Although robot-assisted minimally invasive esophagectomy (RAMIE) reportedly provides better short-term and comparable long-term outcomes compared with open esophagectomy, its long-term outcomes versus those of minimally invasive esophagectomy (MIE) remain insufficiently investigated. This multicenter retrospective cohort study aimed to investigate the perioperative safety, efficacy, and long-term survival of patients of RAMIE versus MIE for esophageal cancer. We included patients with cStage 0-IVa thoracic esophageal cancer who underwent esophagectomy through the right thoracic cavity between January 2016 and December 2019 in six Japanese hospitals. The short- and long-term outcomes between RAMIE and MIE were compared by using propensity score matching. After matching, 268 of 396 patients were analyzed. Compared with MIE, RAMIE had a longer operative time (629 vs. 574 min, p < 0.01), a trend toward less severe morbidity (Clavien–Dindo grade ≥ III: 18
BACKGROUND AND AIMS:Atrial functional mitral regurgitation (AFMR) commonly affects elderly and frail individuals. The prognostic impact of transcatheter edge-to-edge repair (TEER) for AFMR has not been investigated. METHODS:Patients with AFMR who underwent TEER were selected from the OCEAN-Mitral registry, and medically managed controls were selected from the REVEAL-AFMR registry, using an identical AFMR definition. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization. The secondary endpoint was all-cause mortality. RESULTS:A total of 1081 patients (mean age 80.1 ± 8.2 years, 60.5% female) with moderate or severe AFMR were included, of whom 441 underwent TEER and 640 remained on medical treatment. Overlap weighting based on the propensity score yielded well-balanced characteristics (n = 441 vs 640; all standardized mean differences <0.01), where TEER was associated with a lower incidence of the primary (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.43-0.99, P = .044) and secondary endpoints (HR 0.58, 95% CI 0.35-0.99, P = .044). In an exploratory subgroup analysis, favourable outcomes might be pronounced in patients with ≤mild residual AFMR after TEER, while event rates in those with ≥ moderate residual AFMR were comparable with the medication group. As sensitivity analyses, inverse probability of treatment weighting (n = 158 vs 173), propensity score matching (n = 104 vs 104), and multivariable Cox regression (n = 441 vs. 640) all confirmed favourable associations of TEER with both endpoints. CONCLUSIONS:In real-world data, TEER for patients with moderate or severe AFMR were associated with a lower incidence of adverse events compared with medical treatment.
Cerebrospinal fluid drainage (CSFD) is recommended during open or endovascular thoracic aortic repair. However, the incidence of CSFD complications is still high. Recently, CSF pressure has been kept high to avoid complications, but the efficacy of CSFD at higher pressures has not been confirmed. We hypothesize that CSFD at higher pressures is effective for preventing motor deficits. This prospective observational study included 14 hospitals that are members of the Japanese Society of Cardiovascular Anesthesiologists. Patients who underwent thoracic and thoracoabdominal aortic repair were divided into four groups: Group 1, CSF pressure around 10 mmHg; Group 2, CSF pressure around 15 mmHg; Group 3, CSFD initiated when motor evoked potential amplitudes decreased; and Group 4, no CSFD. We assessed the association between the CSFD group and motor deficits using mixed-effects logistic regression with a random intercept for the institution. Of 1072 patients in the study, 84 patients (open surgery, 51; thoracic endovascular aortic repair, 33) had motor deficits at discharge. Groups 1 and 2 were not associated with motor deficits (Group 1, odds ratio (OR): 1.53, 95
J-wave syndromes (JWS)-comprising Brugada syndrome (BrS) and early repolarization syndrome (ERS)-are important causes of malignant ventricular arrhythmias and sudden cardiac death in patients whose hearts appear structurally normal. Since the 2016 consensus, advances in genetics, pathophysiology, and therapy have redefined both understanding and management. BrS, once viewed as a purely electrical disorder, is now recognized along a microstructural-electrical continuum, with sodium-channel dysfunction and subtle epicardial fibrosis of the right ventricular outflow tract as key contributors. Likewise, ERS-historically considered benign-carries significant risk when inferolateral J-waves coexist with arrhythmic events. Genetically, SCN5A remains the sole gene with definitive disease association, while polygenic susceptibility materially modulates risk, underscoring complex inheritance. Risk stratification remains challenging: patients with prior cardiac arrest or arrhythmic syncope are highest risk, whereas asymptomatic individuals warrant multiparametric assessment integrating clinical features, ECG markers, electrophysiologic studies, and genetics. For decades, treatment centered on implantable cardioverter-defibrillators and quinidine, both limited by availability, tolerance, and device complications. More recently, epicardial substrate ablation has emerged as a transformative therapy, with large registries and randomized trials demonstrating durable suppression of ventricular fibrillation and acceptable safety. This APHRS-organized international consensus updates and extends the 2016 Expert Consensus and the 2022 ESC Guidelines, providing contemporary diagnostic frameworks, pragmatic risk-stratification tools, and treatment algorithms for BrS and ERS. It emphasizes JWS as a microstructural-electrical disease spectrum and elevates substrate ablation as a major therapeutic advance, while outlining priorities for genetics, risk-stratification and treatment algorithms.
Purpose Provisional stenting is recommended in percutaneous coronary intervention (PCI) for non-true left main bifurcation lesions (LMBLs); however, unexpected severe stent-jailed left circumflex coronary artery (LCX) narrowing is a clinical concern, and its prediction remains challenging. This study aimed to investigate anatomical features associated with LCX narrowing following provisional stenting for non-true LMBLs without significant LCX lesions and to derive an exploratory risk score using coronary computed tomography angiography (CCTA). Methods This was a multicenter retrospective observational study that enrolled patients who underwent CCTA before PCI for non-true LMBLs with provisional stenting from December 2019 to May 2024. Quantitative CCTA analysis of LMBL was performed, and severe stent-jailed LCX narrowing, defined as angiographic stenosis ≥ 90%, was assessed. Anatomical features associated with LCX narrowing were identified using multivariable analysis, and a CCTA-derived exploratory risk score was derived. Results Overall, 109 patients were recruited, 16 (14.7%) of whom had severe stent-jailed LCX narrowing. Multivariable analysis identified the following parameters as associated with LCX narrowing: left anterior descending artery–LCX vessel angle ≤ 86°, area stenosis (AS) of the distal LM (LMd) ≥ 54%, AS of the ostial LCX ≥ 63%, and calcium thickness of the LMd ≥ 0.5 mm. An exploratory risk score based on these four features showed a stepwise increase in the incidence of severe LCX narrowing, with a C-statistic of 0.877. Conclusion CCTA identified anatomical features associated with severe stent-jailed LCX narrowing following provisional stenting. An exploratory risk score was derived from these features.
