搜索结果：Interdisciplinary cardiovascular and thoracic surgery

Postoperative atrial fibrillation is common after cardiac surgery. Effective preventative measures are lacking, partly due to an incomplete understanding of its pathogenesis. Inflammation is a major contributor to postoperative atrial fibrillation development. This study aims to further characterize the association between systemic inflammation and postoperative atrial fibrillation. A secondary analysis was conducted on a single-center cohort of patients undergoing cardiac surgery. The original study enrolled 405 cardiac surgery patients. After exclusion of patients with a history of persistent or permanent atrial fibrillation, patients undergoing heart transplantation, and patients with incomplete interleukin measurements, 319 patients were included in the present analysis. Postoperative atrial fibrillation was identified through chart review and was defined as at least 1 AF episode lasting more than 30 s, as documented by telemetry or a 12-lead electrocardiogram during the patient's initial hospitalization. Perioperative levels of interleukins and C-reactive protein were measured. The decline in C-reactive protein levels between postoperative days 3 and 10 was modeled using a linear regression. The association with postoperative atrial fibrillation and other outcomes after cardiac surgery was assessed using logistic and Tobit regression models. Of the 319 patients included in the study, 51% developed postoperative atrial fibrillation, most commonly on postoperative days 2 and 3. Cardiopulmonary bypass and intraoperative ventilation time were significantly associated with an increased risk of postoperative atrial fibrillation. Patients with postoperative atrial fibrillation had longer intensive care unit stays and longer times to extubation. C-reactive protein levels peaked on postoperative day 3 and declined more slowly in postoperative atrial fibrillation patients. A slower C-reactive protein decline was independently associated with postoperative atrial fibrillation (odds ratio: 1.71, P&#x2009;=&#x2009;.046), prolonged postoperative intensive care unit length of stay, and time to extubation. Interleukin-10 levels were significantly higher in patients with postoperative atrial fibrillation (mean ratio: 1.28, P&#x2009;<&#x2009;.001). Postoperative atrial fibrillation is a prevalent complication after cardiac surgery and correlates with a slower postoperative C-reactive protein decline. This study suggests that postoperative atrial fibrillation is associated with delayed resolution of postoperative inflammation. German Clinical Trials Registry (DRKS No. 00017057), Date of registration April 5, 2019, www.drks.de.

To assess how different learning mechanisms, including specific learning, analogy-based learning, and cumulative experience, influence surgical outcomes following coronary artery bypass graft (CABG), aortic valve replacement (AVR), and mitral valve reconstruction (MVR) surgeries. Between 2010 and 2023, 46 surgeons performed 21&#x2009;269 cardiac surgeries (CABG, AVR, and MVR) at a major heart surgery centre in Germany. Surgical proficiency was assessed using the 30-day risk-adjusted mortality rate (RAMR) and risk-adjusted re-thoracotomy rate (RARR), calculated for each surgeon and adjusted using EuroSCORE II. Linear regression models examined associations between learning mechanisms and surgical outcomes. Higher procedure-specific volume in the preceding quarter was significantly associated with a lower 30-day RAMR for CABG, demonstrating a decline of 0.49 percentage points (95% CI, -0.88 to -0.10; P&#x2009;=&#x2009;.014). Furthermore, analogy-based learning demonstrated a significant cross-procedural effect for CABG, as prior-quarter volumes of technically related procedures (AVR and MVR) exhibited significant non-linear associations with 30-day RAMR. For MVR, greater cumulative experience significantly reduced the RARR (-0.295; 95% CI, -0.55 to -0.03; P&#x2009;=&#x2009;.028). No significant volume-outcome associations were observed for AVR.This analysis included 21&#x2009;269 total procedures (12&#x2009;706 CABG, 5477 AVR, and 3086 MVR) from 2010 to 2023. Surgeons had a mean specialist experience of 8.2 years (CABG), 10.3 years (AVR), and 11.9 years (MVR) and performed a mean of 12, 5.1, and 5.1 procedure-specific surgeries per quarter, respectively. Maintaining consistent, procedure-specific practice and accumulating experience are crucial for improving cardiac surgery outcomes.

"Publish or perish" is a grim reality for many academic surgeons and has led to authorship proliferation and internationalization of the cardiothoracic surgical literature. We sought to examine whether these trends are continuing today. We reviewed 17&#x2009;267 articles from 2007 to 2022 in the archives of the 3 leading cardiothoracic journals (European Journal of Cardiothoracic Surgery, EJCTS; Journal of Thoracic and Cardiovascular Surgery, JTCVS; Annals of Thoracic Surgery, ATS). Data on the number of authors and geographic origin were collected. The mean number (&#xb1; SE) of authors per article increased with time for all journals: from 6.5&#x2009;&#xb1;&#x2009;0.1 in 2007 to 9.0&#x2009;&#xb1;&#x2009;0.2 in 2022 for the EJCTS (P&#x2009;<&#x2009;.001), from 7.4&#x2009;&#xb1;&#x2009;0.1 in 2007 to 8.2&#x2009;&#xb1;&#x2009;0.2 in 2022 for the JTCVS (P&#x2009;<&#x2009;.001), and from 6.9&#x2009;&#xb1;&#x2009;0.1 in 2007 to 9.0&#x2009;&#xb1;&#x2009;0.2 in 2022 for the ATS(P&#x2009;<&#x2009;.001). North American institutions increasingly dominate JTCVS/ATS, whilst European manuscripts decline in all journals. Only EJCTS showed increasing internationalization. Authorship proliferation continues in the 3 leading cardiothoracic surgical journals, reflecting the natural evolution of the demands of modern research and career progression.

Aortic arch surgery traditionally relies on hypothermic circulatory and cardioplegic arrest, exposing myocardium and visceral organs to ischaemia-reperfusion injury. We developed a total body perfusion (TBP) strategy providing continuous cerebral, myocardial, and visceral perfusion during arch reconstruction. This study compares outcomes between conventionally and TBP-treated patients. Analysis included 121 consecutive elective aortic arch replacements (2014-2025). From June 2022, patients (n&#x2009;=&#x2009;38) were intended for TBP; earlier cases (n&#x2009;=&#x2009;83) underwent conventional techniques. TBP comprised continuous warm myocardial, selective cerebral, and retrograde visceral perfusion. Outcomes included intraoperative characteristics, biochemical markers, and clinical outcomes. Baseline demographics were similar (male 65.8% vs 53.0%, P = .188; median age 63.9 [IQR 60.5-72.4] vs 66.1 [IQR 58.7-70.6] years, P = .915). TBP-patients presented with greater surgical complexity (more concomitant procedures: 65.8% vs 45.8%, P = .041; chronic dissection: 18.4% vs 0.0%, P < .001; active infection at time of surgery: 15.8% vs 3.6%, P = .027). TBP reduced myocardial ischaemia time (median 65.0 [IQR 39.0-98.5] vs 122.0 [IQR 93.0-170.0] min, P < .001) and circulatory arrest use (18.4% vs 86.7%, P < .001), and demonstrated lower peak lactate levels (median 2.2 [IQR 1.5-4.6] vs 3.9 [IQR 2.9-5.2] mmol/L, P < .001), shorter ICU stay (median 2.0 [IQR 1.0-7.0] vs 4.0 [IQR 3.0-8.0] days, P = .006), and improved one-year survival (92.1% vs 72.3%, P = .025). Multivariable analysis confirmed TBP's independent survival benefit (HR&#x2009;=&#x2009;0.187, 95% CI 0.044-0.807, P = .025). Sensitivity analyses were directionally consistent. TBP appeared as a feasible and safe approach in elective aortic arch surgery, associated with improved clinical outcomes and offering comprehensive organ protection. TBP may expand surgical candidacy in high-risk patients.

To evaluate the association between selective antegrade cerebral perfusion (SACP) flow ranges and early clinical outcomes in a large cohort of patients undergoing aortic arch surgery. We retrospectively analysed 492 adult patients who underwent aortic arch surgery with bilateral antegrade cerebral perfusion under moderate hypothermia between 2015 and 2024. Patients were stratified into low, intermediate, or high-indexed SACP pump flow groups according to measured intraoperative flow rates (mL/kg/minute). Primary outcomes included in-hospital mortality, permanent neurologic dysfunction, and transient neurological deficit. Overall, 80.3% of patients received antegrade selective cerebral perfusion flows within the intermediate range (10-15&#x2009;mL/kg/minute). No statistically significant differences were observed among groups in terms of early mortality, permanent neurological dysfunction, or transient neurological deficit. When cerebral perfusion flow was analysed as a continuous variable, no linear association with adverse outcomes was identified (all P&#x2009;>&#x2009;.15). Importantly, intraoperative perfusion strategies were largely guided by clinical judgement, with flow adjustments tailored to individual patient characteristics and dynamic intraoperative factors, including extremes of body weight. No significant association was observed between SACP flow ranges and clinical outcomes within the flow ranges and management strategy applied in this cohort. Nonetheless, maintaining SACP within an optimal range remains advisable. Individualized flow adjustments by the clinical team, based on patient-specific factors, likely contributed to the observed flow distribution and outcomes.

To assess how perfusion interval relates to myocardial injury and whether this is modified by aortic cross-clamp (ACC) duration in minimally invasive mitral valve surgery. We retrospectively analysed 556 patients receiving blood-enriched modified del Nido cardioplegia. The primary exposure and outcome were longest perfusion interval and base-10 logarithm-transformed peak cardiac troponin I (cTnI) within 48 hours. Analyses included multivariable regression, interaction and subgroup analysis, restricted cubic splines, sensitivity analysis, and logistic regression. Longer perfusion intervals were initially associated with higher cTnI (regression coefficient 0.0097, 95% confidence interval [CI], 0.0035-0.0159; P&#x2009;=&#x2009;.002). This association disappeared after adjustment for factors including ACC time and number of perfusions (regression coefficient -0.0006, 95% CI, -0.0109 to 0.0097; P&#x2009;=&#x2009;.913). Aortic cross-clamp time remained independently associated with cTnI (regression coefficient 0.0099, 95% CI, 0.0013-0.0185; P&#x2009;=&#x2009;.024). In patients with prolonged ACC time, exploratory analysis suggested a non-linear increase beyond 80 minutes. In patients with ACC time of 90 minutes or less, perfusion interval was not clearly associated with peak cTnI. No significant associations were found with the composite of adverse events. The association between perfusion interval and myocardial injury depended on ACC duration. Single-dose blood-enriched modified del Nido cardioplegia appeared adequate when ACC time was 90 minutes or less. Longer intervals in prolonged procedures may matter, but the 80-minute threshold remains exploratory. These findings support a context-dependent myocardial protection strategy.

Mitral valve disease remains one of the most prevalent and complex cardiac conditions, with treatment strategies varying based on anatomical and pathological factors. The heterogeneity in mitral valve morphology complicates standardized treatment, highlighting the importance of procedural planning and surgical training. This systematic review evaluates current techniques, materials, and clinical applications of 3D printing in mitral valve disease, with a focus on procedural planning and simulation. A comprehensive literature search of PubMed and MEDLINE databases was conducted to identify studies published from 1996 to August 2025. A total of 63 studies were included, all involving 3D printing technologies related to mitral valve disease. Extracted data covered imaging modalities, software tools, printing techniques, materials used, total time required for model creation, and clinical applications. CT, 3D transoesophageal echocardiography, and MRI were the main imaging modalities, with CT being the most common. Data segmentation and model generation were performed using software such as Mimics, 3D Slicer, and Philips QLAB. The primary 3D printing techniques were stereolithography, fused deposition modelling, and PolyJet, using photopolymer resins and thermoplastics. Total processing time-from image acquisition to model completion-ranged from 45 min to 72 h, depending on complexity. Applications included procedural planning, surgical training, and the development of medical and simulation-based educational devices. 3D printing enhances mitral valve surgery by enabling precise planning and training. Although challenges like standardization and accessibility persist, advances in imaging, software, and materials are expected to expand its clinical impact.

Prolonged air leak (PAL) is the most common complication following pulmonary resection, leading to increased morbidity, hospital stay, and healthcare costs. Although staplers are currently the standard for lung parenchymal closure, ALs remain frequent. Surgical sealants have been introduced as adjuncts to staplers to reduce PAL, but evidence remains inconsistent. Prior systematic reviews frequently pooled together stapled and sutured resections, limiting applicability to contemporary practice. This review specifically evaluates whether surgical sealants reduce the incidence and duration of PAL when used with staplers in adult patients. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251064592). A literature search was conducted in PubMed, Ovid MEDLINE, and Cochrane Library for studies published between 2005 and June 2025. Eligible studies included adult patients undergoing stapler-based pulmonary resection comparing sealants plus staplers versus staplers alone. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB2) and risk of bias in non-randomized studies of interventions (ROBINS-I) tools. Eight studies were included. Surgical sealants studied included fibrin-based (autologous fibrin sealant (FS), FS patch, human FS) and synthetic polymers (polyethylene glycol hydrogel sealant, cyanoacrylate-based sealant). Most studies reported a statistically significant reduction in PAL incidence and/or duration with sealant use. Some also showed reduced chest tube duration and hospital stay, though not always statistically significant. One study showed worse outcomes in the sealant group. No study reported increased complications. Subgroup analyses were limited. Sealants used with staplers may reduce PAL incidence and duration, particularly in high-risk patients, without increased complications. However, variability in study design and limited subgroup data weaken current evidence. Larger, standardized randomized controlled trials are needed to confirm clinical benefit and inform routine use.

Cardiopulmonary bypass (CPB) priming may influence hemodilution, bleeding and end-organ injury during HeartMate 3 (HM3) implantation, but evidence in contemporary left ventricular assist device (LVAD) surgery is limited. We retrospectively analysed 92 HM3 implantations (2015-2025) by priming strategy (blood-based [FFP+RBC], n&#x2009;=&#x2009;36; crystalloid, n&#x2009;=&#x2009;56). Primary endpoint was postoperative right heart failure (RHF; INTERMACS). Multivariable regression and propensity score-based inverse probability of treatment weighting (IPTW) sensitivity analyses were performed. Baseline characteristics were balanced between groups, with comparable age (blood-based: 58 [49.5-66.0]; crystalloid: 62 [55.8-68.2]; p&#x2009;=&#x2009;0,069) and female sex (blood-based: n&#x2009;=&#x2009;3/36 [8.3%]; crystalloid: n&#x2009;=&#x2009;8/56 [14,3%]; p&#x2009;=&#x2009;0.518). RHF was lower with blood-based priming (blood-based: n&#x2009;=&#x2009;3/36 [8.3%]; crystalloid: n&#x2009;=&#x2009;17/56 [30.4%]; p&#x2009;=&#x2009;0.012; adjusted OR 0.23 [95% CI 0.06-0.86]; p&#x2009;=&#x2009;0.030). Dialysis was lower unadjusted (blood-based: n&#x2009;=&#x2009;4/36 [11.1%]; crystalloid: n&#x2009;=&#x2009;18/56 [32.1%]; p&#x2009;=&#x2009;0,021), with a directionally lower adjusted estimate (OR 0.30 [95% CI 0.09-1.01]; p&#x2009;=&#x2009;0.053). Delirium was lower with blood-based priming (blood-based: n&#x2009;=&#x2009;3/36 [8.3%]; crystalloid: n&#x2009;=&#x2009;16/56 [28.6%]; p&#x2009;=&#x2009;0,019; adjusted OR 0.22 [95% CI 0.06-0.84]; p&#x2009;=&#x2009;0.027). Survival did not differ significantly (log-rank p&#x2009;=&#x2009;0.055; adjusted HR 0.59 [95% CI 0.27-1.32]; p&#x2009;=&#x2009;0.201). IPTW analyses showed lower delirium (OR 0.23; [95% CI 0.06-0.84]) and attenuated RHF association (OR 0.35; [95% CI 0.10-1.23]). Blood-based CPB priming was associated with lower RHF and delirium, and directionally lower dialysis rates, after HM3 implantation. Survival estimates were not statistically significant. Findings require prospective validation.

The Ross operation achieves excellent outcomes in children and adolescents, but the influence of age at surgery and underlying pathology on long-term results remains uncertain. Evidence on autograft dilatation necessitating reintervention is also limited. This study aimed to identify patient groups best served from the Ross procedure and to evaluate long-term autograft performance. All consecutive patients <18&#x2009;years undergoing a Ross or Ross-Konno procedure between 1991 and 2024 at a single centre were analysed. Demographic, operative, and follow-up data were collected. Patients were stratified into age groups (neonate, infant, child, adolescent) and diagnostic groups (isolated aortic valve disease, aortic stenosis with subaortic stenosis, Shone's complex, and complex congenital heart disease [CHD]). Outcomes included overall survival, freedom from autograft and right ventricle-pulmonary artery (RV-PA) conduit reintervention, and severe autograft dilatation (>50&#x2009;mm or >25&#x2009;mm/m2). A total of 226 patients underwent surgery at a median age of 8.5&#x2009;years; 67% were male. Median follow-up was 9.5&#x2009;years (IQR 12.7). Operative mortality was 2% and overall mortality 5%. Survival exceeded 90% at 30&#x2009;years in all groups except neonates (60% at 5&#x2009;years). After adjustment for age, Shone's complex and complex CHD were associated with an 11-fold and 8.8-fold increased hazard of death, respectively (P&#x2009;<&#x2009;.03). Freedom from autograft reintervention was 82% and from RV-PA conduit reintervention was 66% at 25&#x2009;years. Freedom from severe autograft dilatation was 71% at 20&#x2009;years by absolute dimension and 54% when indexed to BSA. Greater than mild aortic regurgitation at discharge conferred a 17-fold risk of autograft intervention (P&#x2009;<&#x2009;.001). The Ross procedure provides excellent long-term survival and valve durability in children and adolescents, particularly those with isolated aortic valve disease. Autograft dilatation and conduit reintervention remain important late risks, reinforcing the need for lifelong surveillance in specialised centres.

To evaluate contemporary outcomes of elective ascending aortic replacement (AAR) and the impact of centre volume using a nationwide database. Adults undergoing elective AAR for aneurysms (2003-2021) were identified from the Korean National Health Insurance Service database. Acute dissections, ruptures, and arch involvements were excluded. Restricted cubic splines (RCS) and multivariable regression evaluated the impact of institutional volume and concomitant procedures. Among 5209 patients, operative mortality and stroke rates were 2.9% and 2.2%. Over a 5.9-year median follow-up, RCS revealed a significant non-linear inverse relationship between annual institutional volume and mortality. Treatment at high-volume centres (&#x2265;10 cases/year) independently lowered operative mortality (odds ratio, 0.26; 95% CI, 0.18-0.37) and long-term mortality (hazard ratio, 0.64; 95% CI, 0.57-0.73). Distinct clinical phenotypes, including bicuspid aortic valves and concomitant aortic valve surgery, were associated with favourable survival. Elective AAR demonstrates low perioperative risk and stable long-term survival, significantly influenced by annual institutional volume and clinical phenotypes. These findings support dedicated aortic centres and individualized risk stratification.

The surgical treatment of multiple synchronous bilateral primary lung cancer (mSBPLC) showed promising results and the aims of this retrospective study were to assess the oncologic outcomes and the presence of risk factors of worse survival. Patients underwent radical (all lesions removed) lung resection for mSBPLC from 2017 to 2024 were included. Exclusion criteria: patients unfit for bilateral surgery, pneumonectomy, multifocal ground glass opacities, clinical stage IIIA or more and pre-operative treatment. Overall and disease-free survival analyses were conducted with the Kaplan-Meier method and log-rank test, Cox regression analysis was used to identify the predictors of worse survival. During the study period, 64 patients were screened for the presence of bilateral lung nodules, 45 patients (median age 69 years) were operated for mSBPLC and during the follow-up (median 34 months) we observed 11 deaths and 15 cancer recurrence. In the 80% of patients the main cancer was solid, contralateral was a part-solid in 20% or pure ground glass opacity in 20%. Adenocarcinoma was present in 77.8% at first surgery and in 80% at the second. Spread Through the Air Spaces (STAS) was present in 17.8%. The 5 year overall and disease-free survival rate were 77% (median 86 months -CI95% 72.4-99.5-) and 57% (median 69 months -32-105.9-), respectively. Comparing survivals among patients with and without STAS, we had an overall survival of 0% vs 85% (86 vs 29 months, p&#x2009;<&#x2009;0.01) and a disease-free survival of 0% vs 63% (69 vs 9 months, p&#x2009;<&#x2009;0.01). The multivariable analysis demonstrated STAS as significant predictor of worse overall (HR 7.08, p&#x2009;=&#x2009;0.02) and disease-free survival (HR 5.63, p&#x2009;=&#x2009;0.017). Taking into account the small and highly selected study population, staged bilateral surgery could be considered safe and oncologically adequate, showing the association between the presence of STAS and unfavourable long term outcomes.

Minimally invasive mitral valve surgery (MIV-MVS) continues to evolve through refinements in surgical technique and perioperative management. This study evaluated the association between arterial cannulation strategy and perioperative adverse events. Three arterial cannulations were used: central ascending aortic cannulation (AC), open femoral cannulation via groin cutdown (oFC), and percutaneous femoral cannulation (pFC) using pre-closure devices. Patients from 2 centres were assessed for the composite safety end-point of 30-day mortality or stroke, the composite efficacy end-point of all-cause death, stroke, or cannulation-related adverse events, and postoperative delirium. Cannulation-related adverse events included conversion to sternotomy or re-thoracotomy, vessel dissection or bleeding, and cannulation-site infection. Between January 2013 and January 2020, 823 patients underwent MIV-MVS. Aortic cannulation was performed in 266 patients (32.3%), oFC in 396 (48.1%), and pFC in 161 (19.6%). The composite end-point of 30-day all-cause death or stroke occurred in 19 patients (2.3%) and was similar between AC and FC (odds ratio [OR] 1.16, 95% CI, 0.41-3.16). The extended composite efficacy end-point occurred less frequently with AC than with any FC (OR 0.46, 95% CI, 0.21-0.94), mainly due to fewer access-site complications. Aortic cannulation was also associated with lower odds of perioperative delirium (OR 0.51, 95% CI, 0.29-0.86). No significant difference was observed between oFC and pFC. In patients undergoing MIV-MVS, 30-day death or stroke was similar across cannulation strategies. Aortic cannulation was associated with a lower rate of cannulation-related complications and less perioperative delirium than FC, largely reflecting fewer access-site complications. Further prospective external validation is warranted.

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.

To evaluate whether an activated clotting time (ACT)-guided, formula-based anticoagulation strategy supported by viscoelastic coagulation monitoring (ROTEM) improves perioperative coagulation management and reduces bleeding compared with standard weight-based heparin dosing in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). In this single-center prospective, randomized controlled trial, 100 adults undergoing isolated CABG with CPB were allocated to ACT-guided management (n&#x2009;=&#x2009;50) or standard care (n&#x2009;=&#x2009;50). The ACT-guided group received individualized heparin and protamine dosing calculated using predefined ACT-based formulas targeting ACT &#x2265;400&#x2009;seconds. The control group received a fixed heparin bolus (300&#x2009;IU/kg) with empirical protamine reversal. ROTEM was performed preoperatively, intraoperatively, and postoperatively. The primary end-point was total chest drain output at 24&#x2009;hours. Secondary end-points included transfusion requirements, thrombotic events, platelet count variation, oxygenator performance, additional heparin or protamine use, ROTEM-derived parameters and perioperative clinical outcomes. The ACT-guided group had lower 24-hour chest drain bleeding and reduced total exposure to heparin and protamine. Intraoperative ACT values were more consistently within target range, with fewer supplemental heparin doses required. ROTEM demonstrated shorter clotting times and improved clot firmness, indicating reduced postoperative hypocoagulability. Platelet decline during CPB was attenuated. Transfusion rates (28% vs 52%, p&#x2009;=&#x2009;0.01) and total allogeneic units transfused (0.6&#x2009;&#xb1;&#x2009;1.0 vs 1.4&#x2009;&#xb1;&#x2009;1.6, p&#x2009;=&#x2009;0.003) were significantly lower, with no observed increase in thrombotic events. ACT-guided, formula-based anticoagulation supported by ROTEM was associated with more favourable coagulation parameters and reduced bleeding without evidence of increased thrombotic complications within the limitations of the study sample size. Larger prospective studies are warranted to confirm these findings.

Speckle-tracking echocardiography (STE) identifies subclinical myocardial dysfunction after aortic valve replacement. We compared strain-based remodelling and prognostic values after transcatheter (TAVR) vs surgical (SAVR) aortic valve replacement. We analysed preoperative (preop) and postoperative (postop) left atrial volume index (LAVI), left ventricular (LV) global longitudinal strain (LV-GLS), right ventricular (RV) free wall strain (RV-FWS), RV global longitudinal strain (RV-GLS), and tricuspid annular plane systolic excursion (TAPSE) in 373 patients (TAVR n&#x2009;=&#x2009;195; SAVR n&#x2009;=&#x2009;178). Multivariable logistic regression assessed echocardiographic predictors of 1-year clinical outcomes. Left ventricular ejection fraction and LV-GLS remained stable in both groups. Right ventricular function deteriorated post-SAVR compared to TAVR (P&#x2009;<&#x2009;.001), with marked declines in TAPSE and RV-GLS (both P&#x2009;<&#x2009;.001). Preop LAVI predicted mortality (adjusted OR, 1.03; 95% CI, 1.02-1.05; P&#x2009;=&#x2009;.001) and atrial fibrillation (AF) recurrence (OR, 1.04; 95% CI, 1.02-1.06; P&#x2009;=&#x2009;.001). Stroke was predicted by preop RV-GLS (OR, 0.91; P&#x2009;=&#x2009;.031) and TAPSE (OR, 1.12; P&#x2009;=&#x2009;.013). Postop LAVI (OR, 1.06; P&#x2009;=&#x2009;.001), RV-FWS (OR, 1.06; P&#x2009;=&#x2009;.016), RV-GLS (OR, 1.10; P&#x2009;=&#x2009;.006), and TAPSE (OR, 0.93; P&#x2009;=&#x2009;.035) also remained significant predictors. Furthermore, postop LV-GLS was associated with mortality (OR, 1.08; P&#x2009;=&#x2009;.013) and AF recurrence (OR, 1.16; P&#x2009;=&#x2009;.001). Preop and postop strain parameters, particularly LAVI, LV-GLS, and RV longitudinal metrics, provide substantial prognostic value. Divergent RV remodelling patterns support integrating routine echocardiographic strain assessment for longitudinal risk stratification.

Immunotherapy has expanded curative-intent options in non-small cell lung cancer (NSCLC), but management recommendations remain variable. This survey examined variation in resectability assessment and treatment sequencing among thoracic oncology clinicians managing stage II-III NSCLC. A web-based case-vignette survey was distributed to thoracic oncology clinicians, primarily in Europe. Seven stage II-III NSCLC vignettes, based on the ninth-edition TNM classification, were presented. Treatment options were recorded as independent yes/no endorsements. The primary outcome was endorsement of neoadjuvant chemoimmunotherapy among vignette evaluations considered resectable. Vignette-level binary outcomes were analysed using exploratory generalized estimating equations clustered by respondent. Sixty-eight respondents provided vignette-level assessments. Resectability was generally endorsed in the N0/N1 and selected single-station N2 scenarios but was substantially lower in the multi-station and T3/T4 N2 scenarios. Among cases considered resectable, endorsement of neoadjuvant chemoimmunotherapy increased markedly in N2 scenarios, whereas cases considered unresectable were commonly associated with endorsement of concurrent chemoradiotherapy. In an exploratory model restricted to resectable-branch evaluations (249 observations from 57 respondents), any N2 involvement was associated with endorsement of neoadjuvant chemoimmunotherapy (adjusted odds ratio 28.42, 95% CI 7.31-110.42; P&#x2009;<&#x2009;.001), though the wide interval reflects the limited effective sample. Variation was greatest in borderline N2 disease, particularly multi-station and higher-T N2 scenarios, where clinicians diverged in defining resectability and in selecting surgery-based vs chemoradiotherapy-based pathways. These findings support the need for clearer multidisciplinary frameworks in stage II-III NSCLC, within the limits of a surgeon-weighted respondent pool and an anatomically focused vignette set.

We examined whether cardiopulmonary exercise testing (CPET) variables predict 30&#x2011;day postoperative complications in patients undergoing anatomical resection for non-small cell lung cancer (NSCLC). Consecutive patients who underwent segmentectomy or greater between January 2023 and March 2025 at a single tertiary centre were reviewed. All patients underwent CPET within 30 days preoperatively. Data on demographics, comorbidities, pulmonary function, operative factors, and outcomes were collected. Associations were assessed using univariable and multivariable logistic regression; discrimination was evaluated with receiver operating characteristic curve (ROC). Results with 2&#x2011;sided &#x3b1;&#x2009;=&#x2009;0.05 were considered significant. Statistical analyses were conducted with R 4.4.2 (stats). Among 353 patients (mean age 68.4&#x2009;&#xb1;&#x2009;8.4 years; 58.1% male individuals), 33 (9.4%) experienced complications. Patients were older (71.8 vs 68.0 years) and more often male individuals (81.8% vs 55.6%) than controls; they had lower body mass index (BMI) (23.1 vs 24.4 kg/m2) and lower forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) (69.5% vs 72.7%). In the univariable analysis, age (odds ratio [OR] 1.07), female sex (OR 0.28 vs male), BMI (OR 0.88 per kg/m2), FEV1/FVC (OR 0.96 per %), ventilatory equivalent for carbon dioxide (VE/VCO2) slope (OR 1.06 per unit), attained stage (OR 0.66 per stage), and operation time (OR 1.58 per hour) were associated with complications. In the multivariable analysis, BMI (OR 0.86, 95% confidence interval [CI] 0.75-1.00), FEV1/FVC (OR 0.94, 95% CI, 0.90-0.99), and VE/VCO2 slope (OR 1.06, 95% CI, 1.00-1.11) remained independent predictors. Receiver operating characteristic curves showed poor discrimination: peak oxygen consumption (VO2peak) area under the curve (AUC), 0.52; anaerobic threshold (AT), 0.59; VE/VCO2 slope, 0.40; and AT time 0.43. Dichotomized cut&#x2011;offs were generally non&#x2011;informative. Individual CPET variables had limited discriminative accuracy (AUC < 0.6). Cardiopulmonary exercise testing should complement clinical and spirometric predictors rather than serve as a stand&#x2011;alone gatekeeper.

Aortic valve neocuspidization (AVNeo) has gained widespread recognition in clinical practice; however, multicentre data describing its mid-term functional durability in real-world populations remain limited. This study aimed to evaluate the clinical and echocardiographic outcomes of AVNeo in a large multicentre cohort with extended follow-up. This retrospective multicentre study included 672 patients who underwent AVNeo at 16 institutions. The study population was characterized by advanced age, small body size, and a substantial burden of comorbidities. Mid-term outcomes included overall survival, freedom from reoperation, and longitudinal echocardiographic performance assessed from discharge through mid-term follow-up. Survival analyses were performed using the Kaplan-Meier method, and temporal echocardiographic changes were evaluated using linear mixed-effects models accounting for repeated measurements and centre-level clustering. Early postoperative outcomes demonstrated acceptable procedural safety, with a 30-day mortality of 3.0%. Echocardiographic assessment showed functional optimization during the first postoperative year, while effective orifice area remained stable. Beyond 1 year, transvalvular gradients, peak velocity, valve area, and ventricular function remained stable up to 7 years after surgery. Estimated overall survival was 91.7% at 1 year and 79.5% at 5 years, while freedom from reoperation remained high at 99.4% at 1 year and 96.5% at 5 years. In this large multicentre real-world cohort, AVNeo demonstrated stable mid-term valve performance without evidence of clinically significant progressive deterioration. These findings support the durability and reproducibility of AVNeo in routine clinical practice.