Circadian rhythms affect cardiovascular function, and the timing and severity of stroke and myocardial infarction (commonly known as a heart attack). Afternoon cardiac surgery may improve outcomes by reducing ischaemia-reperfusion injury (i.e. reducing tissue damage caused when blood supply returns to tissue (reperfusion) after a period of oxygen deprivation (ischaemia)). However, the evidence is conflicting. This systematic review assessed the impact of surgical timing on clinical outcomes after cardiac surgery. To assess the effects of early versus late surgical start times for on-pump cardiac surgery on mortality, cardiac outcomes, and quality of life. We searched CENTRAL, MEDLINE, Embase, and Web of Science Conference Proceedings Citation Index - Science, along with ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform trials registers. We also conducted reference checking, citation searching, and contacted study authors to identify studies for inclusion. The latest search date was 26 January 2025. We included randomised controlled trials (RCTs) in adults undergoing cardiac surgery comparing late with early surgical start times. We excluded non-randomised studies and studies in children. Our critical outcomes were short-term mortality (≤ 30 days postoperative), long-term mortality (> 30 days postoperative), and perioperative myocardial infarction. Other important outcomes were perioperative myocardial injury, postoperative atrial fibrillation, left ventricular ejection fraction, lengths of intensive care unit (ICU) and hospital stays, and quality of life. We used the Cochrane Risk of Bias 2 tool to assess bias in the included RCTs. As only one study met the inclusion criteria, we did not perform meta-analysis. We synthesised results descriptively, and used GRADE to assess the certainty of the evidence for specified outcomes. We included one study with 88 participants. The included study was conducted in France, and reported on differences in outcomes between morning and afternoon on-pump elective aortic valve replacement in adults. Critical outcomes No study reported short-term or long-term mortality data for early versus late surgical start times for on-pump cardiac surgery. In the included study, there was no evidence of a difference regarding in-hospital mortality between groups, with no deaths in both groups (risk ratio (RR) and 95% confidence interval (CI) not estimable; 1 study, 88 participants). The evidence is very uncertain about the effect of early versus late surgery on perioperative myocardial infarction (RR 0.29, 95% CI 0.06 to 1.30; 1 study, 88 participants, very low-certainty evidence). Important outcomes There was evidence of lower perioperative myocardial injury as measured by cumulative troponin release over 72 hours in those undergoing late surgery compared to early surgery (MD -46 ng/L × 72 h, 95% CI -79 to -13; 1 study, 88 participants). In the included study, there was no evidence of a difference in new-onset postoperative atrial fibrillation during hospital stay between groups (RR 0.75, 95% CI 0.40 to 1.40; 1 study, 88 participants). No study reported differences in left ventricular ejection fraction at discharge as a continuous variable for early versus late surgical start times for on-pump cardiac surgery. In the included study, there was no evidence of a difference in left ventricular ejection fraction < 45% at discharge between groups (RR 0.40, 95% CI 0.08 to 1.95; 1 study, 88 participants). No study reported differences in length of ICU admission for early versus late surgical start times for on-pump cardiac surgery. There was no evidence of a difference in need for inotropic support between groups in the included study (RR 0.25, 95% CI 0.03 to 2.15; 1 study, 88 participants). The evidence is very uncertain about the effect of late surgery on length of hospital stay (MD 0.00, 95% CI -1.48 to 1.48; 1 study, 88 participants, very low-certainty evidence). No study reported on the outcome of quality of life. The evidence is very uncertain about the effects of early versus late surgical start time for the outcomes of perioperative myocardial infarction and length of hospital stay. We found no data for the outcomes of short-term or long-term mortality, left ventricular ejection fraction, length of ICU stay, or quality of life. Late surgical start time could reduce the risk of perioperative myocardial injury as estimated by cumulative troponin release over 72 hours. More research is needed to determine whether scheduling heart surgery later in the day improves patient outcomes. This Cochrane review had no dedicated funding. Protocol (2022) DOI: 10.1002/14651858.CD014901.
A history of prior cardiac surgery (PCS) determines treatment decision and long-term outcomes in patients requiring aortic valve replacement. This study examined patient profiles, treatment-decisions and long-term outcomes of patients under 75 years with PCS undergoing transcatheter and surgical aortic valve implantation/replacement (TAVI, SAVR) in the Netherlands. Data from 1,284 patients (ages 50-75 years) with PCS undergoing TAVI or SAVR between 2015 and 2020 were analyzed using data from the Netherlands Heart Registration. Logistic and cox regression identified determinants of treatment selection and long-term mortality. Determinants were considered impactful if they had an odds ratio (OR) or hazard ratio (HR) of ≥ 1.5 or ≤ 0.7 and a prevalence of ≥ 5%. Of 1,284 patients, 690 underwent TAVI (54%) and 594 SAVR (46%). Prior index surgery most frequently involved coronary artery bypass grafting (CABG) (57% in the TAVI group vs 40% in the SAVR group; p < 0.001) and previous aortic valve surgery (25% vs 51%; p < 0.001). TAVI patients were significantly older (median 71 vs. 67 years, p < 0.001) and had a higher EuroSCORE II (median 5.7 vs. 4.4, p = 0.003) than SAVR patients. SAVR was the preferred strategy for intermediate-risk patients (62%), while TAVI was favored in high- and prohibitive-risk patients (62% and 94%, respectively). In descending order of odds ratio, the strongest independent determinants of TAVI selection were left ventricular ejection fraction ≤ 30% ((OR: 4.8; 95% CI: 2.6-8.8), poor mobility ((OR: 3.4; 95% CI: 1.6-7.0) and obesity/cachexia (OR 2.7; 95% CI: 1.6-4.4); the key determinants of SAVR selection were pure native aortic regurgitation (OR: 0.1; 95% CI: 0.1-0.3) and failing surgical bioprosthesis (OR: 0.7; 95% CI: 0.5-1.0. Thirty-day, 1- and 5 year survival after TAVI and SAVR was 97% and 96%, 83% and 91%, and 56% and 83%, respectively (p-value < 0.001). Left ventricular ejection fraction ≤ 30% and chronic lung disease were important mortality determinants for both procedures, with higher odds ratios for mortality in SAVR as compared to in TAVI patients. In the Netherlands, TAVI and SAVR rates were comparable among patients < 75 years with PCS. Higher-risk patients were directed toward TAVI except for those presenting with pure native aortic regurgitation and bioprosthesis failure who mainly received SAVR. Severe left ventricular dysfunction and chronic lung disease were key mortality predictors for both procedures.
Although minimally invasive cardiac surgery (MICS) is less invasive, patients may still experience significant postoperative pain. This observational study aimed to evaluate the feasibility and postoperative analgesic profile associated with the combined serratus anterior plane block (CSAPB), a component of multimodal analgesia in patients undergoing MICS. Twenty patients, aged 18 to 80, who underwent MICS and provided written informed consent, were included in the study. Standard cardiac anesthesia monitoring was performed. Ultrasound-guided CSAPB was performed preemptively after induction of general anesthesia as part of a multimodal analgesia strategy, using a total of 40 mL of 0.25% bupivacaine, with 20 mL administered into each of the deep and superficial serratus anterior planes. All patients received intravenous acetaminophen 1 g and tramadol 1 mg·kg- 1 at the end of surgery. Within the first 24 h, patients received 1 gram of acetaminophen every 6 h. Visual Analog Scale (VAS) scores were recorded at 0, 2, 4, 8, and 12 h after extubation. If the VAS score exceeded 40 mm at any point, the initial treatment was tramadol at a dosage of 1 mg·kg- 1. If pain continued, 0.5 mg·kg- 1 morphine was planned. The hemodynamic parameters remained within clinically acceptable ranges. In 2 patients (10%), VAS scores exceeded 40 mm, requiring rescue analgesia. A statistically significant difference was observed in terms of changes in rest VAS scores (p = 0.015). Significant differences were also observed in the changes in cough VAS scores over time (p = 0.003). Nausea and vomiting were observed in 2 patients (10%). No other complications were observed during the follow-up period. Multimodal analgesia, including CSAPB, appears to be a feasible regional analgesia technique associated with low postoperative pain scores and minimal rescue analgesic requirements in patients undergoing MICS via right mini-thoracotomy. Clinicaltrials Registration No: NCT06326320, Registration Date: 17/03/2024.
Pulmonary complications are the most frequent adverse events following surgery for non-small cell lung cancer (NSCLC), influencing both short-term clinical outcomes and long-term prognosis. This study aimed to develop and evaluate artificial intelligence (AI) models to predict postoperative pulmonary complications in patients undergoing surgical treatment for NSCLC. A total of 953 patients who underwent lung resection and mediastinal lymph node dissection for NSCLC between 2001 and 2023 were retrospectively analyzed. Clinical, laboratory, respiratory function, tumor-related radiological, surgical, and pathological parameters served as input variables, while the occurrence of postoperative pulmonary complications constituted the output variable. A fully connected deep neural network was employed, using 10-fold cross-validation. Model performance was evaluated via 10-fold cross-validation using specificity, sensitivity, NPV, PPV, accuracy, and F1 score. Additionally, area under the receiver operating characteristic (ROC) curve (AUC) and Decision Curve Analysis (DCA) were utilized to assess discriminative ability and clinical net benefit, respectively. The model achieved an accuracy of 88.6% and an average F1 score of 84.4% on the training dataset. In the test dataset, the model demonstrated robust performance with an accuracy of 90.4%, an average F1 score of 86.4%, and an area under the receiver operating characteristic curve (AUC) of 0.84. These results indicate high discriminative power and reliability in predicting postoperative pulmonary complications. Accurate prediction of postoperative pulmonary complications in NSCLC surgery is crucial for optimizing perioperative care and reducing morbidity. The proposed deep learning model demonstrates promising predictive performance, enabling stratification of patients into high- and low-risk groups, and may serve as a valuable decision-support tool for clinicians.
According to the prevailing view among experts in the field of surgical research, homografts should be used preferentially over both conventional xenografts and mechanical prostheses in cases of infective endocarditis (IE). The rationale for this recommendation is that homografts possess a greater degree of resistance to infection. Nevertheless, the existence of comparative evidence that validates this assertion is scant. A comprehensive search of the databases of three tertiary academic centres yielded a total of 775 adult patients (aged 18 years or over) who underwent surgical procedures for active IE involving the heart valves during the period from 2005 to 2024. The evaluation of short- and long-term outcomes was conducted using propensity score analysis to reduce baseline confounding between patients receiving homografts and those receiving conventional prosthetic valves. Inverse probability of treatment weighting (IPTW) was applied to create weighted cohorts with balanced baseline characteristics. This study hypothesizes that the nature of the results in question will serve to minimize biases related to institutional volume and surgical experience in the case of homograft implantation when compared to conventional prosthetic valves. Participating centers must maintain an infective valve surgery program, with provisions to guarantee postoperative follow-up and management of late complications from valve surgeries for infective endocarditis. The data that will be collected will provide valuable insight into the comparative effectiveness of various surgical approaches, both standard and advanced, in valve replacement surgery for IE. This will be achieved using conventional prosthetic valves versus cryopreserved homograft. It is further expected that this comprehensive analysis will contribute significantly to the development of robust international guidelines. Clinical Trial Gov. Com. ID: NCT05253469; IRB. ID: 2,022,011,054.
Iatrogenic vertebro-vertebral arteriovenous fistula (VVAVF) is an uncommon and potentially serious postoperative complication of spinal surgery. This case report highlights a rare occurrence of bilateral VVAVF after upper cervical spine fixation and the challenges in its diagnosis and management. The novelty of this case lies in its detailed description of the vascular anatomy involved, the surgical and endovascular interventions used and the successful treatment outcome. A 64-year-old woman presented with bilateral VVAVF following upper cervical spine fixation surgery for an odontoid fracture. She had a history of high-altitude-fall injury and had undergone left frontotemporal craniotomy at another hospital. The patient developed active bleeding from the surgical site 1 week postoperatively. An emergency angiography revealed bilateral VVAVF at the V3 segment of the vertebral arteries. Endovascular treatment was performed that involved coiling of the left vertebral artery and embolisation of the right fistula. The patient's condition improved substantially, and no recurrence of the fistula was observed on follow-up imaging. This case highlights the critical need for early recognition and intervention in iatrogenic VVAVF and demonstrates the efficacy of endovascular management for this rare but serious complication. The findings emphasise the importance of meticulous surgical technique during upper cervical spine procedures and vigilant postoperative surveillance to mitigate vascular risks. Furthermore, this report underscores the value of advanced imaging modalities and endovascular interventions in addressing complex iatrogenic vascular injuries.
The co-occurrence of mirror-image dextrocardia and tetralogy of Fallot (TOF) is a rare congenital condition. Reoperative multivalve surgery in such patients, especially after repaired TOF, presents exceptional challenges due to the mirrored cardiac anatomy and altered surgical field. This case highlights the surgical strategy for concomitant tricuspid, mitral, and pulmonary valve replacement in this unique setting. A 14-year-old male patient with a history of corrected TOF and mirror-image dextrocardia presented with progressive heart failure due to severe regurgitation of the tricuspid, mitral, and pulmonary valves. Preoperative imaging confirmed the complex anatomy, with the atria positioned posteriorly, rendering the atrioventricular valve orifices near-vertical during surgery. The patient successfully underwent triple valve replacement under cardiopulmonary bypass. Key technical adaptations were made to select the valve model and position. The postoperative course was uneventful, with significant symptomatic and echocardiographic improvement at discharge and during the two-month and six-month follow-up. This case demonstrates that concomitant triple valve replacement is feasible in patients with mirror-image dextrocardia and a history of TOF repair, despite the profound technical challenges posed by the anatomical distortions. Success hinges on meticulous preoperative planning using advanced imaging and the development of an individualized surgical approach. This report provides a valuable reference for managing such complex, high-risk reoperations in the setting of congenital situs inversus.
Surgical explantation of transcatheter aortic valves (TAV-explant) is an emerging but uncommon procedure, increasingly required as TAVI is performed in younger and lower-risk patients. Contemporary evidence on outcomes, timing, and valve type remains limited. We conducted a multicenter retrospective study of patients undergoing surgical TAV-explant. Clinical characteristics, indications, surgical strategies, and outcomes were analyzed. Outcomes were compared according to the interval between index TAVI and explantation (< 1 month, 1-12 months, > 12 months). The indication and the type of initial transcatheter valve (balloon-expandable vs. self-expanding) were also analyzed. The primary outcome was 30-day mortality. A total of 62 patients were included. Indications for TAV-explantation were predominantly bioprosthetic valve dysfunction (45.2%), infective endocarditis. (21%), and procedural failure (33.9%)The 30-day mortality was 16.1% and did not differ according to the delay of explantation (p = 0.816). Overall mortality did not differ according to the indication of explantation, nor by type of explanted valve. Concomitant aortic surgery was required in 18% of cases. Although EuroSCORE II values were elevated in this cohort, this tool underestimated the operative risk, as it was not designed for complex redo surgery. TAV-explantation is technically feasible but remains associated with substantial early mortality. Outcomes are not influenced by the timing of explantation or by valve type. These findings highlight the limitations of current surgical risk scores and underscore the importance of thorough pre-operative planning and Heart Team evaluation. Continued multicenter data collection is essential to optimize patient selection and refine management strategies.
Catamenial pneumothorax is a rare manifestation of thoracic endometriosis syndrome and is associated with a high risk of recurrence despite surgical intervention. Increasingly, multimodal strategies combining thoracic surgery with adjunctive hormonal therapy have been put in place as standard practice however, optimal management remains uncertain. A systematic review of the literature was conducted using MEDLINE/PubMed, Scopus, CENTRAL, Google Scholar, SciSpace, and the Cochrane Library for studies published between January 2000 and December 2025. Studies reporting outcomes of surgical management for catamenial pneumothorax were included. Data was extracted on patient characteristics, surgical techniques (diaphragmatic and pleural interventions), use of postoperative hormonal therapy, and recurrence rates.  RESULTS: Analysis of 37 studies encompassing over 1,800 patients suggests that treatment approach is a major determinant of outcomes. Meta-analysis demonstrates a pooled recurrence rate of 17.3% with postoperative hormonal therapy compared to 54.2% without (p < 0.01) [1], with younger age independently associated with higher recurrence risk. Diaphragmatic intervention is critical to reducing recurrence, with studies reporting 12.5% recurrence when diaphragmatic surgery is combined with pleurodesis versus 100% with pleurodesis alone [15]. Diaphragm resection has been identified as an independent protective factor against recurrence (HR 0.16; 95% CI: 0.03-0.77; p = 0.022) [5]. The available evidence supports a multimodal approach to the management of catamenial pneumothorax. Comprehensive thoracoscopic surgery addressing diaphragmatic pathology, combined with pleurodesis and postoperative hormonal therapy, is consistently associated with reduced recurrence. Given the observational nature of the available data, these findings should be interpreted with appropriate caution and highlight the need for prospective, collaborative studies.
Ablation of the persistent left superior vena cava (PLSVC) with a left accessory pathway is more difficult than ablation in the case of an ordinary left accessory pathway. We report a case of successful ablation of the PLSVC with a left double accessory pathway. We also conducted a systematic review of the literature to summarize the procedural precautions and technical points for patients with PLSVC with a left accessory pathway. A 48-year-old man was admitted with recurrent episodes of tachycardia. Electrocardiography revealed preexcitation. Preoperative echocardiography revealed PLSVC. Under the guidance of CARTO system mapping, an ablation catheter was used for mapping under sinus rhythm. The earliest V wave was mapped on the left lateral wall, AV fusion was achieved, the catheter was discharged with temperature control for 30 W, the AV was separated, and the delta wave disappeared. During the observation process, another type of delta wave was observed. The earliest V wave was detected in the anterior wall, the AV was fused, and then, the catheter was discharged at 30 W with temperature control. The AV separated, and the delta wave disappeared. Repeated electrophysiological examination could not induce tachycardia. The delta wave did not recover, and tachycardia did not recur after 5 months of follow-up. This systematic review revealed that approximately 4.23% of patients with PLSVC combined with left accessory pathways also have multiple accessory pathways. In cases of aortic retrograde ablation failure, successful ablation was achieved through the atrial septal puncture approach or via the coronary sinus. This case highlights the complexity of PLSVC combined with a left accessory pathway. Careful observation, accurate mapping and repeated verification are needed to improve the success rate of ablation.
Robotic-assisted CABG is a minimally invasive alternative to conventional sternotomy. The purpose of this study was to evaluate the short and mid-term outcomes of our experience and to enrich the literature with quality comparisons of these procedures. From 1 October, 2020 to 1 July, 2025, 927 CABG procedures were performed at a single institution. Two groups of patients were analyzed: the robotic assisted minimally invasive CABG group (RA-CABG) and the conventional sternotomy CABG group (CS-CABG). This was a retrospective comparison of all consecutive patients undergoing conventional CABG and RA-CABG with the use of propensity score matching with 24 preoperative covariates. Of the 927 cases, 480 patients were matched with 240 patients each in the RA-CABG and CS-CABG groups. The matching successfully eliminated all preoperative differences between the groups. There were three conversions to median sternotomy in the robotic group. Number of distal anastamoses per patient was 2.84 in the RA-CABG group and was 3.05 in the CS-CABG group. The cross clamp time and cardiopulmonary bypass time were statistically significantly shorter in the CS-CABG group (cross clamp: 59 vs. 47, minutes and CPB: 95 vs. 67, minutes, p = 0.001). The RA-CABG group had significantly (p < 0.001) lower 24-h postoperative blood loss (400 ml vs. 800 ml), fewer blood transfusion, shorter mechanical ventilation time (6 vs. 10, hours), shorter length of ICU stay (20 vs. 28, hours), shorter length of hospital stay (6 vs. 7, days). Early mortality (in-hospital and operative) rates were similar between the groups, 0.8% for RA-CABG and 1.3% for CS-CABG (p = 0.683). In like manner, there was no significant difference in mid-term mortality rates between the two groups (p = 0.258). The RA-CABG is safe and feasible alternative to the conventional sternotomy CABG. This method offers advantages such as avoiding sternotomy, providing greater comfort to the surgeon during LIMA harvesting, and enabling longer LIMA harvesting.
This study aimed to investigate events related to proximal anastomosis after acute aortic dissection surgery. We analyzed the data of 119 consecutive patients with Stanford type A aortic dissection who underwent emergency surgery at our hospital between October 2015 and March 2023. All patients underwent proximal anastomosis with felt strips and biologic glue reinforcement. Among these, 18 patients (15%) experienced events related to the proximal anastomosis: 14 (12%) had residual dissection in the aortic root, and 4 (3%) had pseudoaneurysms in the aortic root after surgery. We compared the clinical course between the 18 patients with proximal anastomotic events and the other 101 patients. The primary endpoint was all-cause mortality, and the secondary endpoint was redo open-heart surgery. No significant differences were observed in preoperative and procedural characteristics. The incidence of redo open-heart surgery showed a significant difference between the two patient groups (p = 0.0015); however, all-cause mortality showed no significant difference (p = 0.51). The clinical course was different between patients with residual aortic root dissections and those with proximal anastomotic pseudoaneurysms. Residual aortic root dissections were detected via postoperative computed tomography within 1 month and followed-up conservatively owing to the absence of worsening signs. All proximal anastomotic pseudoaneurysms were detected suddenly in the late postoperative phase and presented prompt worsening. All such cases underwent successful redo surgery with patch repair. At reopening, the anastomosis appeared completely detached and nearly ruptured in all cases. Patients with proximal anastomotic events required redo open-heart surgery significantly more frequently. Patients with residual aortic root dissections and those with proximal anastomotic pseudoaneurysms showed a different clinical course. Residual aortic root dissection was associated with insufficient proximal anastomotic repair because it manifested just after surgery. In contrast, proximal anastomotic pseudoaneurysm occurs suddenly in the late phase and shows prompt worsening, thereby requiring acute repair.
Off-pump coronary artery bypass grafting (OPCAB) minimizes systemic inflammation associated with cardiopulmonary bypass, yet postoperative atrial fibrillation (POAF) incidence remains substantial. This suggests that local pericardial factors may contribute significantly to POAF in this setting. We evaluated the impact of left posterior pericardiotomy (LPP) on POAF and drainage patterns in isolated OPCAB to determine if enhancing local drainage effectively mitigates POAF. We retrospectively analyzed 283 patients (mean age 65.1 ± 10.2 years; female, 18.7%) undergoing elective isolated multivessel OPCAB by a single surgeon (2021-2025). Patients were categorized into LPP (n = 122, routinely performed since April 2024) and no-LPP (n = 161) groups. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. The primary endpoint was in-hospital POAF. Postoperative chest tube drainage distribution and incidence of postoperative pericardial effusion were analyzed to assess the mechanistic efficacy of LPP. After IPTW adjustment, the LPP group showed a significantly lower incidence of POAF (15.1% vs. 30.7%; p = 0.003) and shorter hospital length of stay (p = 0.032). Operative time was significantly shorter in the LPP group (334 ± 44 vs. 349 ± 48 min; p = 0.006), suggesting that LPP did not prolong the procedure. Operative mortality and LPP-related complications were absent. Postoperative pericardial effusion was also less frequent in the LPP group (3.2% vs. 8.4%; p = 0.084). Mechanistically, the LPP group demonstrated a significantly higher left-to-total drainage ratio in the early postoperative period, indicating effective diversion of pericardial fluid to the left pleural space during the critical early postoperative period. In elective isolated OPCAB, concomitant LPP was associated with a lower incidence of POAF and shorter hospital length of stay without increasing operative time or complications. The observed shift in drainage distribution supports the mechanism that LPP reduces POAF by effectively mitigating local pericardial fluid retention.
Aortic dissection (AD) is a life-threatening cardiovascular emergency with declining postoperative quality of life (QoL). The teach-back method has shown effectiveness in chronic disease management, but its application in postoperative AD patients remains unexplored. This quasi-experimental study with ward-level cluster allocation enrolled 210 AD patients (105 per group) at a tertiary hospital in Nanchang, China, from January 2023 to June 2024. The experimental group received teach-back method-based continuing nursing, while the control group received routine care. Primary outcomes included self-management behavior assessed by the Self-Management Assessment Scale (SMAS) and QoL measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-36 Health Survey (SF-36) at baseline, discharge, 1-month, and 6-month follow-up. Secondary outcomes comprised health knowledge scores at baseline and 1-month post-discharge, and adverse clinical outcomes including 30-day unplanned readmission rates, 6-month AD recurrence rates, and total adverse events. The experimental group demonstrated significantly higher SMAS across all dimensions with a significant time×group interaction (P < 0.001). Disease knowledge questionnaire score at 1-month was significantly higher in the experimental group (21.36 ± 2.89 vs. 15.82 ± 3.54, P < 0.001). Both PCS and MCS scores showed significant improvements over time (both P < 0.001), with the experimental group achieving higher scores than the control group at all follow-up time points (all P < 0.001). A significant time×group interaction effect was observed for MCS (P = 0.0052) but not for PCS (P = 0.599). The experimental group achieved significantly better blood pressure control at 6 months (SBP: 125.6 ± 10.8 vs. 133.4 ± 14.8 mmHg, P < 0.001). The experimental group had lower 30-day readmission rates (6.67% vs. 17.14%, P = 0.016), 6-month AD recurrence rates (4.76% vs. 14.29%, P = 0.014), and total adverse events (4.76% vs. 12.38%, P = 0.048). Follow-up completion rates exceeded 93% at all time points. Teach-back method-based continuing nursing significantly improved self-management behaviors, QoL, and reduced adverse outcomes in postoperative AD patients, warranting integration into routine discharge protocols.
We sought to investigate the safety of using left atrial appendage (LAA) closure with clip devices in patients who underwent off-pump coronary artery bypass grafting and who experienced atrial fibrillation. We applied LAA clips in 25 patients between November 2018 and May 2025. The mean age was 74 years, and 5 patients were female. All patients underwent off-pump CABG via a heart positioner and stabilizer and an LAA clip (21 with AtriClip and 4 Penditure). The mean number of coronary anastomoses was 4.0. The mean follow-up period was 28.6 ± 17.5 months. There were no complications related to the LAA clips. During the operations, we used a fluorescence imaging system in 13 patients to confirm the closure of the LAA. Moreover, in all 25 patients, postoperative enhanced computed tomography confirmed the occlusion of the LAA. No patient experienced stroke or thromboembolic events during the follow-up period. Left atrial appendage closure with a clip was safely performed in patients undergoing off-pump CABG without harmful effects on the heart or grafts. This surgical option may be effective for stroke prevention in patients undergoing off-pump CABG.
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The implantable cardioverter defibrillator (ICD) is an effective therapeutic option for hypertrophic cardiomyopathy (HCM). However, a comprehensive quantitative synthesis in this field remains limited. This study aims to analyze the research landscape of ICD application in HCM from 2000 to 2025. Publications related to ICD use in HCM were retrieved from the Web of Science Core Collection between January 1, 2000, and November 3, 2025. Data were visually analyzed using VOSviewer and CiteSpace. A total of 864 publications from 251 countries/regions met the inclusion criteria, with the United States contributing the most. *Circulation* was identified as the most frequently cited journal in this field. Keyword cluster analysis revealed that research hotspots primarily focused on "hypertrophic cardiomyopathy," "sudden cardiac death," and "implantable cardioverter defibrillator." Furthermore, keyword burst analysis indicated that current research frontiers center on terms such as "outcome" and "association." The field of ICD application in HCM has matured and is now on the verge of a paradigm shift. Future research should focus on refining risk prediction models, evaluating long-term patient outcomes, and addressing challenges posed by novel targeted therapies.
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