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Reports of large tumors of the left ventricle are rare. In this instance, we present a situation where a 57-year-old woman underwent surgical intervention for a sizable mass in her left ventricle. The mass was attached to the walls of the left ventricle and the apex of the left ventricle, almost filling the entire left ventricle. The individual had elective cardiac surgery. Fortunately, the patient survived, and this case may help in the treatment of cardiac sarcoma.

Objective This study aimed to compare hospital and long-term clinical outcomes associated with various treatment methods for Stanford A type aortic intramural hematoma (IMH) to provide a reference for clinical decision-making. Methods In this single-center cohort study, we retrospectively analyzed 73 patients with Type A IMH treated at our center from August 1, 2018 to August 1, 2021. Among these patients, 26 were treated conservatively, and 47 underwent surgical intervention. We next compared this IMH cohort with 154 patients with acute type A aortic dissection (AD) who were treated surgically during the same study period. Results Computed tomography angiography revealed that the diameter of the ascending aorta of IMH patients treated with surgery was higher than IMH patients treated with conservative therapy (44.92 ± 7.58 mm vs. 51.22 ± 11.85 mm, P  < 0.05), while there was no significant difference in other clinical parameters. The in-hospital mortality of patients with IMH who underwent surgical treatment was lower than those undergoing conservative treatment (0% vs. 11.5%, P  < 0.05). The long-term mortality of the conservative IMH group was higher than the surgical IMH group (26.1% vs. 8.5%, P  < 0.05). There was no significant difference in the surgical parameters and postoperative complications between AD and IMH surgery patients. The proportion of circulatory arrest time in the lower body (19.98 ± 9.39 min vs. 17.51 ± 3.97 min) and arch involvement (98 (63.6%) vs. 22 (46.8%)) in the IMH surgery group was lower than in the AD surgery group ( P  < 0.05). Conclusions Compared with conservative treatment, surgical treatment of IMH significantly improves the survival rate of patients. Thus, surgical intervention should be considered the primary treatment option if feasible. Furthermore, The safety of IMH surgery can be guaranteed just like AD. But we still need in the future evidence on bigger samples. Graphical abstract

Background To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD). Methods Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models. Results Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69–1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52–2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2–11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4–44.5, in 1000 USD). Conclusions Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes. Trial registration KY20220425-05, April 5th 25 2022.

Objective The main aim of this study is to measure and calculate the ratio of sinotubular junction diameter to body surface area (RDA) in patients with acute type A aortic dissection (ATAAD) and normal subjects, and to analyze the relationship between RDA and ATAAD to provide guidance for primary prevention of ATAAD. Methods This retrospective observational study totally admitted consecutive 320 patients with acute type A aortic dissection diagnosed in Nanjing First Hospital from March 2017 to March 2021. Meanwhile, 608 healthy subjects who took echocardiography examination in outpatient was selected as controls. The diameter of sinotubular junction (D.STJ) was measured using echocardiography and direct vision (in some ATAAD patients). The differences in body surface area (BSA), D.STJ and RDA index in both groups were assessed. The association between D.STJ and demographic characteristics were established. RDA index was used to distinguish the ATAAD and healthy subjects. Results The diameter of STJ (24.41 ± 2.16 mm versus 26.66 ± 2.60 mm) and RDA index (13.16 ± 1.67 versus 15.40 ± 1.59) were significantly different between dissection group and control group. The D.STJ were found a positive, linear correlation to BSA in the healthy subjects. Multivariate logistic regression showed that RDA index was one of the independent risk factors to associated with ATAAD as a continuous variable (odds ratio (OR), 0.403, 95% confidence interval (CI): 0.352–0.457, P  < 0.001) or a categorical variable (RDA cut-off: 13.88 mm/m 2 , OR, 0.070, 95%CI: 0.050–0.098, P  < 0.001). Conclusions RDA index is an independent and key risk factor for ATAAD occurrence. Timely identification of high-risk patients using RDA index has the potential to become an optional guidance for primary prevention of ATAAD.

Objectives Endoscopic vein harvesting (EVH) is an alternative technique to obtain the saphenous vein for coronary artery bypass grafting (CABG) surgery. We aimed to evaluate the early and mid-term outcomes of patients with EVH in CABG. Methods This cohort study included consecutive isolated CABG patients in Nanjing First Hospital from July 2020 to December 2022 using propensity score matching methods. Patients were classified to EVH group and open vein harvesting (OVH) group according to the vein harvesting methods. The primary outcome was the all-cause death, and the secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, heart failure, myocardial infarction and revascularization and asymptomatic survival in the follow-up. Results Totally 1247 patients were included in the study with 849 in OVH group and 398 in EVH group. Patients with EVH were more female, diabetes, higher body mass index, more multi-vessel and left main diseases. 308 pairs were formed after the matching. There was no significant difference in the rates of in-hospital death (EVH vs. OVH, 2.3% vs. 1.3%, P  = 0.543). During the 3 years follow-up, EVH grafts were considered not inferior to OVH grafts, no differences were found in all-cause death [8.5% vs. 5.0%, hazard ratio (HR) 1.565, 95% confidence interval (CI): 0.77–3.17, P  = 0.21], MACEs (8.1% vs. 7.1%, HR 1.165, 95CI: 0.51–2.69, P  = 0.71) and asymptomatic survival (66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65–1.92, P  = 0.68). Conclusions EVH grafts were considered comparable to OVH grafts in patients following CABG in the 3 years follow-up.

Objective This study aimed to investigate the impact of the proportion of hematologic malignancy patients in hospitals on the prognosis of chronic lymphocytic leukemia (CLL) patients undergoing cardiac surgery. Perioperative management of CLL patients is complex, particularly regarding immunosuppression and infection risks. Methods This retrospective study utilized data from the National Inpatient Sample (NIS) from 2010 to 2021. Adult CLL patients undergoing cardiac surgery were included, categorizing hospitals into five quintiles based on hematologic malignancy patient proportions. Outcomes included in-hospital mortality, acute kidney injury (AKI), postoperative bleeding, and infections. Results AKI incidence was significantly lower in the Q5 group (OR: 0.68, 95% CI: 0.49–0.97), as was the rate of respiratory failure (OR: 0.53, 95% CI: 0.35–0.79). However, the rates of transfusion and acute heart failure were significantly higher in Q5 (acute heart failure OR: 1.70, 95% CI: 1.07–2.77). No significant differences were found in in-hospital mortality or other complications. Conclusion The proportion of hematologic malignancy patients affects CLL patient outcomes, with higher proportions linked to lower AKI and respiratory failure rates but increased transfusion and heart failure risks. Further research is warranted.

Background This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n  = 41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n  = 62). Results There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality ( P  = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR+SET group, but with no difference ( p  = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR+SET group, with a statistical difference ( p  = 0.03). Conclusion These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.

To evaluate clinical outcomes, temporal trends, and age-related heterogeneity of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) versus redo surgical aortic valve replacement (re-SAVR) in patients with failed aortic bioprosthetic valves. Patients undergoing ViV-TAVI or re-SAVR between 2011 and 2021 were identified from the Nationwide Readmission Database (NRD). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Temporal trends in procedure utilization and patient age were assessed across calendar years. The primary outcome was all-cause mortality, including in-hospital, 30-day, and 6-month mortality. Secondary outcomes included in-hospital complications, all-cause readmission, and days alive and out of hospital (DAOH). Age-stratified and interaction analyses were performed. ViV-TAVI utilization increased significantly over time (p < 0.001), accompanied by a modest decline in patient age. Compared with re-SAVR, ViV-TAVI was associated with lower in-hospital mortality (OR 0.50, 95% CI 0.35-0.71; p < 0.001) and 30-day mortality (HR 0.60, 95% CI 0.43-0.83; p = 0.002), as well as lower risks of in-hospital stroke or transient ischemic attack, renal failure, and major bleeding (all p < 0.001). However, ViV-TAVI was associated with higher 30-day (HR 1.23, 95% CI 1.02-1.48; p = 0.031) and 6-month readmission (HR 1.25, 95% CI 1.07-1.46; p = 0.006). ViV-TAVI was also associated with higher DAOH at 30 days and 6 months (both p < 0.001). Interaction analyses suggested age-related heterogeneity for selected outcomes. ViV-TAVI use increased substantially and was associated with lower short-term mortality and fewer in-hospital complications, but higher readmission risk. Improved DAOH and potential age-related heterogeneity warrant further evaluation.

Robot-assisted surgical techniques have enhanced surgical precision, control, stability, and vision, particularly in cardiac interventions. However, the relationship between hospital volume and the clinical and readmission outcomes of robot-assisted cardiac surgery remains undefined. This retrospective cohort study analyzed Nationwide Readmissions Database (NRD) data from 2010 to 2020. Patients who underwent various cardiac procedures were categorized into three groups based on hospital volume of robot-assisted cardiac surgery: low-volume centers (LVCs), medium-volume centers (MVCs), and high-volume centers (HVCs). Our primary outcome variables of interest were the incidence of perioperative complications, 30-day readmission, and in-hospital mortality. 10,543 patients were included in the analysis. Compared with those treated in LVCs, the adjusted OR of 30-day readmission [OR, 0.70; (95% CI 0.53–0.92), P  = 0.014] was lower in HVCs. However, higher perioperative bleeding rates were observed in MVCs (OR, 1.38; (95% CI 1.14–1.66), P  = 0.001) and HVCs (OR, 1.84; (95% CI 1.52–2.21), P  = 0.001). No significant differences were found in in-hospital mortality. Our research demonstrated that higher hospital surgical volume was associated with better outcomes in robot-assisted cardiac surgery, despite higher perioperative bleeding rates.

Background: This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes. Methods: From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n=41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n=62). Results: There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P=0.04). The overall survival rates at 5-year follow-up were 82.5±6.0% in LAR group and 75.2±5.6% in TAR+SET group, but with no difference (p=0.151). The freedom from adverse aortic events at 5-year was 84.3±6.5% in LAR group versus 97.9±2.1% in TAR+SET group, with a statistical difference (p=0.03). Conclusion: These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.