Background:Single-port (SP) robotic platforms aim to reduce surgical trauma by allowing all instruments through a single incision. In thoracic surgery, SP experience has been reported mainly via subxiphoid or subcostal routes, whereas the intercostal approach and heterogeneous case series remain scarce. We report an initial technical feasibility experience with intercostal SP robotic thoracic surgery, the first reported from Turkey. Methods:This single-center retrospective review included the first 10 consecutive patients who underwent thoracic surgery with the da Vinci SP Surgical System via a standardized intercostal approach (single 2-4 cm incision at the midaxillary line, approximately the sixth intercostal space; March 13-April 28, 2026). Procedures comprised anatomic and wedge lung resections, esophageal surgery, and mediastinal/paraesophageal mass excision. This is presented as an initial technical experience rather than a comparative outcomes study; the primary endpoint was technical feasibility. Results:Ten patients (seven women and three men; mean age: 57 years, range: 44-68) underwent pulmonary resection (n = 5), esophageal surgery (n = 3), and mediastinal/paraesophageal mass excision (n = 2). All procedures were completed through a single intercostal incision, with no additional incision, no conversion, and no instrument clash. Mean operative time was 48.6 minutes (pulmonary/mediastinal) and 67 minutes (thoracic phase and esophageal); mean docking time was 4.4 minutes. Mean blood loss was 68 ± 32 mL, mean chest tube duration was 2.2 ± 1.3 days, and mean length of stay was 2.8 ± 1.4 days. Four patients underwent synchronous SP abdominal procedures. No complications, reinterventions, or 30-day mortality occurred. Conclusion:In this small, highly selected initial series performed by an experienced team, intercostal SP robotic thoracic surgery appeared technically feasible across a range of thoracic procedures. Given the limited sample size and retrospective design, these findings should be regarded as hypothesis-generating; larger prospective studies are needed before conclusions regarding safety or comparative outcomes can be drawn.
Abstract:BACKGROUND: Studies reported a strong relationship between cystatin C and postsurgical acute kidney injury (AKI) following cardiac surgery. This study aims to establish the above relationship in acute type A aortic dissection (ATAAD) patients. Abstract:METHODS: ATAAD patients receiving hemiarch replacement in combination with modified triple-branched stent-graft (MTBSG) implantation were recruited. The relationship between cystatin C and AKI, as well as in-hospital mortality, was analyzed. Abstract:RESULTS: About 459 patients were enrolled. A total of 223 (48.6%) exhibited AKI and 71 (15.5%) exhibited severe AKI. AKI patients displayed elevated perioperative cystatin C levels. Upon adjustment of known AKI hazards, the logarithmically transformed presurgical cystatin C (odds ratio = 1.66 [95% confidence interval, 1.20-2.30], p = 0.010), postsurgical day 1 cystatin C (odds ratio = 2.61 [95% confidence interval, 1.70-4.13], p = 0.002), postsurgical day 2 cystatin C (odds ratio = 3.01 [95% confidence interval, 2.22-4.07], p = 0.001), and postsurgical day 3 cystatin C (odds ratio = 2.89 [95% confidence interval, 1.99-3.86], p = 0.009) were intricately linked to severe AKI. Moreover, these relationships remained even after adjusting for filtration reduction via alterations in serum creatinine (Δcreatinine) and urea nitrogen (Δurea nitrogen). Relative to the clinical model, cystatin C enhanced the risk discrimination and restratification of AKI. Abstract:CONCLUSION: For ATAAD patients, cystatin C greatly enhanced postsurgical AKI risk stratification. When dynamic cystatin C levels indicate a high risk of severe AKI, more aggressive monitoring should be performed to assess whether more intensive stent intervention is warranted to improve renal artery perfusion.
OBJECTIVE:This study aimed to investigate the relationship between postoperative atrial fibrillation (POAF) following lung resection and surgical factors, particularly the extent and location of resection, alongside preoperative electrolyte levels. We also sought to develop and internally validate a composite risk model for identifying high-risk patients. METHODS:In this single-center retrospective cohort study, 422 patients who underwent lung resection (sublobar, lobar, or major resection) between December 2024 and April 2025 were analyzed. Patients with pre-existing atrial substrate, heart failure, or left atrial dilatation (≥40 mm) were excluded. Independent predictors were identified using multivariable logistic regression. To further address potential confounding, inverse probability of treatment weighting (IPTW) analysis was performed. RESULTS:POAF developed in 66 patients (15.6%). In multivariable analysis, lower preoperative potassium levels (OR 0.40; 95% CI 0.21-0.79; p=0.008), major resection (OR 4.10; 95% CI 1.98-8.49; p<0.001), and upper lobe resection (OR 4.23; 95% CI 2.22-8.05; p<0.001) were independent predictors of POAF. In the IPTW-adjusted analysis, upper lobe resection remained significantly associated with POAF (OR 2.08; 95% CI 1.16-3.75; p=0.013). The composite model demonstrated moderate discrimination (AUC 0.716; 95% CI 0.641-0.777), which remained stable after bootstrap validation. POAF was associated with longer ICU stay and higher in-hospital mortality (16.7% vs. 1.4%, p<0.001). CONCLUSION:POAF after lung resection is a predictable complication associated with the extent of surgery, upper lobe involvement, and preoperative potassium levels. These findings highlight the importance of closer rhythm surveillance and perioperative electrolyte optimization in high-risk patients.
Objective:Post-infarction ventricular septal rupture (PIVSR) is a fatal mechanical complication of acute myocardial infarction. We aimed to develop and interpret a machine learning (ML) model to predict 30-day mortality using routinely available clinical variables in PIVSR patients. Methods:This retrospective cohort study included consecutive PIVSR patients treated at Fuwai Central-China Cardiovascular Hospital from 2018 to 2024. Candidate predictors were screened by three complementary procedures including bootstrap resampling with LASSO, stepwise logistic regression, and the Boruta algorithm. Nine supervised ML algorithms were trained and compared. Model performance was comprehensively evaluated using multiple discrimination, calibration, and clinical utility metrics. Model interpretability was examined using Shapley Additive Explanations (SHAP). We additionally implemented the final model as a web-based calculator to support individualized risk estimation. Results:A total of 237 PIVSR patients were analyzed. Nine clinical predictors were identified. The CatBoost model demonstrated favorable overall performance in both the training set (AUC = 0.92, 95%CI: 0.89-0.94) and testing set (AUC = 0.88, 95%CI: 0.79-0.95). In the testing set, CatBoost achieved an accuracy of 0.79, sensitivity of 0.85, specificity of 0.71, F1-score of 0.82, and Brier score of 0.15. SHAP analysis identified operation, hemodynamic status, inflammatory markers, and renal function as key contributors. Conclusion:We developed, evaluated, and interpreted ML models for predicting 30-day mortality in patients with PIVSR. The CatBoost model demonstrated favorable predictive performance and transparent interpretability. Hemodynamic compromise, inflammation, and renal dysfunction were identified as key predictors of adverse outcomes. An exploratory web-based calculator was developed to support dynamic in-hospital prognostication.
Objectives:This study compared surgical aortic valve replacement (SAVR) via partial upper sternotomy (PUS) and right anterolateral thoracotomy (RALT) with central aortic cannulation regarding intraoperative perfusion parameters, transfusion requirements, and early postoperative outcomes. Methods:We retrospectively analyzed 380 patients who underwent isolated SAVR via PUS or RALT. Propensity score matching yielded 107 matched pairs. All patients underwent central aortic and peripheral venous cannulation. Results:Cardiopulmonary bypass, aortic cross-clamp, and total operative times were longer in the RALT group, whereas reperfusion time was shorter (all p < 0.001). Transfusion requirements for packed red blood cells, fresh-frozen plasma, and platelet concentrates did not differ between groups. Cell salvage volume was generally lower in the RALT group after matching. Intubation times were comparable between groups. Intensive care unit (ICU) length of stay and total postoperative hospital stay were shorter in the RALT group (p < 0.001 and p = 0.008, respectively). Peak catecholamine requirements were lower in the RALT group (p = 0.005). Rates of permanent pacemaker implantation and pulmonary, wound, and urinary tract infections did not differ. In-hospital mortality was 0.9% in the PUS group; no deaths occurred in the RALT group. Conclusion:Both approaches achieved low in-hospital mortality and comparable complication rates. Despite longer operative times, RALT was associated with shorter ICU and hospital stays and lower vasopressor requirements. RALT with central aortic cannulation is a safe and feasible alternative to PUS for minimally invasive aortic valve surgery.
Objective:Infective endocarditis (IE) is a serious disease with a significant morbidity burden. Recurrence occurs in 8 to 10% of cases. Data on risk factors and outcomes in patients with recurrent IE are limited. Methods:This is a single-center observational analysis of consecutive patients, who underwent surgery for IE from 2009 to 2022. Patients with recurrent episodes of IE were identified and compared with patients after single episode IE regarding baseline characteristics and perioperative outcome. Risk factors for recurrence were identified by regression analysis. Results:The total cohort comprised 665 patients. Of these, 10.2% (68/665) had recurrent IE. The median time to recurrence was 1.0 (1.55-3.49) years. Patients with recurrent IE were significantly younger with 58.1 ± 15.8 versus 62.6 ± 14.6 years (p < 0.017), but had a similar overall risk profile with EuroSCORE II 8.8 ± 3.9% versus 8.3 ± 3.7 (p = 0.271) compared with counterparts in the single episode group. Prosthetic valve IE (PVE) was more frequently noticed in the recurrence group at 45.6% (31/68) versus 20.5% (122/595; p < 0.001). Abscess formation with fistulas was documented more frequently in the recurrence group at 5.9% versus 1.8% (p = 0.034). Mortality rates at 30 days was lower in the recurrence group at 2.9% versus 14.7% (p = 0.007), while 1-year mortality was similar at 33.3% versus 32.9% (p = 0.948). Kaplan-Meier (KM) estimates revealed similar long-term survival in both groups (log rank p = 0.726). Previous valve implantation (due to a non-infectious reason) and history of IE (previously treated conservatively or surgically) were identified as independent predictors of recurrence with odds of 1.410 (1.030-1.931; p = 0.023) and 1.822 (1.164-2.628; p < 0.001), respectively. Conclusion:Recurrence of IE is associated with previous valve implantation and paravalvular complications like fistulas. Surgical treatment of such high-risk patients is feasible with good short-term survival and similar long-term outcomes compared with single episode IE patients.
Background:Postoperative cognitive dysfunction (POCD) is a common complication following aortic arch replacement. This study aimed to identify risk factors for early POCD in patients undergoing aortic arch replacement and determine the effect of POCD on long-term survival. Methods:In this prospective cohort study, 103 patients who underwent aortic arch replacement for complex aortic arch diseases were enrolled. Cognitive function was assessed preoperatively and on postoperative days 5 to 7 using the Montreal Cognitive Assessment. POCD was defined as a ≥20% decline in total score compared with baseline. Results:The incidence of POCD was 15.5%. Compared with the non-POCD group, patients with POCD were significantly older (62 ± 13 vs. 52 ± 13, p = 0.008), had a higher proportion of females (68.8 vs. 37.9%, p = 0.044), and experienced greater intraoperative blood loss (751 ± 165 vs. 667 ± 122 mL; p = 0.018). Postoperative adverse events were similar between the two groups. Significant declines were observed in the domains of visuospatial/executive function (p = 0.003), attention/concentration/working memory (p < 0.001), and orientation (p = 0.002). Multivariable logistic regression analysis identified age, female sex, and antegrade cerebral perfusion (ACP) time as independent risk factors for POCD. Midterm survival was similar between POCD and non-POCD groups (1-year survival: 100 vs. 95.2%; p = 0.437). Conclusion:POCD remains a common complication after aortic arch replacement. Advanced age, female sex, and prolonged ACP time are independent predictors of POCD. POCD was not associated with worse midterm survival. These findings may help preoperative risk stratification and optimization of intraoperative management.
