected patients, but long-term data is needed. The online version contains supplementary material available at 10.1007/s12055-025-02146-9.
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A 55-year-old man presented with sudden-onset right-sided neck swelling, fever, and stridor. Clinical examination revealed a firm, non-mobile mass near the angle of the mandible. Ultrasonography and contrast-enhanced computed tomography of the neck confirmed a pseudoaneurysm of the right common carotid artery just proximal to the bifurcation, measuring 37 × 28 × 33 mm, surrounded by a peripherally enhancing inflammatory mass extending into the parapharyngeal space and causing airway compromise. The internal jugular vein was thrombosed. Due to anterior tracheal compression, both intubation and tracheostomy were deemed unsafe. Elective extracorporeal membrane oxygenation (ECMO) was initiated via femoral artery and vein cannulation using a cardiopulmonary bypass machine. Spinal anaesthesia was administered, and systemic heparinization was performed to achieve an activated clotting time > 480 s. ECMO enabled safe general anaesthesia and surgical control. A longitudinal cervical incision exposed the pseudoaneurysm, which was excised along with the surrounding infected mass. The anterior carotid wall was necrotic, and the intima was calcified. A reversed saphenous vein graft was used to reconstruct the artery between the common and internal carotid segments. The external carotid artery and thrombosed internal jugular vein were ligated. Postoperatively, the patient was ventilated and supported with inotropes. He was extubated on postoperative day 3 and discharged on day 10 without neurological deficits. This case highlights the novel use of ECMO in managing carotid pseudoaneurysms with airway compromise, offering a safe alternative when conventional airway access is not feasible.
Esophagopericardial fistula (EPF) is an extremely rare, life-threatening condition that can develop following certain treatments. This case represents, to our knowledge, the first reported case of an EPF as a late complication of stereotactic body radiation therapy (SBRT) for liver metastases. It emphasizes the need for collaborative and individualized management strategies, particularly in the context of post-radiation tissue changes. A female patient in her late sixties, with a history of colon adenocarcinoma, previously treated with SBRT for liver metastases, presented with signs of cardiac tamponade. A multislice computed tomography (MSCT) scan confirmed EPF, and a multidisciplinary board was assembled to manage the patient. Initial management involved urgent pericardial drainage and vancomycin irrigation, followed by an endoscopic placement of a fully covered self-expandable esophageal metal stent. After the intervention, the patient's clinical condition significantly improved. The stent remained in place and maintained a stable position during a 6-month follow-up period. Given the rarity and diverse etiologies of EPF, it is essential to manage each case individually, taking into account prior interventions and the patient's healing capacities. Our experience highlights the importance of prompt hemodynamic stabilization, restoration of anatomical integrity, and a tailored approach to each patient. Specifically, permanent stent retention may be justified when radiation-impaired healing is present. Although EPF will remain uncommon, adherence to these principles, implemented through a multidisciplinary approach, can optimize outcomes when this severe complication does occur.
To evaluate immediate and long-term outcomes of valve-sparing root replacement (VSRR) for patients with dilated aortic roots. This observational study included all patients undergoing VSRR between June 2009 to October 2024, systematically documenting patient demographics, pre-operative characteristics, surgical details, and valve morphology. The primary outcome was all-cause mortality, with secondary endpoints including valve-related complications and reintervention rates. The cohort consisted of 91 patients, predominantly males (81.3%), with a mean age of 38.5 ± 14.2 years. Of these, 83 (91.2%) patients were diagnosed with aortic aneurysm, and 25(27.4%) had connective tissue disorder. The valve morphology analysis revealed that 76 (83.5%) patients had tricuspid aortic valves, and 73 (80.2%) presented with moderate-severe aortic regurgitation. Sixty-one (67%) straight tubular Dacron grafts and 30(33%) Valsalva grafts were used.Surgical complications were relatively low, with 5 (5.4%) patients requiring re-exploration. Serious adverse events were infrequent, and 1(1.1%) patient had a stroke, 3(3.2%) developed acute kidney injury requiring dialysis, and 1(1.1%) patient needed a tracheostomy. Additional complications included complete heart block or permanent pacemaker implantation in 2 patients (2.1%), and extracorporeal membrane oxygenation (ECMO) use in 1 patient (1.1%). The 30-day mortality was 3 (3.2%). The mean survival was 12.7 years; 95% confidence interval (CI): 11.7 to 13.7 years. The cumulative survival rates at 1, 5 and 10-years was 95%, 93%, and 86%. Freedom from moderate/ severe aortic regurgitation at 1, 3, and 5 years was 88%, 88% and 77% respectively. The excellent survival and low complication rates suggest VSRR as a viable surgical approach for patients with aortic root pathologies. The online version contains supplementary material available at 10.1007/s12055-025-02104-5.
We report the case of a 72-year-old man referred to cardiothoracic services with a right-sided spontaneous pneumothorax. High-resolution computed tomography (HRCT) revealed extensive bilateral lung cysts and recurrence of the pneumothorax. Further clinical assessment led to a diagnosis of Birt-Hogg-Dubé (BHD) syndrome-a rare genetic condition marked by cystic lung disease, spontaneous pneumothoraces, skin fibrofolliculomas, and an elevated risk of renal tumors. We discuss the thoracic implications of BHD and the utility of uniportal video-assisted thoracoscopic surgery (UVATS) with pleurodesis in recurrent cases. The report underlines the importance of genetic evaluation and long-term surveillance for patients and at-risk relatives. Genetic testing for the FLCN (Folliculin) gene was initiated and results were consistent with Birt-Hogg-Dubé syndrome.
Perioperative acute kidney injury (AKI) happens to be an actively investigated research subject with a continued focus on the corresponding risk stratification, preventive, and therapeutic strategies. Meanwhile, the peculiarities of cardiac surgery-associated AKI (CSA-AKI) in this regard can indeed not be overemphasized. There exists recent literature that captivates attention for opening newer debates surrounding the Kidney Disease: Improving Global Outcomes (KDIGO) criterion for characterizing CSA-AKI, especially in relation to its prognostic ramifications in the cardiac surgical patient population. Ahead of the significance of discussing these intriguing research findings, there is a concurrent need to delve deeper into the relevant intricacies of the matter. The index narrative review presents the readership with reflective insights into the literature surrounding KDIGO-based CSA-AKI characterization and the allied prognostic ramifications, offering valuable learning points in this topic of importance.
Neodymium-doped yttrium aluminum garnet (Nd:YAG) LASER bronchoscopy has emerged as an important modality in the management of central airway obstruction, particularly in resource-limited settings. We retrospectively reviewed patients who underwent Nd:YAG LASER bronchoscopy between 2021 and 2024 at a tertiary care referral center in Nepal. Demographic characteristics, lesion profile, procedural details, complications, and outcomes were analyzed. Twenty three patients (86.9% male, median age 34.5 years) underwent 33 LASER sessions during the study period. Shortness of breath on exertion (86.9%) was the most common symptom and median symptom duration before presenting to us was 3 months. Patients were referred from centers across Nepal (73.9% from tertiary and 26.1% from district hospitals). The trachea was the most common site of lesion (48%). Benign lesions (60.9% ) were frequent, with post-intubation tracheal stenosis being the most common diagnosis (21.7%). Use of laryngeal mask airway for airway access increased (75%) while rigid bronchoscopy decreased (75%) over the course of four years. A statistically significant reduction in the Cotton-Myer grade was observed following the intervention (p < 0.001). Sixteen of 19 (84.8%) intubated patients were extubated immediately after the procedure. Minor hypoxia, major hypoxia, and minor bleeding occurred in eight (24%), one (3%), and seven sessions (21%), respectively. No airway fire, major hemorrhage, or 30-day mortality occurred. Nd:YAG LASER bronchoscopy is a safe and effective intervention for diverse airway lesions and demonstrates feasibility in a tertiary care center setting.
With the objective to present a minimally invasive surgical approach for excision of left atrial (LA) myxoma via right anterior thoracotomy (RAT), offering a less traumatic alternative to conventional median sternotomy, patients admitted in the department of Cardiothoracic and Vascular Surgery (CTVS), Sawai Man Singh (SMS) Hospital, from January 2017 to December 2024 with isolated intra-cavitatory LA mass with no other cardiac pathology were included in this prospective study. After informed consent, all participants underwent myxoma excision via the RAT approach. The average clamp time ranged from 18 to 30 minutes and pump time between 30 and 45 minutes. Postoperative drain output averaged 50-75 cc which was notably less than seen in conventional sternotomy. The average cardiac intensive care unit (C-ICU) stay was also shorter. There was no procedure-related morbidity or mortality. Patients reported high satisfaction due to improved scar cosmesis. Thus, we conclude that cardiac myxomas, the most common benign cardiac tumors, typically arise in the left atrium, with a myriad of clinical presentations. Surgical resection by midline sternotomy remains the definitive treatment worldwide. However, we present LA myxoma excision via a RAT approach as a less traumatic alternative. Our technique avoids femoral cannulation (no femoral site complications and extra access ports), uses conventional instruments (cost-effectiveness), and eliminates sternotomy. It achieves similar cardiopulmonary bypass (CPB) time (30-45 minutes) and clamp times (18-30 minutes), lower drain output (50-75 cc), and shorter C-ICU stay and operative time, with excellent cosmetic results (small, cosmetic scar) and high patient satisfaction, without procedure-related complications.
Body weight is still the most common metric used for donor-recipient matching in Pediatric Heart Transplantation (PHTX) and its impact on long-term outcomes remains unclear from variable definition and conflicting evidence. In this study, the outcomes of varying weight mismatch on PHTX was analysed. The United Network for Organ Sharing (UNOS) database (1984-2025) was retrospectively analysed. Size mismatch as a percentage donor-recipient weight difference was categorized as Mild (≤ 20%), Moderate (20-30%), Extreme (> 30%), and stratified as undersizing or oversizing. Demographics, clinical characteristics, and post-transplant outcomes were compared. One-year and 15-year mortality were analysed using multivariable logistic and Cox regression, respectively. Oversizing (80%, 9,175/11,583) was more common than undersizing (20%, 2,408/11,583). With increasing oversizing, the recipients were younger, had congenital heart disease (CHD) diagnosis, and elevated pulmonary vascular resistance but with shorter wait-list times. Oversizing had no impact on 30-day, 1-year, or 15-years survival. With increasing undersizing, recipient age was similar, had less restrictive cardiomyopathy diagnosis, and had female donor but with shorter wait-list times. Undersizing had inferior survival till 5-years but not at 15-years. However, on multivariable analysis, undersizing was not predictive of inferior survival anytime as was congenital heart disease diagnosis, Extracorporeal Membrane Oxygenation (ECMO) bridge, elevated pulmonary-vascular resistance, transplantation era, and post-transplant rejection, stroke, and dialysis use. Oversizing is more likely than undersizing in PHTX. While oversizing had no overall survival impact, undersizing had negative mid-term but not long-term survival impact which disappeared when adjusted for underlying cardiac diagnosis, elevated pulmonary vascular resistance, transplantation era and occurrence of post-transplant complications. The online version contains supplementary material available at 10.1007/s12055-026-02195-8.