{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T06:11:18Z","timestamp":1784268678265,"version":"3.55.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014125","name":"Fujian Provincial Health Commission","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic inflammatory response is an important biological factor that determines morbidity after cardiac interventions. Minimally invasive cardiac surgery (MICS) was conceived to reduce surgical trauma but the subtle dynamics of its effect on the clearance of systemic inflammation is an ongoing research target. The aim of the present study was to investigate divergent inflammatory recovery trajectories of MICS and traditional MS with a multidimensional surrogate marker of immunological stress, the Systemic Inflammation Response Index (SIRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study reviewed patients undergoing elective mitral valve surgery between February 2022 and February 2024; of 269 initially identified patients, 235 were eligible, and propensity score matching yielded 89 matched pairs for analysis. SIRI (combination of neutrophils\u2009\u00d7\u2009 monocytes\/lymphocytes) was evaluated at baseline, postoperative day (POD) 1 and POD 5. The main endpoint was the \u201cinflammatory resolution velocity\u201d measured by relative change from baseline (\u0394SIRI).\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05 was considered statistically significant. In addition, the prognostic value of \u0394SIRI in predicting postoperative pulmonary complications (PPCs) was carefully analyzed using Receiver Operating Characteristic (ROC) analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our data showed that there was an acute and uniform inflammatory surge in both groups on POD 1 with no significant statistical divergence (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.619) in the \u0394SIRI values. By POD 5, however, the difference in \u0394SIRI was significant between the two groups, with the MICS group demonstrating a greater re-equilibration to baseline levels than MS group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Interestingly, this improved inflammatory clearance in the MICS group occurred in the context of much longer operative times and cardiopulmonary bypass times (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), implying that the decreased inflammatory may effect of less tissue damage in this group overcame the inflammatory impact of longer cardiopulmonary bypass time. In terms of clinical utility, \u0394SIRI on POD 1 was a good early-warning biomarker for PPCs for both surgical approaches [AUC: MICS\u2009=\u20090.696 (95% CI: 0.530\u20130.841); MS\u2009=\u20090.762 (95% CI: 0.483\u20130.955)]; and the rates of major morbidity and mortality were comparable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MICS may reduce systemic inflammatory resolution time, defined by the kinetic of SIRI, creating optimal physiological environment for systemic inflammatory resolution, which may accelerate functional recovery and cardiac rehabilitation after MICS vs. conventional sternotomy. The data suggests a possible biological basis of sternal sparing techniques with regard to the \u201cinflammatory window\u201d and patient oriented outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1891255","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:45:23Z","timestamp":1784267123000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Does sternal-sparing outweigh prolonged bypass? inflammatory resolution in MICS versus median sternotomy: a SIRI-based analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Chang","family":"Wang","sequence":"first","affiliation":[{"name":"Fujian Medical University Heart Center","place":["Fuzhou, Fujian, China"]},{"name":"Fujian Institute of Coronary Artery Disease, Fujian Medical University, Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huangwei","family":"Li","sequence":"additional","affiliation":[{"name":"Fujian Medical University Heart Center","place":["Fuzhou, Fujian, China"]},{"name":"Fujian Institute of Coronary Artery Disease, Fujian Medical University, Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingsong","family":"Wu","sequence":"additional","affiliation":[{"name":"Fujian Medical University Heart Center","place":["Fuzhou, Fujian, China"]},{"name":"Fujian Institute of Coronary Artery Disease, Fujian Medical University, Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linfeng","family":"Xie","sequence":"additional","affiliation":[{"name":"Fujian Medical University Heart Center","place":["Fuzhou, Fujian, China"]},{"name":"Fujian Institute of Coronary Artery Disease, Fujian Medical University, Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaming","family":"Gao","sequence":"additional","affiliation":[{"name":"Fujian Medical University Heart Center","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liangwan","family":"Chen","sequence":"additional","affiliation":[{"name":"Fujian Medical University Heart Center","place":["Fuzhou, Fujian, China"]},{"name":"Fujian Institute of Coronary Artery Disease, Fujian Medical University, Union Hospital","place":["Fuzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1053\/j.jvca.2008.08.007","article-title":"The inflammatory response to cardiopulmonary bypass: Part 1\u2014mechanisms of pathogenesis","volume":"23","author":"Warren","year":"2009","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B2","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/imi.0b013e3182167feb","article-title":"Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review","volume":"6","author":"Cheng","year":"2011","journal-title":"Innovations (Phila)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.athoracsur.2024.01.007","article-title":"The society of thoracic surgeons 2023 clinical practice guidelines for the surgical treatment of atrial fibrillation","volume":"118","author":"Wyler von Ballmoos","year":"2024","journal-title":"Ann Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/cncr.30057","article-title":"A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy","volume":"35","author":"Qi","year":"2016","journal-title":"Cancer Commun (Lond)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.3390\/jcm12031128","article-title":"Systemic immune inflammation Index (SII), system inflammation response Index (SIRI) and risk of all-cause mortality and cardiovascular mortality: a 20-year follow-up group study of 42,875 US adults","volume":"12","author":"Xia","year":"2023","journal-title":"J Clin Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"7110","DOI":"10.3390\/jcm11237110","article-title":"The systemic inflammation response Index (SIRI) predicts mortality in patients with acute coronary syndrome","volume":"11","author":"Weber","year":"2022","journal-title":"J Clin Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.26355\/eurrev_202302_31196","article-title":"A novel predictor in patients undergoing heart valve surgery: systemic inflammation response index: a single center cross-sectional study","volume":"27","author":"Kara\u00e7al\u0131lar","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.3390\/cells11071124","article-title":"Neutrophil counts, neutrophil-to-lymphocyte ratio, and systemic inflammatory response index (SIRI) predict mortality after off-pump coronary artery bypass surgery","volume":"11","author":"Urbanowicz","year":"2022","journal-title":"Cells"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e0276138","DOI":"10.1371\/journal.pone.0276138","article-title":"Pre-operative systemic inflammatory response index influences long-term survival rate in off-pump surgical revascularization","volume":"17","author":"Urbanowicz","year":"2022","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3425","DOI":"10.3390\/curroncol29050276","article-title":"Inflammatory indexes as predictive biomarkers of postoperative complications in oncological thoracic surgery","volume":"29","author":"Ginesu","year":"2022","journal-title":"Curr Oncol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1093\/icvts\/ivx090","article-title":"Minimally invasive heart valve surgery: influence on coagulation and inflammatory response","volume":"25","author":"Paparella","year":"2017","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/EJA.0000000000000118","article-title":"Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: european perioperative clinical outcome (EPCO) definitions","volume":"32","author":"Jammer","year":"2015","journal-title":"Eur J Anaesthesiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.3390\/diagnostics15121488","article-title":"Predictive role of systemic inflammatory indices in surgically managed postpericardiotomy syndrome following cardiac surgery","volume":"15","author":"Y\u00fccel","year":"2025","journal-title":"Diagnostics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.jtcvs.2012.04.020","article-title":"An open randomized controlled trial of median sternotomy versus anterolateral left thoracotomy on morbidity and health care resource use in patients having off-pump coronary artery bypass surgery: the Sternotomy Versus Thoracotomy (STET) trial","volume":"146","author":"Rogers","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1766","DOI":"10.1161\/CIRCRESAHA.121.318005","article-title":"Immune cells and immunotherapy for cardiac injury and repair","volume":"128","author":"Rurik","year":"2021","journal-title":"Circ Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e40904","DOI":"10.1097\/MD.0000000000040904","article-title":"New systemic inflammatory indices as predictors of ascending aortic dilation in children with bicuspid aortic valve: a retrospective cross-sectional study","volume":"103","author":"Y\u00fckc\u00fc","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e20240266","DOI":"10.21470\/1678-9741-2024-0266","article-title":"Association of aortic cross-clamping time with systemic immune inflammation and systemic inflammatory response indexes in isolated coronary bypass surgery","volume":"40","author":"Durmaz","year":"2025","journal-title":"Braz J Cardiovasc Surg"},{"key":"B18","first-page":"76","article-title":"Minimally invasive versus conventional aortic valve replacement: a prospective randomized trial","volume":"12","author":"Dogan","year":"2003","journal-title":"J Heart Valve Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1111\/j.1423-0410.2008.01100.x","article-title":"Transfusion-related immunomodulation: a second hit in an inflammatory cascade?","volume":"95","author":"Bilgin","year":"2008","journal-title":"Vox Sang"},{"key":"B20","doi-asserted-by":"publisher","first-page":"7632","DOI":"10.3390\/jcm14217632","article-title":"Systemic inflammatory response index as a predictor of postoperative infectious complications in elderly patients undergoing posterior spinal instrumentation","volume":"14","author":"Agar","year":"2025","journal-title":"J Clin Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"667","DOI":"10.2147\/JIR.S505797","article-title":"Relationship between novel inflammatory indices and the incidence of postoperative pneumonia after endovascular embolization for aneurysmal subarachnoid hemorrhage","volume":"18","author":"Li","year":"2025","journal-title":"J Inflamm Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1177\/15569845241264565","article-title":"Maximizing minimally invasive cardiac surgery with enhanced recovery (ERAS)","volume":"19","author":"Salenger","year":"2024","journal-title":"Innovations (Phila)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","volume":"44","author":"DeLong","year":"1988","journal-title":"Biometrics"},{"key":"B24","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.ijcard.2016.08.227","article-title":"Minimally invasive cardiac surgery: a systematic review and meta-analysis","volume":"223","author":"Dieberg","year":"2016","journal-title":"Int J Cardiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/IMI.0000000000000236","article-title":"Minimally invasive versus conventional aortic valve replacement: a propensity-matched study from the UK National Data","volume":"11","author":"Attia","year":"2016","journal-title":"Innovations (Phila)"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1891255\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:45:24Z","timestamp":1784267124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1891255\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":26,"alternative-id":["10.3389\/fcvm.2026.1891255"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1891255","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]},"article-number":"1891255"}}