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        <title>Frontiers in Surgery | Cardiovascular Surgery section | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/surgery/sections/cardiovascular-surgery</link>
        <description>RSS Feed for Cardiovascular Surgery section in the Frontiers in Surgery journal | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-13T13:23:11.697+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1765767</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1765767</link>
        <title><![CDATA[Case Report: Giant myxosarcoma involving both atria]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jianbo Xue</author><author>Yiming Ni</author><author>Jinyu Zheng</author><author>Xianshuai Li</author>
        <description><![CDATA[Background Primary cardiac tumors are uncommon, with an incidence rate ranging from 0.001‰ to 0.3‰. Among cardiac tumors, 75% are benign and 25% are malignant. Approximately 50% of benign cardiac tumors are myxomas, while 75% of malignant cardiac tumors are sarcomas. Compared with myxomas, malignant cardiac tumors have a poorer prognosis. Cardiac myxosarcomas often have an insidious onset in young and middle-aged patients, with an overall survival period of 6 to 12 months. Similar to soft tissue tumors, cardiac sarcomas also consist of a range of histological subtypes. Among these, cardiac myxosarcomas are extremely rare, with only a few case reports documented in domestic and international literature to date. Due to similarities in imaging findings, they are often diagnosed as myxomas preoperatively, which may lead to insufficient resection during surgery. Owing to similarities in gross and histological features, coupled with the rarity of such cases, a small number of cases are misdiagnosed as myxomas in postoperative pathological examinations, and a definitive diagnosis is only made upon recurrence. This paper reports a case of a 23-year-old male patient with congenital heart disease and atrial septal defect, who had a history of interventional occlusion for atrial septal defect 12 years ago. The patient was admitted to the hospital for a rare giant myxosarcoma involving both atria, manifesting as rapidly progressive hemodynamic compromise. He underwent surgical resection of the cardiac tumor, and the pathological diagnosis was cardiac myxosarcoma. The tumor demonstrated highly malignant biological behavior. Rapid postoperative recurrence occurred, resulting in a short survival period. The patient eventually died of vena cava obstruction, heart failure and multiple organ failure secondary to tumor recurrence.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1759439</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1759439</link>
        <title><![CDATA[Bibliometric mapping of artificial intelligence research in surgical education (1997–2025)]]></title>
        <pubdate>2026-03-10T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jinlin Wu</author><author>Junfei Zhao</author>
        <description><![CDATA[BackgroundArtificial intelligence (AI) is rapidly transforming surgical education, yet comprehensive analysis of research trends in this field remains limited.MethodsWe analyzed publications from the Web of Science Core Collection using “surgery” AND “education” AND “artificial intelligence” as search terms (1997–2025). Bibliometric indicators were analyzed using the bibliometrix package in R.ResultsWe identified 572 publications by 3,228 authors across 332 journals, with an 18.39% annual growth rate. The United States and United Kingdom led research output, with Harvard University as the top contributing institution. “Augmented reality”, “video”, and “performance” emerged as mature research themes (motor themes), while large language models represent recent emerging topics. International collaboration accounted for 25.17% of publications, predominantly among developed nations. Citation analysis revealed human-robot interaction and AI-based simulation training as the most influential research topics.ConclusionsAI research in surgical education shows rapid growth but significant geographic disparities exist. Future efforts should focus on developing personalized learning systems and addressing the global digital divide in AI-enhanced surgical education.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1794723</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1794723</link>
        <title><![CDATA[Editorial: Advances in spinal cord injury prevention during endovascular and open aortic repairs]]></title>
        <pubdate>2026-02-16T00:00:00Z</pubdate>
        <category>Editorial</category>
        <author>Mohamed Rahouma</author><author>Massimo Baudo</author><author>Magdy El-Sayed Ahmed</author>
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1677867</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1677867</link>
        <title><![CDATA[Risk factors for perioperative stroke, myocardial infarction, and death in patients undergoing carotid endarterectomy under local anesthesia: a systematic review and meta-analysis]]></title>
        <pubdate>2026-01-22T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Alessandra Ciccozzi</author><author>Diletta Riccio</author><author>Alba Piroli</author><author>Ida Marsili</author><author>Roberta Mariani</author><author>Federico Murgia</author><author>Chiara Angeletti</author><author>Paolo Matteo Angeletti</author><author>Daniele Tienforti</author><author>Franco Marinangeli</author><author>Arcangelo Barbonetti</author>
        <description><![CDATA[BackgroundPatients with vascular disease undergoing surgery face increased perioperative risks, and those scheduled for carotid endarterectomy (CEA) represent a particularly vulnerable subgroup. This study aimed to (1) estimate the prevalence and identify predictors of adverse postoperative outcomes in patients undergoing carotid endarterectomy (CEA) under local/regional anesthesia (LA), and (2) compare these outcomes with those of general anesthesia (GA) where comparative data were available.MethodsFollowing PRISMA and MOOSE guidelines, PubMed, Scopus, and Web of Science were systematically searched for English-language studies published up to January 2025. Pooled prevalence estimates were obtained using random-effects models. Meta-regression explored associations of demographic and clinical variables with postoperative outcomes. In addition, pairwise random-effects meta-analyses were performed for studies reporting separate outcomes for LA and GA. Effect sizes were expressed as odds ratios (OR) with 95% confidence intervals (CIs), and heterogeneity was quantified using the I2 statistic.ResultsOf 267 records identified, 14 studies met eligibility criteria, including 22,302 patients undergoing CEA under LA. The pooled prevalence was 1% for stroke (95% CI: 0.01–0.02) and 0.01% for both myocardial infarction and death (95% CI: 0.00–0.01). Meta-regressions showed that male sex was significantly associated with postoperative stroke (β = 0.010, p = 0.0002), whereas older age predicted myocardial infarction (β = 0.006, p = 0.03). No significant predictors of mortality were identified. In the comparative analysis, LA was associated with a 52% lower risk of myocardial infarction and a 30% lower risk of death compared with GA, while no significant difference emerged for postoperative stroke.ConclusionCEA performed under regional anesthesia is associated with low rates of adverse postoperative events, with male sex and older age emerging as relevant predictors for stroke and myocardial infarction, respectively. Comparative evidence suggests potential advantages of LA over GA in reducing myocardial infarction and mortality, while stroke risk appears similar between anesthetic modalities.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD420251066377.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1728752</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1728752</link>
        <title><![CDATA[Analysis of risk factors and development of a predictive model for IABP application in post-cardiac valve replacement patients]]></title>
        <pubdate>2026-01-13T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Rukeya Hashan</author><author>Wang Zhengkai</author>
        <description><![CDATA[ObjectiveTo identify risk factors for intra-aortic balloon pump (IABP) requirement following heart valve replacement surgery (HVRS) and to develop a predictive model.MethodsThis retrospective cohort study analyzed 161 HVRS patients (October 2023 to January 2025) from the First Affiliated Hospital of Xinjiang Medical University. Patients were stratified into IABP (n = 58) and non-IABP (n = 103) groups. Independent risk factors were identified through univariate analysis, LASSO regression, and multivariate logistic regression. The cohort was randomly split into training and validation sets (7:3 ratio) for model development and internal validation. Model performance was assessed using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow calibration, and decision curve analysis (DCA).ResultsSignificant differences were observed between groups across multiple parameters (all P < 0.05), including demographics, inflammatory markers, cardiac biomarkers, and echocardiographic indices. Multivariate analysis identified five independent risk factors for postoperative IABP use: age (OR = 1.138, 95% CI: 1.067–1.226), stroke volume (SV) (OR = 1.155, 95% CI: 1.060–1.296), cardiac output (CO) (OR = 5.700, 95% CI: 2.700–12.040), cardiac index (CI) (OR = 4.982, 95% CI: 2.879–10.119), and left ventricular end-systolic diameter (LVESD) (OR = 1.463, 95% CI: 1.157–1.849). The prediction model showed excellent discrimination in both the training set (AUC = 0.946, 95% CI: 0.910–0.982) and the validation set (AUC = 0.933, 95% CI: 0.876–0.990). Good calibration was indicated by Hosmer-Lemeshow test (P > 0.05 for both sets), and decision curve analysis confirmed the model's clinical utility.ConclusionA model incorporating five routinely available preoperative variables effectively stratifies the risk of requiring IABP after HVRS, demonstrating strong discriminatory performance and potential clinical applicability for preoperative risk assessment.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1714007</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1714007</link>
        <title><![CDATA[Replacement of the ascending aorta and aortic valve for annuloaortic ectasia with Carbomedics Carbo-Seal valsalva™ graft: mid- to long-term results]]></title>
        <pubdate>2026-01-06T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Raif Cavolli</author><author>Dogan Kahraman</author>
        <description><![CDATA[PurposeThe modified Bentall procedure utilizing the Carbomedics Carbo-Seal Valsalva™ graft can be employed to address aortic root pathologies. In this study, we examined the performance of this conduit specifically for treating isolated annuloaortic ectasia. Our objective was to evaluate the long-term outcomes of these surgeries.MethodsA total of 48 consecutive patients with annuloaortic ectasia underwent aortic root replacement using the Carbomedics Carbo-seal Valsalva™ graft between 2012 and 2024. In 7 patients, additional cardiac procedures were performed: two underwent mitral valve annuloplasty, and five had coronary artery bypass grafting. The mean cardiopulmonary bypass time and aortic clamp time during the modified button-Bentall operations were 151 ± 37 min and 128 ± 14 min, respectively.ResultsThe operative mortality rate was 2.1% (n = 1). Late mortality was 6.3% (n = 3), with causes including chronic heart failure (2.1%; n = 1), cerebral hemorrhage (2.1%; n = 1), and pulmonary complications (2.1%; n = 1). Major late complications included cerebral hemorrhage (4.2%; n = 2), pulmonary bleeding (2.1%; n = 1), and gastrointestinal hemorrhage (2.1%; n = 1). The Kaplan–Meier estimated survival rates were 96.22% at 5 years and 95.20% at 10 years. Additionally, the Kaplan–Meier curves showed event-free survival rates of 98% at 5 years and 82% at 12 years (95% CI).ConclusionsModified button-Bentall operations for annuloaortic ectasia, with Carbomedics Carbo-Seal Valsalva™ graft, can be performed with a low mid- and long-term mortality and morbidity.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1712028</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1712028</link>
        <title><![CDATA[A narrative review of the role of renal artery intervention in renovascular hypertension]]></title>
        <pubdate>2025-12-15T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Li Che</author><author>Zilong Wang</author>
        <description><![CDATA[Renovascular hypertension is a form of secondary hypertension caused by renal artery stenosis and often shows a limited response to medical treatment. Over recent years, renal artery interventions, primarily angioplasty and stenting, have been increasingly used as treatment options in selected patients. This narrative review summarizes current techniques, clinical outcomes, and evidence related to renal artery interventions in the management of renovascular disease. It also highlights existing knowledge, challenges, emerging technologies, and future directions for improving patient selection, procedural safety, and long-term effectiveness of intervention strategies. By consolidating recent developments and identifying critical knowledge gaps, this review provides an updated and practical overview for clinicians and offers guidance for future research in the field of renal artery intervention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1702772</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1702772</link>
        <title><![CDATA[Congenital absence of the right carotid artery with a left carotid artery pseudoaneurysm: a case report]]></title>
        <pubdate>2025-11-27T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Miaomiao Chen</author><author>Junxiang Tang</author><author>Muhammad Asad Iqbal</author>
        <description><![CDATA[A unilateral carotid artery pseudoaneurysm combined with a congenital absence of the contralateral internal carotid artery is clinically rare, and the currently available literature is limited. This article reports a case of a 37-year-old male patient with a left carotid artery pseudoaneurysm and congenital absence of the right common and internal carotid arteries, initially presenting with a neck mass. The patient recovered well 2 years after surgery.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1697977</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1697977</link>
        <title><![CDATA[Analysis of risk factors and linear prediction model construction for prolonged mechanical ventilation after Stanford A-type aortic dissection]]></title>
        <pubdate>2025-11-06T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yu Jiajie</author><author>Lian Hongmei</author><author>Chen Ting</author><author>Wei Yanlin</author><author>Yali Wang</author>
        <description><![CDATA[ObjectiveTo explore the risk factors for prolonged acute ventilation time after Stanford type A aortic dissection and to construct a nomogram prediction model.MethodsA total of 178 patients with Stanford type A aortic dissection admitted to the Department of Cardiac and Vascular Surgery of the Affiliated Hospital of North Sichuan Medical College from 2020 to 2024 were retrospectively enrolled. The patients were randomly divided into a modeling group (124 cases) and a validation group (54 cases) at a 7:3 ratio. Risk factors for prolonged mechanical ventilation time after surgery were analyzed using univariate and multivariate logistic regression analysis, and a risk prediction model was constructed based on the results of multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis showed that age, body mass index, preoperative oxygenation index, cardiopulmonary bypass time, and postoperative serum creatinine were risk factors for prolonged mechanical ventilation time after Stanford type A aortic dissection (p < 0.05).A risk prediction model was constructed based on these findings. The area under the ROC curve was 0.91 (95% CI: 0.86–0.97), with an accuracy of 0.88 (95% CI: 0.81–0.93), sensitivity of 0.92 (95%CI: 0.86–0.98), specificity of 0.82 (95%CI: 0.71–0.92), and an optimal cut-off value of 0.527. The results of model validation showed that the area under the ROC curve was 0.79 (95% CI: 0.66–0.92), with an accuracy of 0.72 (95%CI: 0.58–0.84), sensitivity of 0.77 (95%CI: 0.64–0.90), specificity of 0.6 (95%CI: 0.35–0.85).ConclusionThe prediction model for prolonged mechanical ventilation time in patients with Stanford type A aortic dissection has a good prediction effect and is convenient for clinical use, providing a reference for medical workers to take preventive treatment.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1693409</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1693409</link>
        <title><![CDATA[Pericardio-diaphragmatic rupture after blunt trauma: a case report]]></title>
        <pubdate>2025-10-21T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Dayi Xing</author><author>Boyu Xia</author><author>Jiandong Yang</author><author>Yuansheng Zhao</author>
        <description><![CDATA[BackgroundPericardio-diaphragmatic rupture with intrapericardial herniation is a rare and potentially life-threatening complication of blunt thoracoabdominal trauma. Its diagnosis is challenging because pericardial involvement is often missed on imaging.Case presentationWe present the case of a 70-year-old man who sustained blunt chest trauma in a motor vehicle collision. On admission, he was hemodynamically stable, and echocardiography demonstrated preserved left ventricular function (ejection fraction 59%) without pericardial effusion. Initial CT demonstrated multiple right rib fractures and pulmonary contusion. Repeat CT at our center revealed bilateral lower lobe atelectasis, small pleural effusions, and a bowel gas shadow anterior to the heart, suggestive of diaphragmatic rupture with intrapericardial herniation. Thoracoscopic exploration excluded right-sided injury; however, laparoscopic inspection identified a large left diaphragmatic tear (10 cm) with bowel and omentum herniating into the pericardial sac in direct contact with the epicardial surface. Due to limited exposure and high tension, the procedure was converted to median sternotomy for safe repair. Postoperative CT confirmed resolution of the hernia. The patient recovered uneventfully and remained asymptomatic at 3-month follow-up.ConclusionsPericardio-diaphragmatic rupture with intrapericardial herniation is rare and often underdiagnosed because of nonspecific clinical features and subtle imaging findings. Median sternotomy should be considered when minimally invasive repair is not feasible, and combined thoracoabdominal evaluation is crucial for diagnosis and management.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1666236</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1666236</link>
        <title><![CDATA[Comparison of morrow procedure and transapical beating-heart septal myectomy in patients with hypertrophic obstructive cardiomyopathy: a systematic review and meta-analysis]]></title>
        <pubdate>2025-10-16T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Maxat Zhakayev</author><author>Rustem Tuleutayev</author><author>Zhanar Nurbay</author><author>Marina Izmailovich</author>
        <description><![CDATA[IntroductionTransaortic surgical myectomy is the established gold-standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). In contrast, the less invasive transapical beating-heart septal myectomy (TABSM) has recently gained attention as a potential alternative, although comparative evidence regarding their clinical outcomes remains limited.ObjectivesTo compare the efficacy and safety of surgical myectomy and TABSM in patients with HOCM.MethodsA systematic search of PubMed, Web of Science, Cochrane Library, and ScienceDirect (January 2014–May 2025) identified 24 observational studies including 3,732 patients (2,824 surgical myectomy; 908 TABSM). The primary outcome was the change in left ventricular outflow tract pressure gradient (LVOTPG). Secondary outcomes included improvement in NYHA class, prevalence of moderate-to-severe mitral regurgitation (MR ≥ 2), short-term (30-day) and long-term mortality, and the rate of postoperative permanent pacemaker implantation. Random-effects meta-analysis and meta-regression were performed.ResultsBoth procedures achieved substantial and comparable reductions in LVOTG, with no significant between-group difference (p = 0.75). Functional status improved in both cohorts; younger age and higher study quality were independently associated with greater improvement in NYHA class (p < 0.05). Residual MR ≥ grade 2 decreased in both groups. 30-day mortality was low and similar between surgical myectomy and TABSM. Long-term mortality appeared lower after TABSM (≈2%) compared with surgical myectomy (≈6%); however, this finding should be interpreted cautiously due to substantial heterogeneity and shorter follow-up in TABSM studies. Pacemaker implantation occurred less frequently after TABSM than after surgical myectomy (≈2% vs. ≈6%; p = 0.03).ConclusionBoth surgical myectomy and TABSM are effective and safe approaches for septal reduction in HOCM. While surgical myectomy remains the reference standard, TABSM represents a promising minimally invasive option, particularly in anatomically complex or reoperative cases. Prospective studies with standardized endpoints are required to guide individualized procedural selection and confirm long-term outcomes.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251075522, Identifier CRD420251075522.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1645272</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1645272</link>
        <title><![CDATA[Comparative analysis of postoperative outcomes following surgical and transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation: a meta-analysis & systematic review]]></title>
        <pubdate>2025-10-09T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Dudy A. Hanafy</author><author>Adrian R. Sudirman</author><author>Sari Rahmawati</author><author>Hendry R. Satria</author><author> Safitri</author><author>Stefanus Nursalim</author><author>Muhammad R. Bachmid</author><author>Dwi G. Fardhani</author><author>Tri W. Soetisna</author><author> Sugisman</author>
        <description><![CDATA[IntroductionMitral regurgitation (MR) affects approximately millions of people globally, predominantly older adults, leading to 0.88 million DALY and 34,000 deaths in 2019. Both ESC and ACC/AHA guidelines recommend intervention either surgery or transcatheter for secondary MR despite optimal medical therapy. The comparative effectiveness of SMVr vs. TEER for managing secondary MR remains uncertain, prompting a systematic review to assess outcomes, safety, and long-term implications.MethodThis systematic review and meta-analysis were carried out and documented according to the PRISMA 2020 guidelines. Searches were conducted in the Embase, EBSCOHost, Medline, Sage, Science Direct, and Scopus databases.ResultThis meta-analysis included eight studies and 6224 patients. Both SMVr and TEER showed similar rate of in-hospital mortality (3.85% vs. 2.83%, RR = 2.54; 95% CI = 0.59–10.95; p = 0.21; I2 = 57%), while SMVr was associated with a significantly lower incidence of post-discharge residual MR compared to TEER (RR = 0.27; 95% CI = 0.16–0.45; p < 0.01; I2 = 0%). However, SMVr showed a higher incidence of neurologic events, including stroke or TIA (1.89% vs. 0.94%, RR = 1.88; 95% CI = 1.16–3.05; p = 0.001; I2 = 0%). The rates of acute renal failure (5.26% vs. 5.29%, RR = 1.23; 95% CI = 0.84–1.80; p = 0.28; I2 = 9%) and postoperative myocardial infarction (1.91% vs. 1.81%, RR = 1.07; 95% CI = 0.71–1.62; p = 0.73; I2 = 0%) were higher in the SMVr group, but this was statistically insignificant. Mid-term mortality analysis favored SMVr over TEER, with lower mortality rates observed in SMVr patients (Rate Ratio 0.74; 95% CI, 0.63–0.88; p < 0.001; I²=27%), lower reintervention rates (RR = 0.29, p < 0.001), lower incidence rate ratio of recurrent MR (Rate Ratio = 0.56; 95% CI = 0.40–0.78; p = 0.0005; I2 = 0%) and heart failure rehospitalization (Rate Ratio = 0.81; 95% CI = 0.68–0.97; p = 0.02; I2 = 5%). SMVr patients were more likely to experience improvement in functional status (NYHA) compared to TEER patients (RR = 1.14, p < 0.006).ConclusionSMVr has demonstrated better mid-term outcomes than TEER, including lower mortality rates, fewer reinterventions and rehospitalization, and improved functional status in patients with mitral regurgitation.Systematic Review Registrationidentifier [CRD42024538771].]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1665139</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1665139</link>
        <title><![CDATA[Study on the application of prone and supine lung recruitment maneuvers in the treatment of atelectasis after minimally invasive direct coronary artery bypass surgery]]></title>
        <pubdate>2025-10-02T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yue Xin</author><author>Zelin Meng</author><author>Zhou Fu</author><author>Pixiong Su</author>
        <description><![CDATA[BackgroundAtelectasis is a common complication after minimally invasive direct coronary artery bypass grafting (MIDCABG), which can lead to hypoxemia and even life-threatening conditions. This study aimed to compare the efficacy of prone vs. supine lung recruitment maneuvers in patients undergoing MIDCABG.MethodsThis retrospective study included 170 patients who underwent MIDCABG and developed hypoxemia due to atelectasis during postoperative invasive mechanical ventilation in the cardiac surgical intensive care unit (CSICU). Patients were randomized into prone and supine groups. Clinical recovery indicators and physiological and laboratory parameters at different time points were compared between the two groups. Multiple linear regression was used to analyze the effect of different lung recruitment strategies on the improvement of the oxygenation index. Subgroup analyses were conducted to assess whether the effect of prone vs. supine lung recruitment on oxygenation improvement varied across different patient populations.ResultsProne-position lung recruitment significantly reduced hospital stay, extubation time, time to first ambulation, time to first flatus, duration of mechanical ventilation, and duration of non-invasive oxygen therapy. Lung recruitment strategies significantly improved oxygenation index, carbon dioxide elimination, heart rate control, and inflammatory markers, with the prone group showing superiority at multiple key time points. Multiple linear regression indicated that the prone lung recruitment strategy significantly enhanced the improvement of the oxygenation index, and this effect remained robust after adjusting for age, sex, BMI, and baseline comorbidities. Subgroup analyses revealed that the beneficial effect of prone lung recruitment was more pronounced in patients without diabetes and those with a history of PCI.ConclusionLung recruitment significantly improves oxygenation, carbon dioxide clearance, heart rate control, and inflammatory markers in MIDCABG patients with postoperative atelectasis, with the prone strategy being more effective than the supine. Multivariable and subgroup analyses confirmed the robustness of this effect, particularly in non-diabetic patients and those with a history of PCI.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1618755</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1618755</link>
        <title><![CDATA[Emergency central aortic repair in acute type A aortic dissection complicated by malperfusion]]></title>
        <pubdate>2025-09-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kan-paatib Barnabo Nampoukime</author><author>Adeoumi Esperance Monteiro Igwenandji</author><author>Youmin Pan</author><author>Haihao Wang</author>
        <description><![CDATA[ObjectiveTo assess outcomes of emergency central aortic repair (ECAR) in patients with acute type A aortic dissection (ATAAD) complicated by malperfusion, focusing on in-hospital mortality and long-term survival.MethodsThis retrospective cohort study included 545 ATAAD patients treated surgically at a single center. Patients were stratified into malperfusion (n = 149) and non-malperfusion (n = 396) groups. Preoperative laboratory parameters, intraoperative strategies, and postoperative outcomes were compared. Kaplan–Meier analysis evaluated long-term survival.ResultsPatients with malperfusion presented with significantly higher D-dimer and creatinine levels and more frequent emergency surgery (73.8% vs. 63.9%, P = 0.028). In-hospital mortality was similar between malperfusion and non-malperfusion groups (16.1% vs. 14.1%, P = 0.60), but increased with the number of affected organs: 13.3% (single), 18.4% (double), and 30.8% (triple or more). Cardiac and cerebral malperfusion had the highest mortality (40.0%). At 60 months, survival was significantly lower in malperfusion patients (60% vs. 70%, log-rank P = 0.00035).ConclusionECAR provides acceptable early survival in ATAAD patients with malperfusion. However, multi-organ involvement significantly worsens both in-hospital and long-term outcomes.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1653123</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1653123</link>
        <title><![CDATA[Prediction of the impact of anxiety on atrial fibrillation recurrence after radiofrequency catheter ablation based on heart rate variability]]></title>
        <pubdate>2025-09-23T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yufei Ren</author><author>Hua Zhang</author><author>Yingji Tian</author>
        <description><![CDATA[BackgroundRadiofrequency catheter ablation (RFCA) can significantly improve the prognosis of patients with atrial fibrillation (AF); however, the postoperative recurrence rate remains high. Therefore, identifying accurate predictors of recurrence after RFCA holds important clinical value.MethodsThis retrospective study included 180 patients with AF who underwent RFCA. Patients were grouped by one-year recurrence status. Univariate analysis was conducted to compare demographic and clinical characteristics between the two groups. Cox proportional hazards models and Kaplan–Meier survival curves were used to assess the impact of heart rate variability (HRV), anxiety, and their interaction on recurrence. Predictive performance was evaluated with receiver operating characteristic (ROC) curves. Stratified analyses were performed to explore whether the effect of anxiety on recurrence varied by HRV levels.ResultsCompared with the non-recurrence group, the recurrence group had higher prevalence of persistent AF and heart failure, longer AF duration, and more severe left atrial structural burden (i.e., higher EFT, LAD, and LAVI values). Multivariate Cox analysis identified that both HRV and anxiety were independent risk factors for recurrence, and their interaction term also had significant predictive value (HR > 1, P < 0.05). Kaplan–Meier analysis indicated that patients with low HRV and high anxiety had the lowest recurrence-free survival rate. ROC curve analysis revealed that the combined HRV-anxiety interaction model yielded an AUC of 0.745, indicating a certain predictive advantage over individual indicators. Stratified analysis further confirmed that the recurrence risk associated with high anxiety was more pronounced in the low HRV group.ConclusionHRV and anxiety were identified as independent predictors of AF recurrence following RFCA, with a significant synergistic interaction observed between the two. Their combined assessment may enhance the accuracy of recurrence risk prediction and provide a foundation for the development of individualized intervention strategies.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1612421</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1612421</link>
        <title><![CDATA[Case Report: Renal embolism and acute lower extremity arterial embolism complicated by acute compartment syndrome caused by the detachment of the main body of cardiac myxoma in a child]]></title>
        <pubdate>2025-08-06T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jianbo Xue</author><author>Yi Hong</author><author>Xiaoyi Xu</author><author>Yiming Ni</author>
        <description><![CDATA[BackgroundPrimary cardiac myxoma in pediatric patients is a rare disease, with an annual incidence of approximately 0.1–0.2 cases per million children. This report presents the case of an 11-year-old male who developed multiple peripheral emboli following the detachment of a left atrial myxoma. The patient presented to the emergency department with acute abdominal pain and sudden-onset pain and sensory loss in both legs. Physical examination indicated bilateral lower limb ischemia, which was corroborated by Doppler arterial ultrasound, revealing emboli in the abdominal aorta and bilateral common iliac arteries. Abdominal CT demonstrated patchy non-enhancing low-density areas in both kidneys and the spleen, while echocardiography identified a left atrial mass. A diagnosis of acute lower limb arterial embolism, renal embolism, and splenic embolism secondary to left atrial myxoma was established. Additionally, lower limb ischemia resulted in acute compartment syndrome. The multidisciplinary team initiated systemic anticoagulation, followed by abdominal aortic embolectomy, fasciotomy decompression, and left atrial myxoma resection. Postoperative outcomes were favorable, with no residual tumor in the left atrium and complete restoration of arterial perfusion in both lower limbs. Histopathological analysis confirmed the diagnosis of myxoma.ConclusionAlthough pediatric cardiac myxoma is exceedingly rare, the clinical presentation of peripheral embolism in this case raised a strong suspicion of an embolic etiology, facilitating rapid assessment and timely intervention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1603896</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1603896</link>
        <title><![CDATA[Conventional aortic valve replacement can be safely done by very early stage trainee]]></title>
        <pubdate>2025-07-10T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Kentaro Shirakura</author><author>Nobuhiro Mochizuki</author><author>Ryohei Ushioda</author><author>Shingo Kunioka</author><author>Masahiro Tsutsui</author><author>Hiroyuki Kamiya</author>
        <description><![CDATA[ObjectivesWe have continuously performed conventional aortic valve replacement (AVR) with median sternotomy as the primary approach because we believe that it is the safest approach, and even very young trainees have performed surgical AVR (SAVR) under proper supervision. Here we reviewed our results of AVR to clarify whether our aggressive training program would be justified.MethodsThis retrospective study evaluates the outcomes of trainee surgeons performing SAVR under supervision at a single institution. We analyzed 145 patients who underwent isolated SAVR between January 2015 and April 2024. Patients were divided into two groups: those operated on by staff surgeons with more than 7 years of postgraduate experience in the Japanese residency program (n = 91), and those operated on by resident surgeons with 2–6 years of postgraduate experience in the Japanese residency program (n = 54). Outcomes compared preoperative characteristics, intraoperative metrics, postoperative complications, and survival rates.ResultsResults showed no significant difference in operative time, and aortic cross-clamp time between the groups. Furthermore, early postoperative mortality and mid-term survival rates were comparable. Although staff surgeons had higher Japan SCORE, residents demonstrated similar clinical outcomes.ConclusionsSAVR can be safely performed by very early-stage trainees under proper case selection and supervision.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1515732</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1515732</link>
        <title><![CDATA[Identification of mitochondria-related genes associated with anesthetics in patients undergoing off-pump coronary artery bypass grafting surgery]]></title>
        <pubdate>2025-07-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yuhu Zhang</author><author>Xinjian Li</author><author>Tingru Sun</author>
        <description><![CDATA[BackgroundAnesthetics have been reported to play a protective role in the heart during surgery. This study aimed to identify mitochondrial-related genes (Mito-RGs) involved in sevoflurane- and propofol-induced anesthesia in patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery.MethodsThe GSE4386 dataset, which contains atrial samples obtained from patients receiving sevoflurane or propofol during OPCABG, was downloaded from GEO database for differential expression analysis and immune cell infiltration analysis between the pre-operative and post-surgery groups. Furthermore, to model the ischemia-reperfusion injury encountered during cardiac surgery, we established an in vitro hypoxia/reoxygenation (H/R) model and investigated the effects of sevoflurane and propofol on the expression of hub genes in cardiomyocytes subjected to H/R injury.ResultsIn this study, we identified a total of 11 common Mito-RGs that were influenced by sevoflurane and propofol during OPCABG. Furthermore, a PPI network of these genes was constructed using STRING, followed by the application of the MCODE and cytoHubba plug-ins to further identify hub genes within the network. Our analysis revealed that MCL1, RGS2, PPP1R15A, and MAFF may be the hub Mito-RGs associated with anesthetics. In the post-surgery group, the levels of these genes were negatively correlated with pro-inflammatory M1 macrophages. Notably, compared to pre-OPCABG levels, both sevoflurane and propofol significantly upregulated the expressions of these four hub genes in atrial samples following OPCABG. Furthermore, RT-qPCR and western blot analyses validated that both sevoflurane and propofol can upregulate the expression of Maff, Ppp1r15a, Rgs2, and Mcl1 in H9C2 cardiomyocytes following H/R injury.ConclusionCollectively, these four genes may be linked to the potential cardioprotective effects of anesthetics during OPCABG, which could facilitate further research into the underlying mechanisms and contribute to the development of a more comprehensive and effective anesthesia protocol.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1587370</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1587370</link>
        <title><![CDATA[Success: the synergy of off-pump coronary artery bypass and living donor liver transplantation—a two-case report]]></title>
        <pubdate>2025-06-19T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Sinan Efe Yazici</author><author>Ahmet Atasever</author><author>Ozge Cetinarslan</author><author>Ebru Turan</author><author>Ertan Sagbas</author><author>Yıldıray Yuzer</author>
        <description><![CDATA[BackgroundEnd-stage liver disease (ESLD) patients frequently exhibit comorbid coronary artery disease (CAD), complicating liver transplantation (LT) due to increased perioperative cardiovascular risk. In patients for whom percutaneous coronary intervention (PCI) is not feasible, coronary artery bypass grafting (CABG) may be required prior to or during LT. Off-pump CABG (OPCAB) presents a promising strategy to minimize the hemodynamic and inflammatory burdens associated with cardiopulmonary bypass, especially in ESLD patients undergoing major surgery.Case presentationsWe present two male patients (aged 60 and 61) with ESLD and significant LAD stenosis who underwent simultaneous OPCAB and living donor liver transplantation (LDLT). The first case involved cryptogenic cirrhosis and recurrent variceal bleeding; the second had HBV/HDV-related cirrhosis and hepatocellular carcinoma. In both cases, OPCAB was performed using the left internal mammary artery (LIMA) graft on a beating heart. Subsequently, LDLT was carried out using standard piggy-back techniques. Portal pressure modulation via splenic artery ligation was performed in the first case due to elevated post-reperfusion portal flow. Anesthetic management emphasized hemodynamic monitoring and stability. Both patients were extubated on postoperative day one, discharged with triple immunosuppression, and followed for 6–12 months with preserved cardiac and graft function. A bile leak from the cystic duct anastomosis was encountered in one case.ConclusionSimultaneous OPCAB and LDLT is a feasible and safe approach in carefully selected ESLD patients with CAD when performed by experienced multidisciplinary teams. Avoiding PCI mitigates bleeding risks associated with dual antiplatelet therapy, while OPCAB circumvents the deleterious effects of cardiopulmonary bypass. This strategy may shorten transplant wait times and optimize both cardiac and hepatic outcomes in high-risk populations.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2025.1561690</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2025.1561690</link>
        <title><![CDATA[Evaluation of the SAMe-TT2R2 score to predict the quality of anticoagulation control in patients after mitral valve replacement]]></title>
        <pubdate>2025-06-09T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yilin Li</author><author>Yang Gao</author><author>Qiuming Hu</author><author>Xu Meng</author><author>Shubin Li</author>
        <description><![CDATA[BackgroundThis study aimed to evaluate the role of the SAMe-TT2R2 score in the prediction of anticoagulation control after mechanical mitral valve replacement.Methods and resultsWe retrospectively reviewed clinical data of 160 patients who received mechanical mitral valve replacement at Beijing Anzhen Hospital from January to December 2013. Collected data included the patient's general information and any history of medication, smoking, post-operative embolism due to anticoagulant, bleeding complications, and death information. In the SAMe-TT2R2 score results, the lowest score was 2 points (5.6%), and the highest score was 7 points (0.6%). The number of people with 4 points was the largest (69 people, 43.1%). When the cut-off value of the SAMe-TT2R2 score was set to ≥4, the sensitivity and specificity of predicting Time in Therapeutic Range (TTR) ≥65% were 69.8% and 93.1%, respectively. The Youden index was 0.629. If the cut-off value of the SAMe-TT2R2 score was set to ≤4, the sensitivity and specificity of predicting TTR ≥65% were 93.0% and 44.1%, respectively, and the Youden index was 0.371. The Receiver Operator Characteristic (ROC) curve evaluates the predictive power of the SAMe-TT2R2 score for TTR ≥65%. The figure showed that when the cut-off point was ≥4, the best combination of sensitivity and specificity was shown (69.8% and 93.1%, respectively). The Area Under the Curve (AUC) was 0.854.ConclusionsAfter mechanical mitral valve replacement, the SAMe-TT2R2 model can effectively predict the TTR level during the course of oral warfarin anticoagulation therapy. The SAMe-TT2R2 score ≥4 can predict TTR <65%.]]></description>
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