Background We retrospectively analyzed 367 patients receiving surgical resection of cardiac myxomas in our center over six years, and analyzed the incidence and surgical results of 28 cases of right atrial myxomas. We also compared the age, gender, and attached sites between left atrial myxoma and right atrial myxoma. Methods Between January 2007 and December 2012, 28 patients with right atrial myxomas underwent surgical resection. There were 16 males and 12 females. The mean age was 47.77 ± 13.20 years (range: 8.00–79.00 years). Associated cardiac lesions included moderate and severe tricuspid regurgitation in four, coronary atherosclerotic heart disease in five, and pulmonary embolism in one. Twenty‐seven patients (96.43%) were followed from 26 to 94 months (mean 55.78 ± 21.10 months). Results There was no early death after operation. The incidence of right atrial myxomas among sporadic cardiac myxomas was 7.89%. One patient died of lung cancer 34 months after myxoma resection. Two patients underwent coronary artery stent implantation due to coronary atherosclerotic heart disease during the follow‐up period. One patient underwent myxoma resection due to recurrence in the left atrium four years after the first operation. There was no significant difference in the age between left atrial myxoma and right atrial myxoma (p > 0.05). There was a significant difference in the gender between left atrial myxomas and right atrial myxomas (p < 0.05). The most common attached sites of left atrial myxomas and right atrial myxomas are the atrial septum. Conclusions Surgical resection of the right atrial myxoma results in good clinical outcomes and a decreased incidence of recurrence. doi: 10.1111/jocs.12663 (J Card Surg 2016;31:15–17)

Background: Data on the clinical features and surgical outcomes of type A intramural hematoma (IMH) in Chinese patients are very limited. We aimed to present the surgical experiences on type A IMH in our center, and report early and late outcomes. Methods: From February 2012 to April 2018, 106 consecutive patients underwent open surgery for type A IMH at our hospital. We adopted emergent operation for patients with cardiac tamponade or other severe complications, and recommended initial medical treatment followed by elective surgery for stable patients. The composite endpoints included operative mortality, permanent nerve damage (stroke, paraplegia), and new-onset renal failure necessitating hemodialysis. Risk factors for operative mortality and the composite endpoints were identified using univariable and multivariable logistic regression model analysis. The survival and freedom from aortic events were analyzed using a Kaplan-Meier surviving curve and a log-rank test. Results: Except 1 patient receiving emergent surgery (within 24 hours from onset) because of cardiac tamponade and cerebral malperfusion, all patients received initial medical treatment and delayed surgery. Two patient developed pericardial tamponade while waiting for surgery, and then received emergent surgery. Preoperative conversion to aortic dissection (AD) was noted in no patient. The operative techniques included ascending aorta replacement in 9 patients, hemiarch replacement in 18 patients, total arch replacement (TAR) with frozen elephant trunk (FET) in 45 patient and hybrid aortic arch repair in 34 patients. The mean cardiopulmonary bypass (CPB) time and cross-clamp time were 138.7±41.6 and 79.3±27.8 min, respectively. The operative mortality was 1.9% (2/106). And the composite endpoints occurred in 7 patients. Multivariable logistic regression analysis showed CPB time ≥200 min and chronic kidney disease were risk factors for the composite endpoints. The follow-up data were available in 97 survivors, with the mean follow-up time of 30.8±16.2 months. Three patients died and 5 patients developed aortic events during the follow-up. The overall survival at 1-, 3- and 5-year were 97.0%, 95.3%, and 79.4%, respectively. And freedom from aortic events at 1-, 3- and 5-year were 97.7%, 95.3% and 89.4%, respectively. Conclusions: Our strategy had got low mortality and excellent mid-term survival in patients with type A IMH. Therefore, our strategy was suitable for the surgical repair of type A IMH in Chinese population.

Background: Primary cardiac lipoma is very rare, and no consensus has been developed regarding its ideal treatment strategy. This study reviewed the surgical treatment of cardiac lipomas in 20 patients over 20 years. Methods: Twenty patients with cardiac lipomas were treated at Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College from January 1, 2002, to January 1, 2022. The patients’ clinical data and pathological reports were retrospectively analyzed, and the follow-up with a range of 1 year to 20 years was conducted. Results: The cardiac lipomas were located in the right atrium (RA) or superior vena cava (SVC) in seven patients (35%) (RA in six patients and SVC in one patient), left ventricle in eight patients (40%) (left ventricular chamber in four patients and left ventricular subepicardium and myocardium in four patients), right ventricle in three patients (15%) (right ventricular chamber in one patient and right ventricular subepicardial layer and myocardium in two patients), subepicardial interventricular groove in one patient (5%), and pericardium in one patient (5%). Complete resection was achieved in 14 patients (70%), including seven patients with lipomas in the RA or SVC. Incomplete resection occurred in six patients (30%) with lipomas in the ventricles. No perioperative deaths occurred. Long-term follow-up was conducted for 19 patients (95%), including two (10%) who died. Both patients who died had lipomas incompletely resected due to ventricles involvement, and preoperative malignant arrhythmias persisted post-operatively. Conclusions: The complete resection rate was high, and the long-term prognosis was satisfactory in patients with cardiac lipomas that did not involve the ventricle. The complete resection rate was low in patients with cardiac lipomas in ventricles; and complications, including malignant arrhythmia, were common. Failure of complete resection and post-operative ventricular arrhythmia are correlated with post-operative mortality.

Objective: To develop and validate a nomogram model to predict postoperative 30-day mortality in acute type A aortic dissection patients receiving total aortic arch replacement with frozen elephant trunk technique. Method: Clinical data on 1,156 consecutive acute type A aortic dissection patients who got total aortic arch replacement using the frozen elephant trunk technique was collected from January 2010 to December 2020. These patients were divided into training and testing cohorts at random with a ratio of 7:3. To predict postoperative 30-day mortality, a nomogram was established in the training set using the logistic regression model. The novel nomogram was then validated in the testing set. The nomogram's calibration and discrimination were evaluated. In addition, we created four machine learning prediction models in the training set. In terms of calibration and discrimination, the nomogram was compared to these machine learning models in testing set. Results: Left ventricular end-diastolic diameter <45 mm, estimated glomerular filtration rate 4 h were independent predictors of the 30-day mortality. The nomogram based on these 6 predictors manifested satisfying calibration and discrimination. In testing set, the nomogram outperformed the other 4 machine learning models. Conclusion: The novel nomogram is a simple and effective tool to predict 30-day mortality rate for acute type A aortic dissection patients undergoing total aortic arch replacement with frozen elephant trunk technique.

Background: The triglyceride‐glucose index (TyG), a novel marker of insulin resistance, is recognised as a risk factor for multiple cardiovascular diseases. The link between its risk and aortic dissection and aortic aneurysm (AD/AA) is not well‐defined. This research seeks to explore the relationship. Methods: This study analysed 386 063 participants from the UK Biobank, a large prospective cohort, all initially free of AD/AA. The main focus was on the occurrence rate of AD/AA. Multivariate Cox regression models were used to analyse the association between the TyG index, its related parameters, and the risk of AD/AA. Association was further validated using a real‐world clinical cohort from Central China Fuwai Hospital. A two‐sample Mendelian randomisation (MR) analysis utilising the inverse variance weighting method was conducted to investigate the causal link between TyG and AD/AA. Result: Among the 386 063 participants in the UK Biobank cohort, 3805 cases of AD/AA were reported. After controlling for covariates, a higher TyG index and its related parameters were associated with an increased incidence of AD/AA. The hazard ratios (HRs) were as follows: TyG (HR = 1.14, 95% CI: 1.07–1.22, p <.001), TyG‐WHR (HR = 1.17, 95% CI: 1.12–1.22, p <.001), and TyG‐WHtR (HR = 1.11, 95% CI: 1.06–1.16, p <.001). Association between TyG and the risk of aortic diseases was also replicated in the single‐centre cohort. Two‐sample MR analysis indicated strong evidence of a causal relationship between genetically predicted TyG levels and AA (OR = 1.97, 95% CI: 1.37–2.84, p <.001), while no significant association was observed with AD (OR = 0.79, 95% CI: 0.31–1.99, p = .61). Conclusion: Through complementary epidemiological, clinical, and genetic approaches, our findings indicate that elevated TyG index represents a robust and potentially causal risk factor for aortic diseases (especially AA). These results highlight the importance of metabolic risk assessment in aortic disease prevention and emphasise the need for further mechanistic studies to understand the differential links between TyG and specific aortic phenotypes. Highlights: Higher TyG index and related ratios are linked to increased AD/AA risk. Prospective cohort analysis confirms robust linear associations. Mendelian randomisation supports a causal role of TyG in AA. Findings highlight TyG as a potential target for early prevention.