Due to the poor prognosis of dialysis patients, accurately predicting life expectancy after aortic stenosis surgery remains challenging, leading to potential misselection of treatment options. This study aimed to develop a prognostic model specific to dialysis patients to facilitate individualized treatment selection. A total of 171 dialysis patients with aortic stenosis who underwent initial isolated surgical aortic valve replacement at seven cardiovascular centers in Japan between 2011 and 2021 were enrolled. The cohort was randomly divided into the training and validation cohorts in a 2:1 ratio. Risk factors contributing to mortality were identified from preoperative variables, and a prognostic model was developed using the Cox proportional hazards model. Among the 171 patients, 88 deaths occurred during the total observation period of 488.9 person-years. The cumulative overall survival rates at 1, 3, and 5 years, estimated using the Kaplan-Meier method, were 74.7%, 59.4%, and 38.7%, respectively. An optimal risk model was developed, incorporating six factors: age, serum albumin, peripheral artery disease, sex, insulin-dependent diabetes mellitus, and atrial fibrillation. The model demonstrated strong predictive accuracy, with a 5-year C-statistic of 0.723 (95% confidence interval: 0.658-0.788) and 0.656 (95% confidence interval: 0.543-0.770) in the training and validation cohorts, respectively. Calibration plots confirmed that actual survival up to 5 years was well predicted (intraclass correlation coefficient = 0.918, 95% confidence interval: 0.703-0.981). The proposed model is a reliable prognostic tool for dialysis patients who underwent surgical aortic valve replacement.

In minimally invasive surgeries such as video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS), unexpected complications may necessitate conversion to thoracotomy. This study aimed to compare the rates, causes, and implications of conversion to thoracotomy between VATS and RATS. We retrospectively reviewed data from 1135 patients who underwent anatomical lung resection for primary lung cancer via VATS (n = 580) or RATS (n = 555) from 2011 to 2024. Conversion causes were categorized using the Vascular, Anatomy, Lymph node, Technical (VALT) system. Perioperative outcomes and independent predictors of conversion were analyzed via multivariate logistic regression. The overall conversion rate was significantly lower in the RATS group than in the VATS group (2.0% vs. 7.8%, p < 0.001). RATS was associated with fewer anatomical (0.9% vs. 3.1%, p = 0.010) and lymph node-related (0.2% vs. 2.6%, p < 0.001), with no significant difference in vascular-related conversions (0.9% vs. 2.1%, p = 0.142). Multivariate analysis identified age ≥ 75year, clinical T2-4, and N1-2 stage as independent risk factors, while RATS use was protective. Emergency conversions were uncommon in both groups, whereas RATS appeared advantageous in technically demanding settings. RATS significantly reduces the risk of conversion, particularly in anatomically or nodally complex cases, without increasing vascular complications.

To evaluate the feasibility and safety of total arch replacement with a frozen elephant trunk in patients with Stanford type B aortic dissection and an entry ≤ 10mm distal to the left subclavian artery. We retrospectively reviewed 40 consecutive patients who underwent either total arch replacement with a frozen elephant trunk (n = 30) or thoracic endovascular aortic repair (n = 10). The primary outcome was late all-cause mortality. Secondary outcomes included major complications, planned additional endovascular repair after total arch replacement with a frozen elephant trunk, false lumen thrombosis, and aortic remodeling. In the thoracic endovascular aortic repair group, procedure-related complications occurred, including retrograde type A dissection and one death from aortic rupture. In the total arch replacement with a frozen elephant trunk group, all deaths were unrelated to the index procedure. Planned additional endovascular repair was more frequently performed after total arch replacement with a frozen elephant trunk. Total arch replacement with a frozen elephant trunk is safe for anatomically challenging type B aortic dissection with an entry near the left subclavian artery and represents a viable treatment option in this setting.

This study aimed to report "real-world" mid-term clinical experiences and outcomes after surgical mitral valve replacement with the Epic bioprosthesis in a high-volume Japanese heart center. Patients undergoing surgical mitral valve replacement with the Epic bioprosthesis from 2012 to 2023 were enrolled. Postoperative outcomes, survival, and hemodynamic performance were analyzed. The study endpoints were all-cause mortality, freedom from mitral valve reintervention, and major adverse cardiac events. A total of 122 patients (mean age: 73 ± 8years, 73 males) successfully underwent surgical mitral valve replacement with the Epic bioprosthesis (25mm, n = 22; 27mm, n = 37; 29mm, n = 26; and 31mm, n = 37). The primary valve etiologies were infective endocarditis (n = 17), stenosis (n = 18), stenosis and regurgitation (n = 13), regurgitation (n = 73), and thrombosis (n = 1). The median follow-up period was 33 (interquartile range: 20-48) months. Overall survival rates at 1, 3, and 5years after mitral valve replacement were 86.8%, 82.0%, and 76.9%. The rates of freedom from rehospitalization for heart failure were 96.7% at 1year, 95.5% at 3years, and 91.2% at 5years. The mean pressure gradient was 5 (interquartile range: 4-6.4) mmHg at discharge, 5.4 (interquartile range: 4.3-6.9) mmHg at 1year, and 5.4 (interquartile range: 4-7.5) mmHg at late follow-up (Friedman test, p = 0.46). During the study period, only one patient required reintervention because of valve deterioration at 31 postoperative months. The clinical outcomes of mitral valve replacement with the Epic bioprosthesis are satisfactory, with stable hemodynamics and extremely low incidence of structural valve deterioration and reintervention over 5years.

Despite advances in cerebral protection strategies, aortic arch surgery remains associated with significant neurological risk. Unilateral antegrade cerebral perfusion (uACP) and bilateral ACP (bACP) are widely used during moderate hypothermic circulatory arrest, but the optimal strategy remains controversial. A comprehensive literature search was performed to identify RCT and comparative studies comparing uACP and bACP in patients undergoing aortic arch surgery. Studies were pooled using the random-effects model to perform a pairwise meta-analysis. Primary outcomes were 30-day mortality, permanent neurological deficit (PND), and transient neurological deficit (TND). Secondary outcomes included paraplegia, transfusion, acute kidney injury, tracheostomy, and long-term mortality. A total of 20 studies with 5,647 patients were included. There was no significant difference between uACP and bACP in 30-day mortality (RR 1.16, p = 0.26) or PND (RR 1.10, p = 0.57). However, uACP was associated with a significantly higher risk of 30-day TND (RR 1.32, p = 0.006). No significant difference was observed for any other explored outcomes. Meta-regression revealed no significant correlation between duration of circulatory arrest or ACP on primary outcomes. Compared to bACP, uACP during aortic arch surgery is associated with increased transient neurologic deficits but similar rates of mortality and PND. Selection of cerebral perfusion strategy should be individualized to patient anatomy, operative context, and anticipated circulatory arrest duration, recognizing that some subgroups may derive greater benefit from bACP.

Thrombus formation in atrial fibrillation is caused by blood flow stagnation within the left atrial appendage (LAA). It is believed that blood flow tends to stagnate within the LAA even in patients with sinus rhythm and high risk of stroke. This study evaluated blood flow within the LAA using four-dimensional flow magnetic resonance imaging among patients stratified by the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, vascular disease, age, sex category (CHA2DS2-VASc) score. Ninety-eight participants with sinus rhythm (70 patients, 28 controls) underwent non-contrast four-dimensional flow magnetic resonance imaging. Participants were divided into low- and high-risk groups (CHA2DS2-VASc scores 0-2 and 3-9, respectively. Blood flow parameters, including the blood flow volume in the basal, middle, and top segments of the LAA, were analyzed and compared between groups. The blood flow volume was significantly reduced in the top segment of the LAA in the high-risk group (low-risk: 3.13 ± 1.07mL/cm2 vs. high-risk: 2.54 ± 0.96mL/cm2, p = 0.006). However, the blood flow volume in the basal and middle segments did not differ significantly between the two groups (basal segment, p = 0.14; middle segment, p = 0.44). In addition, larger LAA volumes (EDV, ESV, and mean volume) were associated with reduced top-segment flow, but correlations with intra-LAA flow were not statistically significant. In patients with high CHA2DS2-VASc scores, blood flow stagnation can occur in the LAA top segment even in the presence of sinus rhythm. Establishing blood flow-based criteria may enhance the potential applications of LAA closure to prevent stroke.

Recent advances in therapeutics have substantially improved breast cancer treatment outcomes. However, data on prognostic factors after surgical resection of pulmonary metastases from breast cancer remain limited. This single-center retrospective study analyzed data from patients with breast cancer who had undergone pulmonary metastasectomy between 2000 and 2023. We reviewed clinical and pathological parameters, including the disease-free interval (DFI), size and number of pulmonary metastases. This study included 33 patients. The median postoperative survival of breast cancer patients with lung metastasis was 40 (range 4-217) months. According to univariate analysis, hormone receptor-positive breast cancer, pStage I or II breast cancer, lung metastases < 20mm, hormone receptor-positive lung metastases, absence of other metastases, and DFI ≥ 24 months were significantly associated with better survival. Multivariate analysis identified DFI < 24 months (hazard ratio [HR] 9.520, 95% confidence interval [CI] 2.158-27.070) andtumor size ≥ 20mm (HR 4.958, 95% CI 1.290-27.550) independently predicted poorer survival; ≥ 2 metastatic lesionsshowed anon-significant trendtoward worse outcomes (HR 3.272, 95% CI 0.913-11.090). This study clarified the criteria for pulmonary metastasectomy in patients with breast cancer. Considering subtype changes between the primary tumor and metastases could enable personalized therapies.

Postoperative inflammation can promote immunosuppression and cancer recurrence. The present study investigated the correlation between serum C-reactive protein (CRP) levels after minimally invasive esophagectomy and long-term patient outcomes with large scale of cases. Data from 329 patients who underwent minimally invasive esophagectomy were analyzed. Serum CRP levels were measured from postoperative day (POD) 1 to 7, 10, and 14. Low and high CRP groups were stratified by the median CRP values for each POD. Overall survival (OS) was defined as the time from esophagectomy to patient death. Relapse-free survival (RFS) was defined as the time to disease relapse or death from other cause. The high CRP group on PODs 5-7 and 10 had a significantly lower OS rate than the low CRP group. The high CRP group on POD 6, 7, and 10 also had a significantly lower RFS rate than the low CRP group. A high CRP level on POD 7 was identified as an independent risk factor for poor OS/RFS. In contrast, preoperative CRP levels (before esophagectomy) were not identified as a risk factor for unfavorable OS/RFS. The high CRP group had a higher mortality rate from other diseases than the low CRP group (15.0% vs 8.9%). Secondary malignancies tended to be more frequent in the high CRP group than in the low CRP group (26.1% vs 6.3%). Elevated CRP levels in the immediate postoperative period after minimally invasive esophagectomy, particularly on POD 7, were significantly associated with poor OS and RFS.

In South Korea, extracorporeal membrane oxygenation (ECMO) is used as a bridge to optimize utilization of heart obtained from donors after brain death. However, the heart utilization rate and the effectiveness of ECMO in donation after brain death (DBD) donors, prior to donation, remain unclear. This study aimed to analyze the early postoperative outcomes of recipients who received hearts from DBD donors supported by ECMO, and to identify the factors associated with successful transplantation outcomes. Donors who received ECMO support were divided into two groups, one, whose hearts were successfully transplanted (n = 3), and the other, whose hearts were not utilized for transplantation (n = 13), at our institution between 2013 and 2024. Preoperative donor characteristics of the two donor groups were compared to identify the factors influencing successful heart transplantation. Recipients' preoperative, intraoperative findings, and 1-year postoperative outcomes were analyzed. Among 190 DBD donors, 16 (8.4%), supported by ECMO, were grouped. The transplanted heart rate in this group was 18.8% (3 out of 16 ECMO-supported potential donors). The 1-year graft survival and recipient survival rates were 100%. The transplanted donor group tended to be younger than the non-transplanted group, with a median age difference of 26years (p = 0.031). Prior to donation, ECMO can be effectively used in brain-dead donors, to improve the rate of heart transplants. The postoperative outcomes of recipients, who received hearts procured from ECMO-supported donors, were satisfactory. Among ECMO-supported DBD donors, the median age tended to be lower in the transplanted donor group.