Intractable bleeding during cardiac surgery is a rare but life-threatening complication. We describe a novel management approach in which the patient was supported with venoarterial extracorporeal membrane oxygenation until hemostasis could be achieved. This approach serves as an unloading technique for the heart while allowing compression of bleeding sites and safe transfusion without hemodynamic instability or myocardial dysfunction.
Intractable bleeding during cardiac surgery is a rare but life-threatening complication. We describe a novel management approach in which the patient was supported with venoarterial extracorporeal membrane oxygenation until hemostasis could be achieved. This approach serves as an unloading technique for the heart while allowing compression of bleeding sites and safe transfusion without hemodynamic instability or myocardial dysfunction.
{"title":"Use of Extracorporeal Membrane Oxygenation for Management of Hemostasis After Complex Cardiac Surgery","authors":"Dagmawi Demessie MD, Yara Menassa MD, Aabha Divya MD, Jamil Borgi MD","doi":"10.1016/j.atssr.2026.03.013","DOIUrl":"10.1016/j.atssr.2026.03.013","url":null,"abstract":"<div><div>Intractable bleeding during cardiac surgery is a rare but life-threatening complication. We describe a novel management approach in which the patient was supported with venoarterial extracorporeal membrane oxygenation until hemostasis could be achieved. This approach serves as an unloading technique for the heart while allowing compression of bleeding sites and safe transfusion without hemodynamic instability or myocardial dysfunction.</div></div><div>Intractable bleeding during cardiac surgery is a rare but life-threatening complication. We describe a novel management approach in which the patient was supported with venoarterial extracorporeal membrane oxygenation until hemostasis could be achieved. This approach serves as an unloading technique for the heart while allowing compression of bleeding sites and safe transfusion without hemodynamic instability or myocardial dysfunction.</div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 1066-1068"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cardiac tamponade and postoperative atrial fibrillation remain significant challenges after cardiac surgery, contributing to higher morbidity, mortality, and health care costs. Posterior pericardiotomy (PP) has been used to reduce these complications. This review summarizes the history, technique, and clinical evidence for PP.
Methods
We identified recent studies related to PP to perform a narrative overview of its indications, techniques, and clinical outcomes. This was supplemented with historical context from cardiac surgeons who were early adopters of the procedure.
Results
Evidence demonstrates that PP reduces postoperative pericardial effusion, tamponade, and postoperative atrial fibrillation by improving pericardial drainage, preventing tamponade, and secondarily decreasing pericardial inflammation and oxidative stress.
Conclusions
Despite receiving a class 2a recommendation in recent American College of Cardiology guidelines for atrial fibrillation prevention, PP is not widely performed. Given its simplicity, safety, and effectiveness, wider use of PP could improve outcomes after cardiac surgery.
{"title":"Posterior Pericardiotomy: Historical Perspective, Current Techniques, and Clinical Outcomes","authors":"Edward Hauptmann MD, Erin Hoover MD, Raghav Chandra MD, Madhuri Nagaraj MD, Paige Deblieux MD, Jasmina Ehab MD, Suresh Keshavamurthy MD","doi":"10.1016/j.atssr.2026.03.006","DOIUrl":"10.1016/j.atssr.2026.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac tamponade and postoperative atrial fibrillation remain significant challenges after cardiac surgery, contributing to higher morbidity, mortality, and health care costs. Posterior pericardiotomy (PP) has been used to reduce these complications. This review summarizes the history, technique, and clinical evidence for PP.</div></div><div><h3>Methods</h3><div>We identified recent studies related to PP to perform a narrative overview of its indications, techniques, and clinical outcomes. This was supplemented with historical context from cardiac surgeons who were early adopters of the procedure.</div></div><div><h3>Results</h3><div>Evidence demonstrates that PP reduces postoperative pericardial effusion, tamponade, and postoperative atrial fibrillation by improving pericardial drainage, preventing tamponade, and secondarily decreasing pericardial inflammation and oxidative stress.</div></div><div><h3>Conclusions</h3><div>Despite receiving a class 2a recommendation in recent American College of Cardiology guidelines for atrial fibrillation prevention, PP is not widely performed. Given its simplicity, safety, and effectiveness, wider use of PP could improve outcomes after cardiac surgery.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 1069-1075"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-03-18DOI: 10.1016/j.atssr.2026.02.035
Ting-Wei Lin MD, MS, Wei-Lin Hsu MD, Heng Su MD, Yi-Chen Wang MD, Hsuan-Yin Wu MD
<div><h3>Background</h3><div>Root-preserving repair is commonly used for acute type A aortic dissection without root aneurysm or sinus tears. We evaluated whether the extent of sinus of Valsalva involvement predicts late outcomes and postoperative aortic root growth.</div></div><div>Root-preserving repair is commonly used for acute type A aortic dissection without root aneurysm or sinus tears. We evaluated whether the extent of sinus of Valsalva involvement predicts late outcomes and postoperative aortic root growth.</div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of patients undergoing root-preserving acute type A aortic dissection repair with >1 month follow-up and ≥1 postoperative imaging. Fifty patients were included and stratified by sinus of Valsalva involvement (≥2 vs <2 sinus involvement). Primary outcomes were aortic root adverse event–free survival and longitudinal root diameter.</div></div><div>We conducted a single-center retrospective study of patients undergoing root-preserving acute type A aortic dissection repair with >1 month follow-up and ≥1 postoperative imaging. Fifty patients were included and stratified by sinus of Valsalva involvement (≥2 vs <2 sinus involvement). Primary outcomes were aortic root adverse event–free survival and longitudinal root diameter.</div><div><h3>Results</h3><div>Baseline and perioperative characteristics were similar between groups, and no late aorta-related deaths occurred. Aortic root adverse event–free survival was worse with ≥2 sinuses than with <2 (<em>P</em> = .027). At 10 years, the ≥2 sinus involvement group had an estimated mean aortic root diameter of 50.38 mm vs 40.18 mm in the <2 group. The mean root diameter was 10.19 mm larger (95% CI, 4.27-16.11; <em>P</em> = .001) in the ≥2 sinus involvement group at 10 years.</div></div><div>Baseline and perioperative characteristics were similar between groups, and no late aorta-related deaths occurred. Aortic root adverse event–free survival was worse with ≥2 sinuses than with <2 (<em>P</em> = .027). At 10 years, the ≥2 sinus involvement group had an estimated mean aortic root diameter of 50.38 mm vs 40.18 mm in the <2 group. The mean root diameter was 10.19 mm larger (95% CI, 4.27-16.11; <em>P</em> = .001) in the ≥2 sinus involvement group at 10 years.</div><div><h3>Conclusions</h3><div>The degree of sinus of Valsalva involvement is associated with postoperative aortic root enlargement and adverse root events after root-preserving repair. In experienced centers, broader use of aortic root replacement, preferably valve-sparing procedures, may be considered for patients with involvement of ≥2 sinuses.</div></div><div>The degree of sinus of Valsalva involvement is associated with postoperative aortic root enlargement and adverse root events after root-preserving repair. In experienced centers, broader use of aortic root replacement, preferably valve-sparing procedures, may be considered for pat
背景：保留根部修复术常用于急性A型主动脉夹层，无根部动脉瘤或窦性撕裂。我们评估了Valsalva窦受累程度是否能预测晚期预后和术后主动脉根生长。保根修复常用于急性A型主动脉夹层，无根动脉瘤或窦性撕裂。我们评估了Valsalva窦受累程度是否能预测晚期预后和术后主动脉根生长。方法对急性a型主动脉夹层保根修复术患者进行单中心回顾性研究，随访1个月，术后影像学检查≥1次。50例患者被纳入并按受累的Valsalva窦（≥2 vs <2）进行分层。主要结局是主动脉根部无不良事件生存和纵向根部直径。我们对接受保根急性a型主动脉夹层修复术的患者进行了一项单中心回顾性研究，随访1个月，术后影像学检查≥1次。50例患者被纳入并按受累的Valsalva窦（≥2 vs <2）进行分层。主要结局是主动脉根部无不良事件生存和纵向根部直径。结果两组患者的基线和围手术期特征相似，未发生晚期主动脉相关死亡。≥2个鼻窦组的主动脉根部无不良事件生存率低于≥2个鼻窦组（P = 0.027）。10年时，≥2个窦受累组估计主动脉根平均直径为50.38 mm，而≥2个窦受累组为40.18 mm。10年时，≥2个鼻窦受累组的平均根径增大10.19 mm （95% CI, 4.27-16.11; P = .001）。两组之间的基线和围手术期特征相似，未发生晚期主动脉相关死亡。≥2个鼻窦组的主动脉根部无不良事件生存率低于≥2个鼻窦组（P = 0.027）。10年时，≥2个窦受累组估计主动脉根平均直径为50.38 mm，而≥2个窦受累组为40.18 mm。10年时，≥2个鼻窦受累组的平均根径增大10.19 mm （95% CI, 4.27-16.11; P = .001）。结论主动脉瓣窦受累程度与术后主动脉根扩大及保留根修复后的不良根事件有关。在经验丰富的中心，对于累及≥2个鼻窦的患者，可以考虑更广泛地使用主动脉根置换术，最好是保留瓣膜的手术。Valsalva窦受累程度与术后主动脉根扩大和保留根修复后的不良根事件有关。在经验丰富的中心，对于累及≥2个鼻窦的患者，可以考虑更广泛地使用主动脉根置换术，最好是保留瓣膜的手术。下载：下载高清图片（272KB）下载：下载全尺寸图片
{"title":"Sinus of Valsalva Involvement Affects Aortic Root Growth After Acute Type A Aortic Dissection Repair","authors":"Ting-Wei Lin MD, MS, Wei-Lin Hsu MD, Heng Su MD, Yi-Chen Wang MD, Hsuan-Yin Wu MD","doi":"10.1016/j.atssr.2026.02.035","DOIUrl":"10.1016/j.atssr.2026.02.035","url":null,"abstract":"<div><h3>Background</h3><div>Root-preserving repair is commonly used for acute type A aortic dissection without root aneurysm or sinus tears. We evaluated whether the extent of sinus of Valsalva involvement predicts late outcomes and postoperative aortic root growth.</div></div><div>Root-preserving repair is commonly used for acute type A aortic dissection without root aneurysm or sinus tears. We evaluated whether the extent of sinus of Valsalva involvement predicts late outcomes and postoperative aortic root growth.</div><div><h3>Methods</h3><div>We conducted a single-center retrospective study of patients undergoing root-preserving acute type A aortic dissection repair with >1 month follow-up and ≥1 postoperative imaging. Fifty patients were included and stratified by sinus of Valsalva involvement (≥2 vs <2 sinus involvement). Primary outcomes were aortic root adverse event–free survival and longitudinal root diameter.</div></div><div>We conducted a single-center retrospective study of patients undergoing root-preserving acute type A aortic dissection repair with >1 month follow-up and ≥1 postoperative imaging. Fifty patients were included and stratified by sinus of Valsalva involvement (≥2 vs <2 sinus involvement). Primary outcomes were aortic root adverse event–free survival and longitudinal root diameter.</div><div><h3>Results</h3><div>Baseline and perioperative characteristics were similar between groups, and no late aorta-related deaths occurred. Aortic root adverse event–free survival was worse with ≥2 sinuses than with <2 (<em>P</em> = .027). At 10 years, the ≥2 sinus involvement group had an estimated mean aortic root diameter of 50.38 mm vs 40.18 mm in the <2 group. The mean root diameter was 10.19 mm larger (95% CI, 4.27-16.11; <em>P</em> = .001) in the ≥2 sinus involvement group at 10 years.</div></div><div>Baseline and perioperative characteristics were similar between groups, and no late aorta-related deaths occurred. Aortic root adverse event–free survival was worse with ≥2 sinuses than with <2 (<em>P</em> = .027). At 10 years, the ≥2 sinus involvement group had an estimated mean aortic root diameter of 50.38 mm vs 40.18 mm in the <2 group. The mean root diameter was 10.19 mm larger (95% CI, 4.27-16.11; <em>P</em> = .001) in the ≥2 sinus involvement group at 10 years.</div><div><h3>Conclusions</h3><div>The degree of sinus of Valsalva involvement is associated with postoperative aortic root enlargement and adverse root events after root-preserving repair. In experienced centers, broader use of aortic root replacement, preferably valve-sparing procedures, may be considered for patients with involvement of ≥2 sinuses.</div></div><div>The degree of sinus of Valsalva involvement is associated with postoperative aortic root enlargement and adverse root events after root-preserving repair. In experienced centers, broader use of aortic root replacement, preferably valve-sparing procedures, may be considered for pat","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 752-756"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-03-18DOI: 10.1016/j.atssr.2026.02.032
Étienne Fasolt Richard Corvin Meinert MD, Arlene Körner MD, Willem Hendrik te Gussinklo MD, Alexander Brobeil MD, Matthias Karck MD, Bashar Dib MD
A 36-year-old female patient presented with syncope and retrosternal chest pain. Computed tomography revealed contained rupture of the ascending aorta with no false lumen but an intraluminal thrombus. She underwent emergent open aortic repair. Postoperatively, refractory hypertension was noticeable. Upon further examination of the computed tomographic scan, a large right-sided adrenal mass became evident. Endocrinologic workup ruled out pheochromocytoma and revealed primary aldosteronism. She underwent robotic adrenalectomy, subsequently showed close to normal blood pressure values, and was discharged without further complications. We present here a rare case of contained aortic rupture in the setting of primary aldosteronism.
A 36-year-old female patient presented with syncope and retrosternal chest pain. Computed tomography revealed contained rupture of the ascending aorta with no false lumen but an intraluminal thrombus. She underwent emergent open aortic repair. Postoperatively, refractory hypertension was noticeable. Upon further examination of the computed tomographic scan, a large right-sided adrenal mass became evident. Endocrinologic workup ruled out pheochromocytoma and revealed primary aldosteronism. She underwent robotic adrenalectomy, subsequently showed close to normal blood pressure values, and was discharged without further complications. We present here a rare case of contained aortic rupture in the setting of primary aldosteronism.
{"title":"Contained Rupture of the Ascending Aorta Caused by Primary Aldosteronism","authors":"Étienne Fasolt Richard Corvin Meinert MD, Arlene Körner MD, Willem Hendrik te Gussinklo MD, Alexander Brobeil MD, Matthias Karck MD, Bashar Dib MD","doi":"10.1016/j.atssr.2026.02.032","DOIUrl":"10.1016/j.atssr.2026.02.032","url":null,"abstract":"<div><div>A 36-year-old female patient presented with syncope and retrosternal chest pain. Computed tomography revealed contained rupture of the ascending aorta with no false lumen but an intraluminal thrombus. She underwent emergent open aortic repair. Postoperatively, refractory hypertension was noticeable. Upon further examination of the computed tomographic scan, a large right-sided adrenal mass became evident. Endocrinologic workup ruled out pheochromocytoma and revealed primary aldosteronism. She underwent robotic adrenalectomy, subsequently showed close to normal blood pressure values, and was discharged without further complications. We present here a rare case of contained aortic rupture in the setting of primary aldosteronism.</div></div><div>A 36-year-old female patient presented with syncope and retrosternal chest pain. Computed tomography revealed contained rupture of the ascending aorta with no false lumen but an intraluminal thrombus. She underwent emergent open aortic repair. Postoperatively, refractory hypertension was noticeable. Upon further examination of the computed tomographic scan, a large right-sided adrenal mass became evident. Endocrinologic workup ruled out pheochromocytoma and revealed primary aldosteronism. She underwent robotic adrenalectomy, subsequently showed close to normal blood pressure values, and was discharged without further complications. We present here a rare case of contained aortic rupture in the setting of primary aldosteronism.</div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 778-781"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tetralogy of Fallot (TOF) often requires transannular patch repair, leading to pulmonary regurgitation. Systemic pulmonary shunt can be associated with pulmonary valve annulus (PVA) growth, thus potentially enabling valve-sparing repair. This study evaluated PVA growth after systemic pulmonary shunt and the midterm impact of valve-sparing repair on pulmonary valve function.
Methods
We reviewed 54 patients with TOF who underwent staged repair with systemic pulmonary shunt. PVA z scores were compared before and after systemic pulmonary shunt. Freedom from pulmonary regurgitation (PR) was assessed. Freedom from PR was defined as PR less than moderate.
Results
The median follow-up duration after intracardiac repair was 7.6 years (interquartile range [IQR], 3.1-10.8 years). In the staged repair group, the median PVA z score increased from −3.4 (IQR, −5.2 to −2.6) at the time of systemic pulmonary shunt to −2.7 (IQR, −4.4 to −1.8) before intracardiac repair. Freedom from PR at 8 years after intracardiac repair was higher in the valve-sparing repair group (84% vs 45%; P = .009). The pre–systemic pulmonary shunt PVA z score was a significant predictor of PVA growth (odds ratio, 1.87; P = .002), with a threshold of −4.1 predicting growth with 82.1% sensitivity and 72.7% specificity.
Conclusions
PVA growth was observed in patients with TOF after systemic pulmonary shunt. The pre–systemic pulmonary shunt PVA z score predicts successful growth and informs surgical planning. Valve-sparing repair offers superior midterm freedom from PR compared with transannular patch repair.
{"title":"Impact of Systemic Pulmonary Shunt for Tetralogy of Fallot on Pulmonary Valve Annulus Growth and Midterm Pulmonary Valve Function","authors":"Tsutomu Hataoka MD, Fumiaki Shikata MD, PhD, Toru Okamura MD, PhD, Norihiko Oka MD, PhD, Takahiro Tomoyasu MD, PhD, Masahiro Kaneko MD, PhD, Yoshikiyo Matsunaga MD, Kenta Matsui MD, Sakura Horie MD, Kagami Miyaji MD, PhD","doi":"10.1016/j.atssr.2026.02.025","DOIUrl":"10.1016/j.atssr.2026.02.025","url":null,"abstract":"<div><h3>Background</h3><div>Tetralogy of Fallot (TOF) often requires transannular patch repair, leading to pulmonary regurgitation. Systemic pulmonary shunt can be associated with pulmonary valve annulus (PVA) growth, thus potentially enabling valve-sparing repair. This study evaluated PVA growth after systemic pulmonary shunt and the midterm impact of valve-sparing repair on pulmonary valve function.</div></div><div><h3>Methods</h3><div>We reviewed 54 patients with TOF who underwent staged repair with systemic pulmonary shunt. PVA <em>z</em> scores were compared before and after systemic pulmonary shunt. Freedom from pulmonary regurgitation (PR) was assessed. Freedom from PR was defined as PR less than moderate.</div></div><div><h3>Results</h3><div>The median follow-up duration after intracardiac repair was 7.6 years (interquartile range [IQR], 3.1-10.8 years). In the staged repair group, the median PVA <em>z</em> score increased from −3.4 (IQR, −5.2 to −2.6) at the time of systemic pulmonary shunt to −2.7 (IQR, −4.4 to −1.8) before intracardiac repair. Freedom from PR at 8 years after intracardiac repair was higher in the valve-sparing repair group (84% vs 45%; <em>P</em> = .009). The pre–systemic pulmonary shunt PVA <em>z</em> score was a significant predictor of PVA growth (odds ratio, 1.87; <em>P</em> = .002), with a threshold of −4.1 predicting growth with 82.1% sensitivity and 72.7% specificity.</div></div><div><h3>Conclusions</h3><div>PVA growth was observed in patients with TOF after systemic pulmonary shunt. The pre–systemic pulmonary shunt PVA <em>z</em> score predicts successful growth and informs surgical planning. Valve-sparing repair offers superior midterm freedom from PR compared with transannular patch repair.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 857-862"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case in which a new synthetic hybrid patch inducing autologous tissue ingrowth was used to replace the obstructed Senning atrial baffle in a double switch operation for congenitally corrected transposition of the great arteries. However, recurrent baffle obstruction developed after 10 months postoperatively and was removed. Histology of the excised specimen showed promising tissue ingrowth but cautionary peripheral folding of the patch in this clinically challenging condition.
We report a case in which a new synthetic hybrid patch inducing autologous tissue ingrowth was used to replace the obstructed Senning atrial baffle in a double switch operation for congenitally corrected transposition of the great arteries. However, recurrent baffle obstruction developed after 10 months postoperatively and was removed. Histology of the excised specimen showed promising tissue ingrowth but cautionary peripheral folding of the patch in this clinically challenging condition.
{"title":"Early Biological Reaction to a Synthetic Hybrid Patch Inducing Tissue Ingrowth as a Senning Atrial Baffle","authors":"Akira Yamaguchi MD, Hiroomi Murayama MD, Shintaro Nemoto MD, PhD","doi":"10.1016/j.atssr.2026.02.030","DOIUrl":"10.1016/j.atssr.2026.02.030","url":null,"abstract":"<div><div>We report a case in which a new synthetic hybrid patch inducing autologous tissue ingrowth was used to replace the obstructed Senning atrial baffle in a double switch operation for congenitally corrected transposition of the great arteries. However, recurrent baffle obstruction developed after 10 months postoperatively and was removed. Histology of the excised specimen showed promising tissue ingrowth but cautionary peripheral folding of the patch in this clinically challenging condition.</div></div><div>We report a case in which a new synthetic hybrid patch inducing autologous tissue ingrowth was used to replace the obstructed Senning atrial baffle in a double switch operation for congenitally corrected transposition of the great arteries. However, recurrent baffle obstruction developed after 10 months postoperatively and was removed. Histology of the excised specimen showed promising tissue ingrowth but cautionary peripheral folding of the patch in this clinically challenging condition.</div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 872-875"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prolonged air leakage (PAL) is a common postoperative complication after lung resection. The conventional air leak test, widely used to detect intraoperative air leaks, is limited to restricted thoracic space during lung inflation, which may result in undetected leaks, and fragile lung parenchyma may allow new air leaks to develop during chest closure. This study evaluated the efficacy of tidal volume discrepancy monitoring for intraoperative air leak detection during video-assisted thoracoscopic surgery anatomical lung resection (lobectomy and segmentectomy).
Methods
We retrospectively reviewed 310 patients with a smoking history who underwent video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer. Since May 2020, a new intraoperative air leak assessment method was implemented. After the conventional air leak test, bilateral lung ventilation was continued until chest closure, with continuous monitoring of inspired and expired tidal volumes. A sustained discrepancy >20 mL per breath prompted further intrathoracic inspection and repair.
Results
PAL occurred in 4.1% of patients in the new method group, significantly lower than 10.9% in the conventional method group (P = .0205). Multivariate analysis identified the evaluation method and presence of intrathoracic adhesion as independent predictors of PAL. Importantly, all procedures were completed thoracoscopically, including a substantial number of segmentectomies.
Conclusions
Intraoperative evaluation of intraoperative air leaks using tidal volume discrepancies is a reliable and effective method to detect air leaks and reduce PAL incidence in video-assisted thoracoscopic surgery anatomical lung resections.
{"title":"Tidal Volume Discrepancy for Air Leak Detection in Thoracoscopic Lung Resection in Smokers","authors":"Masaya Otabe MD, Masayuki Ishida MD, Atsushi Kamigaichi MD, Atsushi Kagimoto MD, PhD, Michiyoshi Sanuki MD, PhD, Takeshi Mimura MD, PhD","doi":"10.1016/j.atssr.2026.02.028","DOIUrl":"10.1016/j.atssr.2026.02.028","url":null,"abstract":"<div><h3>Background</h3><div>Prolonged air leakage (PAL) is a common postoperative complication after lung resection. The conventional air leak test, widely used to detect intraoperative air leaks, is limited to restricted thoracic space during lung inflation, which may result in undetected leaks, and fragile lung parenchyma may allow new air leaks to develop during chest closure. This study evaluated the efficacy of tidal volume discrepancy monitoring for intraoperative air leak detection during video-assisted thoracoscopic surgery anatomical lung resection (lobectomy and segmentectomy).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 310 patients with a smoking history who underwent video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer. Since May 2020, a new intraoperative air leak assessment method was implemented. After the conventional air leak test, bilateral lung ventilation was continued until chest closure, with continuous monitoring of inspired and expired tidal volumes. A sustained discrepancy >20 mL per breath prompted further intrathoracic inspection and repair.</div></div><div><h3>Results</h3><div>PAL occurred in 4.1% of patients in the new method group, significantly lower than 10.9% in the conventional method group (<em>P</em> = .0205). Multivariate analysis identified the evaluation method and presence of intrathoracic adhesion as independent predictors of PAL. Importantly, all procedures were completed thoracoscopically, including a substantial number of segmentectomies.</div></div><div><h3>Conclusions</h3><div>Intraoperative evaluation of intraoperative air leaks using tidal volume discrepancies is a reliable and effective method to detect air leaks and reduce PAL incidence in video-assisted thoracoscopic surgery anatomical lung resections.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 909-913"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-03-03DOI: 10.1016/j.atssr.2026.02.017
Leonardo Paim N da Costa MD, PhD, Nicholas Prinz BA, Diego Reino MD, Vijay Subramanian MD, Kiran Dhanireddy MD, Lucian Lozonschi MD
A 69-year-old male individual with Child-Pugh class C alcoholic cirrhosis and 2-vessel coronary artery disease underwent combined robotic off-pump minimally invasive direct coronary artery bypass (MIDCAB) and simultaneous orthotopic liver transplant. The patient tolerated the procedure without complications, was extubated on postoperative day 1, and discharged home on day 9. At 15 months postprocedure he had preserved graft function, stable liver tests, and no major adverse cardiac events. This novel procedure of combined robotic minimally invasive direct coronary artery bypass and orthotopic liver transplant may offer a promising alternative for high-risk patients with end-stage liver disease and coronary artery disease.
A 69-year-old male individual with Child-Pugh class C alcoholic cirrhosis and 2-vessel coronary artery disease underwent combined robotic off-pump minimally invasive direct coronary artery bypass (MIDCAB) and simultaneous orthotopic liver transplant. The patient tolerated the procedure without complications, was extubated on postoperative day 1, and discharged home on day 9. At 15 months postprocedure he had preserved graft function, stable liver tests, and no major adverse cardiac events. This novel procedure of combined robotic minimally invasive direct coronary artery bypass and orthotopic liver transplant may offer a promising alternative for high-risk patients with end-stage liver disease and coronary artery disease.
{"title":"Simultaneous Robotic Off-Pump Coronary Artery Bypass and Orthotopic Liver Transplantation in a Child-Pugh C Patient: An Operative Playbook","authors":"Leonardo Paim N da Costa MD, PhD, Nicholas Prinz BA, Diego Reino MD, Vijay Subramanian MD, Kiran Dhanireddy MD, Lucian Lozonschi MD","doi":"10.1016/j.atssr.2026.02.017","DOIUrl":"10.1016/j.atssr.2026.02.017","url":null,"abstract":"<div><div>A 69-year-old male individual with Child-Pugh class C alcoholic cirrhosis and 2-vessel coronary artery disease underwent combined robotic off-pump minimally invasive direct coronary artery bypass (MIDCAB) and simultaneous orthotopic liver transplant. The patient tolerated the procedure without complications, was extubated on postoperative day 1, and discharged home on day 9. At 15 months postprocedure he had preserved graft function, stable liver tests, and no major adverse cardiac events. This novel procedure of combined robotic minimally invasive direct coronary artery bypass and orthotopic liver transplant may offer a promising alternative for high-risk patients with end-stage liver disease and coronary artery disease.</div></div><div>A 69-year-old male individual with Child-Pugh class C alcoholic cirrhosis and 2-vessel coronary artery disease underwent combined robotic off-pump minimally invasive direct coronary artery bypass (MIDCAB) and simultaneous orthotopic liver transplant. The patient tolerated the procedure without complications, was extubated on postoperative day 1, and discharged home on day 9. At 15 months postprocedure he had preserved graft function, stable liver tests, and no major adverse cardiac events. This novel procedure of combined robotic minimally invasive direct coronary artery bypass and orthotopic liver transplant may offer a promising alternative for high-risk patients with end-stage liver disease and coronary artery disease.</div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 802-804"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148870874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-02-20DOI: 10.1016/j.atssr.2026.02.005
Marilina La Porta MD, Mathieu Echivard MD, Stéphane Renaud MD, PhD, Joseph Seitlinger MD, PhD
This case report describes a medically fragile patient with sustained ventricular arrhythmia who was anticoagulated and thus underwent bilateral video-assisted thoracoscopic sympathetic cryoablation as the least-invasive option. This technique provides a temporary, reversible sympathetic block, reducing procedural risks compared with conventional denervation. The gradual inverse nerve remodeling after cryoablation may account for early arrhythmic recurrences. Overall, this approach shows promise for rhythm control and safety in high-risk patients, but further evaluation is required.
This case report describes a medically fragile patient with sustained ventricular arrhythmia who was anticoagulated and thus underwent bilateral video-assisted thoracoscopic sympathetic cryoablation as the least-invasive option. This technique provides a temporary, reversible sympathetic block, reducing procedural risks compared with conventional denervation. The gradual inverse nerve remodeling after cryoablation may account for early arrhythmic recurrences. Overall, this approach shows promise for rhythm control and safety in high-risk patients, but further evaluation is required.
{"title":"Application of Bilateral Sympathetic Nerve Cryoablation as a Bridge to Transplant for Refractory Ventricular Tachycardia","authors":"Marilina La Porta MD, Mathieu Echivard MD, Stéphane Renaud MD, PhD, Joseph Seitlinger MD, PhD","doi":"10.1016/j.atssr.2026.02.005","DOIUrl":"10.1016/j.atssr.2026.02.005","url":null,"abstract":"<div><div>This case report describes a medically fragile patient with sustained ventricular arrhythmia who was anticoagulated and thus underwent bilateral video-assisted thoracoscopic sympathetic cryoablation as the least-invasive option. This technique provides a temporary, reversible sympathetic block, reducing procedural risks compared with conventional denervation. The gradual inverse nerve remodeling after cryoablation may account for early arrhythmic recurrences. Overall, this approach shows promise for rhythm control and safety in high-risk patients, but further evaluation is required.</div></div><div>This case report describes a medically fragile patient with sustained ventricular arrhythmia who was anticoagulated and thus underwent bilateral video-assisted thoracoscopic sympathetic cryoablation as the least-invasive option. This technique provides a temporary, reversible sympathetic block, reducing procedural risks compared with conventional denervation. The gradual inverse nerve remodeling after cryoablation may account for early arrhythmic recurrences. Overall, this approach shows promise for rhythm control and safety in high-risk patients, but further evaluation is required.</div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 989-992"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148871032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-09-01Epub Date: 2026-03-11DOI: 10.1016/j.atssr.2026.02.029
Ye In Christopher Kwon BA, Michael Keller BS, Holly Caboti-Jones BS, Matthew Ambrosio MS, Barry C. Gibney DO, Luca Paoletti MD, Rachit D. Shah MD, Vipul Patel MD, Vigneshwar Kasirajan MD, Zubair A. Hashmi MD
Background
Chronic lung allograft dysfunction (CLAD) remains a major cause of mortality after lung transplantation. Diabetes mellitus (DM) may contribute to CLAD through metabolic dysregulation. We evaluated post–lung transplant outcomes in recipients with DM.
Methods
Adults undergoing first-time, isolated lung transplant (November 2017 to December 2024) with at least 6 months of follow-up were identified in the United Network for Organ Sharing registry and stratified by DM diagnosis at waitlist registration. CLAD was defined as ≥20% forced expiratory volume in 1 second and/or forced vital capacity decline after >3 months follow-up. Kaplan-Meier and multivariable Cox models assessed survival and CLAD risk, with subgroup analysis by race and ethnicity.
Results
Among 18,199 analyzed patients, 3479 (18.3%) had DM. CLAD rates were higher among recipients with DM (21.3% vs 17.4%, P = .003). Grade 3 primary graft dysfunction at 72 hours was more frequent among recipients with DM (20.3% vs 17.1%, P = .03). Additionally, 5-year overall survival was lower in DM patients (55.2% vs 58.7%, P = .003). On multivariate analysis, DM was associated with increased risk of 5-year mortality (hazard ratio, 2.58, P = .004) and CLAD (odds ratio, 1.46, P = .03). Notably, in patients with DM, 5-year survival was significantly decreased among Asian patients (P = .024) compared with other races. Among patients with DM, Asian status was independently associated with increased risk of mortality (hazard ratio, 1.72, P = .002).
Conclusions
Recipient DM is associated with reduced long-term survival and CLAD risk after lung transplant. Asian American recipients with DM appear to face disproportionately worse survival, suggesting a potential interaction between race, ethnicity, and metabolic status.
慢性同种异体肺移植功能障碍（chronic lung allograft dysfunction， CLAD）仍然是肺移植术后死亡的主要原因。糖尿病（DM）可能通过代谢失调导致CLAD。我们评估了DM受体肺移植后的结果。方法：在联合器官共享注册网络中确定首次进行分离肺移植的成人（2017年11月至2024年12月），随访至少6个月，并在等待名单注册时根据DM诊断进行分层。CLAD定义为1秒用力呼气量≥20%和/或随访3个月后用力肺活量下降。Kaplan-Meier和多变量Cox模型评估了生存率和覆层风险，并按种族和民族进行了亚组分析。结果在分析的18199例患者中，3479例（18.3%）患有糖尿病。糖尿病患者的覆层率较高（21.3% vs 17.4%, P = 0.003）。DM患者在72小时内3级原发性移植物功能障碍更为常见（20.3% vs 17.1%, P = 0.03）。此外，糖尿病患者的5年总生存率较低（55.2% vs 58.7%, P = 0.003）。在多因素分析中，DM与5年死亡风险增加（风险比2.58,P = 0.004）和CLAD（优势比1.46,P = 0.03）相关。值得注意的是，在糖尿病患者中，与其他种族相比，亚洲患者的5年生存率显著降低（P = 0.024）。在糖尿病患者中，亚洲人身份与死亡风险增加独立相关（风险比1.72,P = 0.002）。结论：受体DM与肺移植术后长期生存和慢性肺衰竭风险降低有关。美籍亚裔糖尿病患者的生存率明显较低，提示种族、民族和代谢状态之间存在潜在的相互作用。
{"title":"The Impact of Preexisting Diabetes Mellitus on Chronic Lung Allograft Dysfunction After Lung Transplantation","authors":"Ye In Christopher Kwon BA, Michael Keller BS, Holly Caboti-Jones BS, Matthew Ambrosio MS, Barry C. Gibney DO, Luca Paoletti MD, Rachit D. Shah MD, Vipul Patel MD, Vigneshwar Kasirajan MD, Zubair A. Hashmi MD","doi":"10.1016/j.atssr.2026.02.029","DOIUrl":"10.1016/j.atssr.2026.02.029","url":null,"abstract":"<div><h3>Background</h3><div>Chronic lung allograft dysfunction (CLAD) remains a major cause of mortality after lung transplantation. Diabetes mellitus (DM) may contribute to CLAD through metabolic dysregulation. We evaluated post–lung transplant outcomes in recipients with DM.</div></div><div><h3>Methods</h3><div>Adults undergoing first-time, isolated lung transplant (November 2017 to December 2024) with at least 6 months of follow-up were identified in the United Network for Organ Sharing registry and stratified by DM diagnosis at waitlist registration. CLAD was defined as ≥20% forced expiratory volume in 1 second and/or forced vital capacity decline after >3 months follow-up. Kaplan-Meier and multivariable Cox models assessed survival and CLAD risk, with subgroup analysis by race and ethnicity.</div></div><div><h3>Results</h3><div>Among 18,199 analyzed patients, 3479 (18.3%) had DM. CLAD rates were higher among recipients with DM (21.3% vs 17.4%, <em>P</em> = .003). Grade 3 primary graft dysfunction at 72 hours was more frequent among recipients with DM (20.3% vs 17.1%, <em>P</em> = .03). Additionally, 5-year overall survival was lower in DM patients (55.2% vs 58.7%, <em>P</em> = .003). On multivariate analysis, DM was associated with increased risk of 5-year mortality (hazard ratio, 2.58, <em>P</em> = .004) and CLAD (odds ratio, 1.46, <em>P</em> = .03). Notably, in patients with DM, 5-year survival was significantly decreased among Asian patients (<em>P</em> = .024) compared with other races. Among patients with DM, Asian status was independently associated with increased risk of mortality (hazard ratio, 1.72, <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>Recipient DM is associated with reduced long-term survival and CLAD risk after lung transplant. Asian American recipients with DM appear to face disproportionately worse survival, suggesting a potential interaction between race, ethnicity, and metabolic status.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"4 3","pages":"Pages 1027-1032"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148871005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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