ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

A 73-year-old male developed early prosthetic aortic valve endocarditis complicated by haemorrhagic cerebral lesions 45 days after tissue valve replacement. Transesophageal echocardiography revealed bulky vegetations and an annular abscess. Urgent surgical valve replacement with extensive debridement was performed, while broad-spectrum antifungal therapy was initiated. Aspergillus terreus was subsequently confirmed. Postoperatively, the patient experienced acute hydrocephalus, subarachnoid haemorrhage, and recurrent vegetations, ultimately precluding further surgery. He died on postoperative day 57. This case highlights the diagnostic and therapeutic challenges of early fungal prosthetic endocarditis with intracranial haemorrhage, emphasizing individualized management by multidisciplinary teams and the high mortality associated with Aspergillus infections.

BackgroundThe Ross procedure, introduced in 1967, transformed cardiac surgery. This study presents one of the first global bibliometric analyses, to the best of our knowledge, mapping research trends, collaborations, and authorship to identify future directions in this field.MethodsA global bibliometric analysis of Ross procedure publications (1967-2025) was performed using Scopus and PubMed. Data processed in R (bibliometrix, biblioshiny) explored productivity, collaborations, authorship, and thematic evolution. Future publication trends to 2050 were forecast using a linear extrapolation model with 95% confidence intervals.ResultsA total of 2370 Ross procedure publications were identified (1967-2025), showing an 8.1% average annual growth rate. Original articles dominated (65%), followed by reviews/meta-analyses (13.9%) and case reports (13.5%). Among 6228 authors (69.5% male), collaboration averaged 4.9 coauthors/document, with 12.6% international partnerships. The USA (32.3%), the Netherlands (19.3%), and Germany (14.5%) led in productivity. Top institutions were Erasmus University Medical Center (4.3%), Mount Sinai Health System (3.0%), and University Heart Center Lübeck (2.2%). Major journals included Annals of Thoracic Surgery (13.5%), Journal of Thoracic and Cardiovascular Surgery (12.2%), and European Journal of Cardio-Thoracic Surgery (7.6%). Faculty surgeons authored 66% of first-author papers. Main research themes involved allograft reintervention, durability, suture technique, failure, and postoperative complications. Linear regression predicted 164 annual publications by 2050.ConclusionsThis analysis reveals an exponentially increasing and sustained global interest in the Ross procedure, which continues to shape cardiac surgery worldwide. The findings highlight growing research output, robust international collaboration, and a focus on clinical innovation, ensuring ongoing advancements in surgical techniques, patient outcomes, and global cardiovascular surgical excellence.

ObjectiveSurgical access to the mitral valve can be achieved through various techniques, with the transseptal (TS) and left atrial (LA) approaches being the most commonly used in mitral valve surgery (MVS). However, the optimal approach remains a subject of debate, as studies report differing perioperative and postoperative outcomes associated with each technique. This meta-analysis aims to systematically compare the clinical outcomes of TS versus LA approaches in MVS.MethodsThis meta-analysis followed the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus databases was performed until June 2025. The primary outcome was permanent pacemaker (PPM) implantation.ResultsTwenty-five studies were included. The TS approach was associated with higher risk of PPM implantation (risk ratio: 1.44, 95% confidence interval [1.07-1.95]; P = 0.01), postoperative atrial fibrillation, postoperative junctional rhythm, atrioventricular block, need for temporary pacing and longer cardiopulmonary bypass time, aortic cross-clamp time (CCT), hospital-stay and bleeding. No significant differences were found in intensive care unit stay, mortality, infections, stroke and renal failure. Subgroup analysis of isolated MVS showed no differences in most outcomes except for a higher risk of PPM implantation and postoperative atrial fibrillation in the TS group.ConclusionOur meta-analysis demonstrates that the TS approach is associated with longer operative times and a higher risk of postoperative conduction disturbances and PPM implantation. However, no significant differences were observed in other major clinical outcomes. These findings do not support the overall superiority of either approach, and surgical access should be individualized according to patient anatomy, procedural requirements, and surgeon experience. Further high-quality studies are needed to strengthen the available evidence.

BackgroundThis study determined the incidence of major adverse cardiovascular events and identified independent predictors of in-hospital mortality in patients with acute limb ischemia undergoing revascularization.MethodsA retrospective cohort study was conducted on 240 consecutive patients with acute limb ischemia who underwent revascularization at a tertiary-care academic hospital between February 2014 and February 2022. Perioperative adverse events were recorded, and multivariable logistic regression was used to identify independent predictors of in-hospital mortality.ResultsIn-hospital major adverse cardiovascular events occurred in 42 patients (17.5%), while cardiovascular death accounted for 1.7%. All-cause in-hospital mortality was 13.3% (32 patients). On univariable analysis, markers of physiological stress including leukocytosis and elevated neutrophil-to-lymphocyte ratio, renal dysfunction, and multiple postoperative complications were significantly associated with mortality. Multivariable analysis identified four independent predictors: preoperative leukocytosis with white blood cell count greater than 15,000 per microliter (adjusted odds ratio 4.05, 95% confidence interval 1.52-10.75), intraoperative vasopressor use (adjusted odds ratio 4.00, 95% confidence interval 1.48-10.83), postoperative respiratory failure (adjusted odds ratio 8.44, 95% confidence interval 3.20-22.27), and postoperative bowel ischemia (adjusted odds ratio 15.24, 95% confidence interval 2.40-96.90).ConclusionsMajor adverse cardiovascular events are frequent but not independently associated with in-hospital mortality in patients with acute limb ischemia undergoing revascularization. Mortality is determined by a cascade of perioperative systemic insults rather than isolated cardiovascular events. Postoperative surveillance should prioritize early recognition of respiratory failure and bowel ischemia, particularly in patients presenting with leukocytosis or requiring intraoperative vasopressor support.

Scimitar syndrome is a rare congenital anomaly characterized by abnormal pulmonary venous drainage. This report describes the case of a 15-year-old girl with scimitar syndrome in which the scimitar vein drained into the hepatic vein. Surgical correction was successfully performed using an intra-atrial tunnel technique with right atrial anastomosis of the scimitar vein to reroute the scimitar vein to the left atrium. This case demonstrates the efficacy of this technique in managing complex cases of scimitar syndrome.

Coarctation of the aorta (CoA) is a rare congenital anomaly which can remain undiagnosed into adulthood. Furthermore, additional congenital anomalies of dextrocardia and situs inversus pose significant diagnostic and perioperative challenges and are exceedingly rare in occurrence. We report a unique case of a 53-year-old male with bicuspid aortic valve, severe aortic stenosis, ascending aortic aneurysm and post-ductal CoA, along with dextrocardia and situs inversus. He underwent staged surgical correction: first, CoA repair via right posterolateral thoracotomy due to dextrocardia; followed by a modified Bentall procedure five months later. Anaesthetic management required tailored planning, modified monitoring and careful interpretation of standard investigations like ECG and transoesophageal echocardiography. Multidisciplinary collaboration enabled successful outcomes in this complex setting.

Thoracoabdominal aortic aneurysm (TAAA) repair remains associated with significant morbidity and mortality, especially in elderly and comorbid patients. Although total endovascular repair using fenestrated or branched endografts has broadened therapeutic options, anatomical limitations, patient frailty, and logistical constraints still prevent a purely endovascular approach in many cases. For this subset, hybrid repair with visceral debranching has emerged as an alternative strategy, though its role remains controversial. This narrative review explores the rationale, indications, technical approaches, perioperative management, and outcomes of visceral debranching in hybrid TAAA repair. Particular attention is given to frailty assessment, anatomical complexity, staging strategies, and quantitative outcome data, with the goal of defining the position of hybrid repair within current algorithms compared with open and fully endovascular techniques. Hybrid repair is mainly used in high-risk patients who are unsuitable for open surgery and anatomically unfit for total endovascular reconstruction. Reported early mortality varies widely from 5% to over 20%, reflecting heterogeneity in aneurysm extent, operative strategies, and patient selection; elective series from experienced centres more commonly report mortality between 5% and 10%. Long-term bypass durability is generally good, with overall graft patency around 85%-90% at 5 years. Superior mesenteric artery grafts show the highest durability, while renal bypasses - particularly right-sided - have lower patency rates. Acute kidney injury occurs in 20%-40% of patients, with permanent dialysis dependence in 5%-15%. Mesenteric ischaemia is uncommon but highly lethal, while spinal cord injury occurs in 5%-15%, with permanent deficits in 3%-10%. Staged hybrid approaches may reduce physiological burden and neurological risk but require careful surveillance due to interval risks. Overall, visceral debranching remains a relevant and durable option when applied selectively, particularly in patients with hostile anatomy or prior aortic interventions. Optimal outcomes depend on careful patient selection, meticulous technique, appropriate staging, and structured long-term follow-up.

BackgroundAcute type B aortic dissection (TBAD) has traditionally been classified as either complicated or uncomplicated, guiding management toward urgent intervention or optimal medical therapy with surveillance. However, growing evidence suggests that this binary framework inadequately captures the biological and haemodynamic heterogeneity of the disease. A subset of patients initially classified as uncomplicated demonstrates clinical or radiological features associated with adverse outcomes, commonly described as "high-risk" uncomplicated TBAD.MethodsA structured narrative review was conducted to synthesise contemporary evidence relating to clinical predictors, imaging markers, and outcome data in TBAD. Major observational studies, meta-analyses, guideline statements, and recent registry data were evaluated to examine the pathophysiological basis and prognostic significance of high-risk features and their implications for disease classification and management.ResultsAccumulating data indicate that TBAD represents a dynamic continuum of haemodynamic and morphological instability rather than discrete clinical categories. Clinical markers such as refractory pain and persistent hypertension provide early indicators of potential instability but demonstrate limited specificity. In contrast, imaging findings, including false lumen diameter, entry tear geometry, true lumen compression, and aortic diameter, more reliably reflect underlying biomechanical stress and risk of progression. Contemporary outcome studies and meta-analyses suggest that thoracic endovascular aortic repair promotes favourable aortic remodelling and may improve survival in selected patients with high-risk disease, although heterogeneity in patient selection remains substantial.ConclusionsHigh-risk uncomplicated TBAD likely represents a transitional phenotype within a broader spectrum of disease progression. Moving beyond binary classification toward integrated clinical, imaging, and haemodynamic risk stratification may enable more precise identification of patients who would benefit from early intervention while avoiding overtreatment in stable disease.

BackgroundNorwood surgery is the first stage in the surgical palliation of hypoplastic left heart syndrome (HLHS) and its variants. Postcardiotomy extracorporeal membrane oxygenation (ECMO) may be required in some patients undergoing the Norwood procedure given its complexity.MethodsKids Inpatient Database (2000-2022) and National Inpatient Sample (2016-2022) datasets were used. 2284 patients underwent a Norwood procedure. The cohort was dichotomized into ECMO (EG, n = 147) and Non-ECMO (NEG, n = 2137) groups; Survivor and Nonsurvivor. Demographic and clinical characteristics were extracted. Overlap weights were used to attain covariate balance and perform overlap-weighted analysis.ResultsPostcardiotomy ECMO utilization was 6% (147/2284). The EG was more likely to have HLHS as compared to its variants, total anomalous pulmonary venous return, small for gestational age, congestive heart failure, and arrhythmias. Overall discharge mortality for the entire cohort is 10%. The EG experienced higher mortality compared to NEG "44% versus 8%" and higher morbidity such as cardiac arrest, pericardial complication, cardiogenic shock, respiratory complications, acute kidney injury (AKI), postoperative bleeding, sepsis and reoperation, longer length-of-stay, and higher hospital charges than NEG. ECMO utilization rose over time, peaking after 2015, while mortality progressively declined. The Midwest had the highest ECMO use (8.93%). In multivariate analysis, ECMO use and AKI were independent predictors of mortality.ConclusionsPostcardiotomy ECMO utilization for the Norwood procedure remains rare, but utilization is increasing with regional variation. Postoperative AKI and ECMO utilization were independent predictors of mortality among Norwood.

A 2-month-old male infant weighing 2.8 kg developed a deep sternal wound infection on postoperative day 16 following repair of an atrial septal defect, ventricular septal defect and patent ductus arteriosus. Staphylococcus aureus was isolated on wound swab, and culture-sensitive antibiotics were given for 14 days. The infant remained intubated with an unstable chest wall, so conventional higher negative pressures were considered unsafe near the exposed mediastinum. After debridement, polyurethane-foam vacuum-assisted closure (VAC) was applied at a deliberately low -40 mmHg on day 1, increased to -50 mmHg thereafter, and changed every third day. Four cycles were completed over 12 days. The wound granulated progressively ( Figure 1) and healed by secondary intention; the infant was extubated, recovered well and was discharged on postoperative day 42. This case illustrates that stepwise low-pressure VAC is a safe, effective option for deep sternal wound infection in the ventilated, very-low-weight infant.