Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Ventricular assist devices in functionally univentricular hearts.","authors":"Maruti Haranal, Thakut Gowtham","doi":"10.1007/s12055-025-01900-3","DOIUrl":"10.1007/s12055-025-01900-3","url":null,"abstract":"<p><p>The enhanced survival rates of patients with functionally univentricular hearts can be credited to the ongoing development of surgical techniques and improved perioperative care. Hence, the population of single ventricle patients reaching the treating physician is increasing. Many of these patients go on to develop end-stage heart failure and may need a heart transplant. In this subgroup, the scarcity of donors calls for the potential necessity of employing mechanical circulatory support to facilitate heart transplantation. Ventricular assist devices are crucial in supporting the failing myocardium and improving systemic perfusion and tissue oxygenation. However, their implantation poses significant challenges due to the unique intrinsic anatomical and physiological characteristics of these patients. There is mounting evidence bolstering the use of ventricular assist devices in a subset of patients with functionally univentricular hearts. The purpose is to examine the evolution and current role of ventricular assist devices in this spectrum of patients, including its challenges and outcomes.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"892-905"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgically implanted temporary ventricular assist pump - \"Impella 5.5\".","authors":"Akshay Chauhan, Mikiko Senzai, Sriram Vijayapuri, Hiromu Kehara, Roh Yanagida, Kewal Krishan, Yoshiya Toyoda","doi":"10.1007/s12055-025-01946-3","DOIUrl":"10.1007/s12055-025-01946-3","url":null,"abstract":"<p><p>The Impella 5.5 (Abiomed, Danvers, MA, USA) is an advanced left ventricular assist device that provides short-term cardiac support for patients with severe heart failure and cardiogenic shock. Its compact size and catheter-based design facilitate relatively straightforward insertion, offering mechanical support to the left ventricle without significantly increasing afterload-two key advantages. A substantial body of clinical trials and real-world evidence have confirmed its efficacy in enhancing cardiac output and organ perfusion. Notably, its short-term support has been associated with improved patient outcomes in cases of cardiogenic shock. However, the use of Impella is not without risks, including bleeding events, peripheral vascular complications, and hemolysis, underscoring the importance of appropriate patient selection, surgical planning, and meticulous post-insertion management. Future research should focus on long-term outcomes, cost-effectiveness, and continued advancements in technology. This review provides a comprehensive analysis of the Impella device, including its design, clinical applications, surgical strategies, benefits, and indications, as well as the challenges associated with its use. It reassesses its role considering the most recent evidence.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"906-910"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of the maze procedure for postoperative sinus rhythm restoration with and without concomitant tricuspid annuloplasty during mitral valve surgery.","authors":"Fumio Yamana, Keitaro Domae, Masatoshi Hata, Yukitoshi Shirakawa, Takafumi Masai, Yoshiki Sawa","doi":"10.1007/s12055-025-01894-y","DOIUrl":"10.1007/s12055-025-01894-y","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited studies evaluating the impact of concomitant tricuspid annuloplasty (TAP) on maze surgery outcomes in atrial fibrillation (AF) patients undergoing mitral valve (MV) surgery. This study aimed to assess the efficacy of the maze procedure in restoring sinus rhythm (SR) post-MV surgery, with and without concomitant TAP.</p><p><strong>Methods: </strong>We reviewed 88 patients who underwent MV surgery with the maze procedure from January 2010 to December 2020. The primary endpoints included the 5-year postoperative SR restoration rate in patients undergoing bi-atrial maze (BM) versus left atrial maze (LM) procedures, with and without concomitant TAP, and the identification of risk factors for postoperative arrhythmia in the total cohort. Secondary outcomes included hospital mortality, postoperative heart failure, stroke, and pacemaker implantation.</p><p><strong>Results: </strong>The 30-day mortality rate in the study population was 2.3%. There was no significant difference in SR restoration at hospital discharge between the BM and LM groups (BM, 76.2%; LM, 73.9%; <i>p</i>=0.80). In patients who did not undergo TAP, the 5-year SR restoration rates between the BM and LM groups were not significantly different (log-rank test: <i>p</i>=0.65). However, in those undergoing TAP, the BM group demonstrated a significantly higher 5-year SR restoration rate compared to the LM group (BM+TAP, 74.2% vs LM+TAP, 42.1%; log-rank test: <i>p</i>=0.044). Multivariate analysis identified TAP with the LM procedure (hazard ratio (HR), 2.94; 95% confidence interval (CI), 1.25-6.92; <i>p</i>=0.014) and long-standing persistent atrial fibrillation (AF) (HR, 3.35; 95% CI, 1.46-7.68; <i>p</i>=0.0044) as significant predictors of postoperative arrhythmia.</p><p><strong>Conclusion: </strong>The BM procedure may be crucial in restoring postoperative SR, particularly in patients undergoing concomitant TAP during MV surgery.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01894-y.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"843-851"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-stage paediatric heart failure in low- and middle-income countries: challenges in surgical management.","authors":"Komarakshi Balakrishnan","doi":"10.1007/s12055-024-01853-z","DOIUrl":"10.1007/s12055-024-01853-z","url":null,"abstract":"<p><strong>Purpose: </strong>To define the challenges faced in the surgical treatment of end-stage heart failure in low- and middle-income countries and offer possible solutions.</p><p><strong>Methods: </strong>The World Bank definition of low- and middle-income countries (LMIC) is gross national income less than US $1085 and US $4255 respectively. In this list, India is the only country with a significant paediatric heart transplant and mechanical circulatory support programme. Hence, the Indian experience was used as an example in this study. A total of 141 children less than or equal to 18 years underwent a heart transplant over a 10-year period in a single surgical unit. The youngest was 8 months old. Twenty children were younger than 5 years of age and 58 were less than 10 years. The major problems to overcome were shortage of paediatric donors, challenges in organ transport, challenges in keeping sick recipients alive while awaiting a donor heart and dealing with cost implications and long-term care. A third of these patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) I or II. Fourteen percent were on mechanical circulatory support prior to transplant. Hospital mortality was defined as death within 90 days of transplant. The follow-up was up to 10 years.</p><p><strong>Results: </strong>The 90-day survival was 85.11%. The risk factors for hospital mortality were low INTERMACS (odds ratio - OR 0.3, <i>p</i> ~ 0.004), high creatinine (OR 3.6, <i>p</i> ~ 0.06) and high pretransplant right atrial pressure more than 15 mm Hg (OR 4.7, <i>p</i> ~ 0.03). The Kaplan-Meier survival curve showed a survival of over 70% at 10-year follow-up. The donors were typically older and the donor to recipient weight ratio was also significantly more than in published literature. Donor age more than 25 years had poorer outcomes long term. The economic challenges of running a programme in LMIC economies are enormous and need several innovative solutions including routine use of commercial aircrafts for organ transport.</p><p><strong>Conclusions: </strong>Despite numerous challenges, a successful paediatric heart transplant programme is possible in LMIC countries with outcomes comparable to published data.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-024-01853-z.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"768-783"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free surgery for CHD through philanthropy-a sustainable model?","authors":"Prabhatha Rashmi Murthy, Sowmya Jandhyala, Shaun Prasanth Setty, Sreenivas Chodagam","doi":"10.1007/s12055-024-01813-7","DOIUrl":"10.1007/s12055-024-01813-7","url":null,"abstract":"<p><p>Among the multiple challenges faced by children from low- and middle-income countries (LMICs) with congenital heart disease (CHD), the economics of care remains foremost, contributing significantly to morbidity and mortality. This paper evaluates the four existing finance models available for healthcare systems and proposes a new model-the GIVE model (government, institutions and individuals, values, and engagements)-as the fifth model for global sustainable healthcare systems. The paper presents an evaluation of a chain of three paediatric cardiac hospitals in India to assess the sustainability of their philanthropy-based operational model, through which surgeries are offered completely free of cost to children with CHD. The three Sri Sathya Sai Sanjeevani Centres for Child Heart Care in India have been proponents of this philanthropic model for over a decade. From February 2013 to January 2024, 19,684 patients with CHD received surgeries at no cost. The average cost of surgery was reported to be USD (United States Dollar) 1800. A case study of one of the Sanjeevani Centres showed that 23.8% of patients were in STAT Category 3 and above, as defined by the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery, with an in-hospital mortality rate of 2.08%. The evaluation highlighted the institution's numerous strategies to enable sustainability in key aspects of operations, economics, and social impact. Despite challenges, the Sai Sanjeevani philanthropic model, which encompasses both economic and social impact, is dependable and can be replicated. The proposed GIVE model is recommended for adoption by LMICs as a global way forward to enable free CHD surgeries through sustained philanthropy, strengthened by a shared vision and collaborations.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"672-685"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing the regressed left ventricle in late presenting TGA.","authors":"Dhananjay Prakash Malankar, Rajesh Sharma","doi":"10.1007/s12055-024-01880-w","DOIUrl":"10.1007/s12055-024-01880-w","url":null,"abstract":"<p><strong>Introduction: </strong>The arterial switch operation (ASO) remains the gold standard of care for neonates with transposition of great arteries (TGA). However, the timing and the choice of surgical procedure in children presenting late with transposition of great arteries with intact ventricular septum (TGA/IVS) and regressed left ventricle (rLV) is still a matter of debate. Evolution of the concept of left ventricular re-training with different techniques has led to a paradigm shift in the management of this subset of late presenting 'simple' transposition.</p><p><strong>Materials and methods: </strong>Literature review was done in Pubmed and Scopus to identify relevant articles pertaining to the pathophysiology and different treatment options for late presenting TGA with intact ventricular septum with an aim of writing a review on the subject.</p><p><strong>Results: </strong>Multiple treatment options have been reported in the literature varying from a single-stage operation to multi-stage procedure to achieve good long-term result. Majority are isolated case reports or case series with small number of children and only few studies have mid-term and long-term outcomes.</p><p><strong>Conclusions: </strong>In children presenting late with TGA and rLV, left ventricular re-training seems the most feasible and effective method. In hospital setups with cost constraints, other low-risk techniques can be attempted but corrective surgery will be needed in the future, thus making these procedures cost-shifting strategies rather than cost-saving procedures.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"756-767"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late presenting tetralogy of Fallot-surgical management.","authors":"Sachin Talwar, Niwin George, Vishal Vinayak Bhende, Balram Airan","doi":"10.1007/s12055-025-01949-0","DOIUrl":"10.1007/s12055-025-01949-0","url":null,"abstract":"<p><p>Late presentation of tetralogy of Fallot (TOF) poses unique diagnostic and management challenges, differing significantly from those diagnosed and treated in infancy. This review discusses the definition and natural history of late-presenting TOF, emphasizing the surgical and perioperative considerations specific to this population. We also explore the role of phlebotomy in managing polycythemic patients, a practice not universally adopted, and highlight postoperative challenges, including residual defects and complications. While discussing the surgical correction of TOF, we analyse the outcomes of specific strategies and the role of elective pulmonary valve replacement in adult patients. This comprehensive overview aims to shed light on the nuances of managing these complex cases.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"730-744"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of pediatric cardiac surgery in Indonesia-a thousand islands and a handful of centers.","authors":"Budi Rahmat, Putu Wisnu Arya Wardana","doi":"10.1007/s12055-024-01793-8","DOIUrl":"10.1007/s12055-024-01793-8","url":null,"abstract":"<p><p>Providing good medical access for patients with congenital heart disease (CHD) is still a significant issue in most developing countries, including Indonesia. With approximately 50,000 newborns with CHD annually, the development of pediatric cardiac surgery in Indonesia needs to be intensified. After the establishment of the National Cardiovascular Center Harapan Kita in 1985, followed by other centers, the development of pediatric cardiac surgery in Indonesia has surpassed several milestones in treating CHD. However, some main problems, including lack of human, medical, and financial resources, lack of education centers, and uneven distribution of the centers, still need to be solved urgently with the cooperation of medical health providers, the government, and the stakeholders.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"807-811"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric cardiac intensivists in low-middle-income countries - necessity or dispensable luxury?","authors":"Parvathi Unninayar Iyer, Krishna Subramony Iyer","doi":"10.1007/s12055-025-01928-5","DOIUrl":"10.1007/s12055-025-01928-5","url":null,"abstract":"<p><p>Pediatric cardiac intensive care (PCIC) is now a well-recognized specialty in the well-resourced developed world, and its need and utilization in optimal delivery of care for congenital heart disease (CHD) especially congenital heart surgery (CHS) is well established. The delivery of CHD care in low- and middle-income countries (LMICs) continues to face numerous challenges, not the least of which is the availability of resources to develop and maintain PCIC units and the pediatric intensivists to man them. This article explores the question as to whether reliable PCIC is feasible in LMICs and remains a necessity, or if it is dispensable. The article also looks at the current status and challenges of PCIC in resource-limited environs.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"697-703"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The single ventricle presenting late: surgical options.","authors":"Sachin Talwar, Supreet Marathe, Manan Desai, Navnita Kisku, Vishal Vinayak Bhende","doi":"10.1007/s12055-025-01948-1","DOIUrl":"10.1007/s12055-025-01948-1","url":null,"abstract":"<p><p>The term single ventricle (SV) comprises a wide variety of congenital anomalies with a structurally or functionally univentricular heart where a biventricular repair is not possible or undesirable. The surgical management of these patients is often staged and the ultimate palliation is the Fontan operation (FO). Despite advances in surgical techniques, significant challenges persist in the management of SV patients, particularly in low- and middle-income countries (LMICs), where delayed presentation and limited healthcare access are common. This review explores current management strategies for patients beyond childhood, including those who have never undergone palliation and post-Fontan patients facing long-term complications. Key topics include the surgical approaches to SV, such as pulmonary artery banding (PAB), bidirectional Glenn (BDG), and FO, with particular focus on considerations for late-presenting adults in LMICs. The disparities in healthcare resources between high-income countries and LMICs are highlighted, demonstrating that resource constraints significantly impact timely interventions and on-going follow-up care.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 6","pages":"745-755"},"PeriodicalIF":0.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}