As minimally invasive and alternative approaches for aortic valve repair gain increased popularity, this trial reports on outcomes of an established program using the underreported novel right transaxillary (rTX) access for aortic valve surgery.
Between June 2023 and May 2025, a total of 22 patients underwent aortic valve surgery using the rTx approach (female: n = 14 (63.6%); age: 64.5 (60.0–70.0) years; EuroSCORE II: 0.9 (0.6–1.1)), mainly for aortic valve stenosis (n = 17 (77.3%)) and primarily with cannulation of the right groin (n = 21 (95.5%)) for cardiopulmonary bypass (CPB).
The median aortic clamp time was 78.5 (74.8–90.3) minutes, and the median extracorporeal circulation time was 143.0 (134.8–178.3) minutes. One (4.5%) patient underwent acute surgical revision via sternotomy due to bleeding from the aortotomy, while aortic root replacement was successfully performed. One (4.5%) patient experienced a stroke, and one (4.5%) received a pacemaker for high-grade atrioventricular block. Regarding CPB and surgical access site complications, one (4.5%) patient had a postoperative hematoma at the right groin, and one (4.5%) had a surgically revised thoracic hematoma. The median intensive care unit stay was 1.0 (1.0–2.3) days. No patient died during the median follow-up period of 6.0 (3.0–16.5) months.
Minimally invasive aortic valve surgery by rTX is feasible for a variety of valve pathologies, revealing good clinical outcomes even at the start of such a program. The low learning curve at experienced centers for minimally invasive cardiac surgery encourages other centers to adopt this approach as the potential future standard for aortic valve surgery.
Congenital anomalies in the thoracic aorta, although rare, can present challenging clinical scenarios. Current literature suggests that an aberrant aortic anatomy may be associated with higher rates of aneurysm formation; however, specific screening and management guidelines have yet to be established.
This report presents a case of a 61-year-old male who experienced progressive dysphagia and was diagnosed with an aberrant right-sided aortic arch accompanied by a 5.8 cm descending thoracic aortic aneurysm. Successful endovascular repair was performed with no postoperative complications.
Endovascular repair may be a successful treatment option for these patients, although further studies with long-term follow-up are needed.
Percutaneous intervention for calcified saphenous vein graft (SVG) stenosis poses significant challenges. Intravascular lithotripsy (IVL) addresses these limitations through low-pressure acoustic energy that selectively fractures calcium while preserving vessel integrity, enabling safer stent delivery and expansion in fragile vein grafts. Current evidence suggests IVL achieves effective calcification modification with reduced risks of embolization and perforation compared to conventional atherectomy techniques. This review summarizes contemporary experience with IVL for calcified SVG lesions, evaluates its technical advantages over alternative approaches, and identifies future research priorities to advance clinical adoption.
This study aimed to evaluate the safety and efficacy of total endoscopic removal of patent foramen ovale (PFO) or atrial septal defect (ASD) occluder devices in managing nickel hypersensitivity complications.
A retrospective analysis of 95 patients (2020–2025) undergoing total endoscopic occluder device removal via femoral cardiopulmonary bypass was performed using preoperative nickel allergy screening via patch testing. Outcomes included procedural success, symptom resolution, quality-of-life (QoL) trends, and complications.
All devices were removed successfully without thoracotomy. The median bypass time was 71.2 min; 96.8% of residual defects were directly sutured. Nickel hypersensitivity was confirmed in 89.5% of cases. QoL “good” ratings increased from 7.4% preoperatively to 95.8% at 6 months (p < 0.001). No major complications were observed; however, there were two cases of transient atrial fibrillation (2.1%). The median blood loss was 36.8 mL; no reoperations/mortality were noted.
Total endoscopic removal is safe and effective for nickel allergy-related complications, with high symptom resolution and improvement in QoL. Preoperative nickel screening optimizes outcomes, while this minimally invasive approach reduces morbidity, thereby supporting the adoption of this approach for device explantation.
Rheumatic heart disease (RHD) remains highly prevalent in Yemen, often presenting with advanced mitral valve lesions and pulmonary hypertension (PH). However, prospective data on early postoperative outcomes, including 3-month mortality, are limited. Therefore, this study aimed to evaluate the association between preoperative PH severity and 3-month outcomes following mitral valve surgery for RHD in Yemen.
A prospective observational study was performed on 134 adult patients with RHD who were undergoing mitral valve surgery at the Cardiovascular and Kidney Transplantation Center, Taiz, Yemen (January 2022–August 2024). Patients were stratified according to preoperative systolic pulmonary artery pressure (sPAP) into Group I (<60 mmHg) and Group II (≥60 mmHg). All-cause 3-month mortality, readmissions, and major postoperative complications were recorded.
The 30-day mortality was low and did not differ significantly between groups (3.9% vs. 3.5%; p = 0.907). The overall 3-month all-cause mortality rate was 10.4%, with no significant difference in mortality within the two groups (12.3% vs. 9.1%; p = 0.551). The early complication rates and hospital readmissions were comparable between groups.
Early mitral valve surgery before the development of severe PH and right ventricular dysfunction was shown to improve survival outcomes. Surgery is safe and feasible for RHD patients with severe PH, with low early mortality and an 89.6% 3-month survival rate.
Psoas muscle cross-sectional area predicts morbidity and mortality as a surrogate for frailty in cardiac surgery patients, but routine preoperative abdominal imaging is uncommon. We hypothesized that pectoralis and psoas muscle cross-sectional area correlate, and pectoralis area may predict morbidity and mortality for patients undergoing surgical aortic valve replacement (SAVR).
A psoas muscle area validation cohort of moderate to high-risk patients undergoing SAVR (1/2009–12/2016) were identified from the University of Virginia. Pectoralis muscle area identified on preoperative computed tomography (CT) was indexed to body surface area to define pectoralis index. Sarcopenia was defined as pectoralis index below sex-specific 25th percentile. Patients were stratified by sarcopenic status, and regression analysis identified risk-adjusted associations utilizing Society of Thoracic Surgeons (STS) predicted risk scores.
Preoperative chest imaging was available for 228 patients. Sarcopenic patients were significantly older (median 82 vs 80 years, p = 0.041) and had greater mean society of thoracic surgeons predicted risk of mortality (STS PROM) (7.0% vs 5.7%, p = 0.047). There was no difference by sarcopenic status for operative mortality (8.8% vs 4.1%, p = 0.171) or major morbidity (21.1% vs 19.9%, p = 0.849). Risk-adjusted pectoralis index was associated with greater STS major morbidity (OR 0.998, p = 0.021), likelihood of discharge to a facility (OR 0.998, p = 0.014), and one-year mortality (OR 0.997, p = 0.025).
Lower pectoralis index may be associated with worse risk-adjusted outcomes after SAVR. Pectoralis defined sarcopenia may serve as a useful measure of frailty in cardiac surgery patients.
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with high rates of morbidity. Oral or intravenous administration of amiodarone is commonly used for treatment and prophylaxis; however, systemic delivery of amiodarone is associated with significant, well-known extracardiac side effects. Therefore, this study aimed to evaluate the effectiveness of combining a pericardial reconstruction matrix (CardiaMend) with amiodarone to prevent POAF in patients undergoing isolated coronary artery bypass grafting (CABG) or valve surgery.
This was a single-center, prospective, pilot study that enrolled patients undergoing CABG or valve surgery via complete median sternotomy. The amiodarone-soaked CardiaMend patch was applied intraoperatively. The primary outcome was the incidence of POAF up to patient discharge. Secondary outcomes were time until discharge and burden of atrial fibrillation.
A total of 29 patients were included, all undergoing CABG, of whom 10% (3/29) had concomitant valve replacements. POAF was experienced by 10 patients (34%). All patients were discharged in sinus rhythm, and none required a wearable rhythm monitor.
The use of a pericardial reconstruction matrix for local amiodarone delivery during cardiac surgery is a safe, potential prophylactic treatment for POAF. The clinical results of this pilot study showed a trend toward reduced POAF following cardiac surgery. These results, in combination with prior research, suggest that a more targeted application of amiodarone-eluting patches could be used to treat the atria and further improve outcomes.
NCT05681182, https://clinicaltrials.gov/study/NCT05681182.
Cardiopulmonary bypass (CPB) is essential in cardiac surgery but is associated with significant postoperative inflammation. Epicardial adipose tissue (EAT), due to its close proximity to the myocardium and vasculature, may play a role in mediating these inflammatory responses. A systematic search of MEDLINE and EMBASE identified five studies that analyzed molecular changes in EAT, subcutaneous adipose tissue (SAT), and/or serum before and after CPB. Outcomes included changes in mRNA expression and protein levels of inflammatory and metabolic biomarkers. EAT demonstrated increased expression of fibroblast growth factor 21 (FGF-21), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) following CPB. Adipokine profiles revealed decreased EAT protein levels of leptin, adiponectin, and adipocyte fatty acid-binding protein (A-FABP), while circulating levels varied depending on patient comorbidities. Mitochondrial electron transport chain (ETC) gene expression significantly decreased in EAT but not in SAT. Endoplasmic reticulum (ER) stress markers including activating transcription factor 4 (ATF4), DNA damage inducible transcript 3 (DDIT3), activating transcription factor 6 (ATF6), and heat shock protein family A (Hsp70) member 5 (HSPA5) showed differential upregulation, particularly in patients with coronary artery disease (CAD). EAT is biologically active and contributes to both local and systemic inflammation following CPB. These biomolecular changes may underlie adverse postoperative outcomes, highlighting EAT as a potential therapeutic target to reduce CPB-associated complications.
Endovascular therapy provides a new treatment modality for patients with aortic disease. By avoiding the morbidity of open surgery, endovascular approaches make treatment possible for a larger array of patients. However, the durability and long-term survival benefit of endovascular aortic intervention require further discussion and additional follow-up. We believe that the characterization of the role of endovascular therapy involves close risk-benefit analysis based on patient risk, disease presentation, native and pathological anatomy, and long-term outlook. Through review of the randomized prospective literature and relevant retrospective data, we explore the role of catheter-based solutions in abdominal and thoracic aortic disease, with a focus on aortic aneurysm and aortic dissection (AD). For patients with appropriate anatomy, endovascular aortic repair (EVAR) has largely supplanted open aortic repair (OAR) in the treatment of abdominal aortic aneurysm (AAA), both in the elective setting and during rupture. Similarly, thoracic endovascular aortic repair (TEVAR) has gained popularity in treating disease of the descending thoracic aorta, in both aneurysmal degeneration and AD. Similar adoption has been seen in treating other disease states, namely traumatic aortic injury. However, we recognize the current limitations of endovascular therapy and detail the innovations being pursued to advance endovascular therapy in the future.
Coronary artery bypass grafting (CABG) is the most frequently performed cardiac surgery worldwide. Improvements in operative technique and perioperative care have led to a significant reduction in associated morbidity and mortality. Achieving optimal outcomes requires meticulous surgical technique that is complemented by comprehensive postoperative care. This review aims to summarize the principles of postoperative care following CABG based on latest evidence and our extensive institutional experience. Immediate postoperative care in the intensive care unit focuses on management of acute cardiorespiratory issues, bleeding, and pain management. Ward care focuses of ensuring a smooth transition from inpatient treatment to outpatient recovery. Protocolized postoperative interventions, including Enhanced Recovery after Surgery-cardiac and emerging applications of automation and artificial intelligence, are transforming postoperative CABG care by promoting faster recovery, reducing complications, and enabling more personalized, data-driven decision-making.