Thoracic and Cardiovascular Surgeon最新文献

{"title":"Radiation Exposure during Cardiac Interventions in Congenital Heart Defects: A Multicenter German Registry Analysis 2012-2020.","authors":"Anja Tengler, Jörg Michel, Claudia Arenz, UIrike Bauer, Jens Beudt, Alexander Horke, Gunter Kerst, Andreas Beckmann, Michael Hofbeck","doi":"10.1055/a-2514-7436","DOIUrl":"10.1055/a-2514-7436","url":null,"abstract":"<p><strong>Background: </strong>Interventional cardiac catheterizations have gained major importance in the treatment of congenital heart defects (CHDs). Since patients with CHDs frequently require lifelong medical care and sometimes subsequent invasive treatment, repeated radiation exposure during interventional procedures is a relevant issue concerning potential radiation-related risks. Therefore, a 9-year subanalysis on radiation data during interventional cardiac catheterizations from the German Registry for Cardiac Operations and Interventions in patients with CHDs was performed.</p><p><strong>Methods: </strong>The German Registry for Cardiac Operations and Interventions in Patients with CHDs is a real-world, prospective all-comers database collecting clinical and procedural data on invasive treatment of CHDs. From January 2012 until December 2020, a total of 28,374 cardiac catheter interventions were recorded. For a homogeneous case mix and for obtaining comparable data, eight specified interventions were selected for detailed evaluation. The selected procedures were: atrial septal defect (ASD)/patent foramen ovale (PFO) occlusion, patent ductus arteriosus (PDA) occlusion, ventricular septal defect (VSD) occlusion, coarctation of the aorta (CoA) balloon dilatation and stent implantation, aortic valvuloplasty, pulmonary valvuloplasty, and transcatheter pulmonary valve implantation (TPVI). Data on radiation exposure included total fluoroscopy time (TFT), dose area product (DAP), and DAP per body weight (DAP/BW).</p><p><strong>Results: </strong>The cohort accounted for 9,350 procedures, including 3,426 ASD/PFO occlusions, 2,039 PDA occlusions, 599 aortic and 1,536 pulmonary valvuloplasties, 383 balloon dilatations and 496 stent implantations for CoA, 168 VSD occlusions, and 703 TPVI. Six hundred and ten ASD/PFO procedures (17.8%) were performed without radiation. During the 9-year period, median annual TFT, DAP, and DAP/BW showed a continuous decrease while radiation burden correlated with intervention complexity: For ASD/PFO and PDA occlusion, aortic and pulmonary valvuloplasty as well as balloon dilatation of CoA the median DAP/BW was <20.0 μGy*m²/kg, while median values of 26.3 μGy*m²/kg and 31.6 μGy*m²/kg were noted for stent treatment of CoA and VSD closure, respectively. Radiation burden was highest in TPVI with a median TFT of 23.6 minutes, median DAP of 4,491 μGy*m², and median DAP/BW of 79.4 μGy*m²/kg.</p><p><strong>Conclusion: </strong>A decrease in radiation exposure was found in eight cardiac interventions from January 2012 to December 2020. Comparison with international registries revealed a good quality of radiation protection. The data underline the requirement of surveillance of radiation burden, especially in this patient group.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"e1-e10"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Need.","authors":"Markus K Heinemann","doi":"10.1055/s-0044-1801297","DOIUrl":"https://doi.org/10.1055/s-0044-1801297","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"73 1","pages":"1-2"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Endovascular Treatment of Complex Aortic Pathologies.","authors":"Levent Mavioglu, Hakki Zafer Iscan, Goktan Askin, Serkan Mola, Naim Boran Tumer, Ertekin Utku Unal","doi":"10.1055/a-2132-4571","DOIUrl":"10.1055/a-2132-4571","url":null,"abstract":"<p><strong>Aim: </strong>Multisegmented aortic pathologies present challenging issues independent of the treatment chosen. Whether open or endovascular, staged, or simultaneous, every treatment modality has its own pros and cons. We revealed our patients retrospectively with early and midterm results who had simultaneous endovascular thoracic and abdominal aortic repair for thoracic aortic pathologies and infrarenal abdominal aortic aneurysm (iAAA) as a single-center experience.</p><p><strong>Materials and methods: </strong>Between January 2016 and January 2021, 16 patients were diagnosed with thoracic aortic pathology and iAAA was simultaneously repaired in an endovascular manner. All patients were operated on with the same cardiovascular surgeon team.</p><p><strong>Results: </strong>The average age of the patients were 76.9 ± 6.2 (64-86) years. There was no early mortality. The technical success was 100%. In total, 18 thoracic endografts were deployed in 16 patients for thoracic aortic pathologies. Follow-up period was 21.85 ± 8.96 months, and in the follow-up period, two patients had a secondary intervention. One cardiac and one coronavirus disease 2019 mortality was detected in the follow-up period. There was no aneurysm-related mortality. The postoperative first-year survival was 84.6 ± 10.0.</p><p><strong>Conclusion: </strong>Simultaneous endovascular solution for complex multisegmented aortic pathologies provides a rapid, less-invasive approach with successful early and midterm morbidity, mortality with short intensive care unit period, and length of hospital stay. A combination of endovascular aortic aneurysm repair and thoracic endovascular aortic repair where anatomic suitability exists is a strong alternative over staged and hybrid therapies. Contrast-induced nephropathy, postimplantation syndrome, and spinal cord ischemia should be carefully monitored with this strategy.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"19-24"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex Differences in the Histopathology of Acute Type A Aortic Dissections.","authors":"Nimrat Grewal, Onur Baris Dolmaci, Robert Jm Klautz, Robert E Poelmann","doi":"10.1055/a-2239-1741","DOIUrl":"10.1055/a-2239-1741","url":null,"abstract":"<p><strong>Background: </strong>Although sex-related differences in cardiovascular surgery outcomes have increasingly garnered attention in the past decades, knowledge about sex disparities in the pathophysiology of acute type A aortic dissections (ATAADs) remains sparse. In this study, we evaluate the histopathologic and atherosclerotic lesions in female and male ATAAD patients.</p><p><strong>Methods: </strong>A total of 68 patients were studied: 51 ATAAD patients (mean age: 62.5 ± 10.8 years; 49% women) and 17 control patients (mean age: 63 ± 5.5 years; 53% women). Cardiovascular risk factors were assessed clinically. Intimal and medial histopathological features were systematically evaluated in all.</p><p><strong>Results: </strong>Compared to the control group, all ATAAD patients showed significantly more elastic fiber pathology, mucoid extracellular matrix accumulation, smooth muscle cell nuclei loss, and overall medial degeneration (<i>p</i> < 0.0001). The tunica intima was significantly thinner in the ATAAD patients than in the control group (<i>p</i> < 0.023), with the latter exhibiting significantly more progressive atherosclerotic lesions than the former. No difference in medial vessel wall pathology was seen between female and male patients. As compared to male ATAAD patients, atherosclerotic lesions were more severe in female ATAAD patients, independent of age and the cardiovascular risk factor hypertension.</p><p><strong>Conclusion: </strong>All ATAAD patients had a significantly thinner tunica intima and significantly diseased tunica media compared to the control patients. Our results suggest that the severity of medial aortic pathology is not sex specific in ATAAD patients. Intimal differences between females and males could, however, be considered a potential risk factor for the development of an aortic dissection.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"57-65"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Ethnic Distribution of Aortic Aneurysms in a Caribbean Cohort.","authors":"Michael J Ramdass, Shivani T Persad, Patrick Harnarayan","doi":"10.1055/a-2128-5016","DOIUrl":"10.1055/a-2128-5016","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data regarding relationships between patient demographics and aneurysm characteristics in the West Indies. With this in mind, a retrospective cross-sectional review was conducted analyzing the computed tomography aortogram reports/images of 273 aortic aneurysms.</p><p><strong>Methods: </strong>Data were collected and analyzed on ethnicity, size, type, morphology, presence and maximum size of thrombus and aneurysm location, demographics, and clinical presentation with correlations.</p><p><strong>Results: </strong>There were 273 patients with aortic aneurysms giving an incidence rate of 4.33 per 100,000 people per annum. Statistically significant associations were noted with age, gender, and ethnicity. All false aneurysms were male (<i>p</i> = 0.004). The average size of aortic aneurysms being 0.7 cm larger in males than females (<i>p</i> < 0.001). Females were more likely to present with rupture (<i>p</i> = 0.001). Thrombus was more likely in males, Black and mixed races, and in the 8th decade (<i>p</i> < 0.001). Mean age of presentation was the highest in East Indians at 78 than the other ethnicities (Chinese: 65, Black: 70, mixed: 71, White: 73).</p><p><strong>Conclusion: </strong>Aortic aneurysmal disease is increasing in Trinidad and the Caribbean. Infrarenal fusiform aneurysms are the most common types with many significant differences based on age, gender, and ethnicity in the Caribbean population.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"10-18"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9971170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solitary Fibrous Tumor of the Pleura: Surgical Treatment and Recurrence.","authors":"Mary Bove, Giovanni Natale, Gaetana Messina, Matteo Tiracorrendo, Erino Angelo Rendina, Alfonso Fiorelli, Antonio D'Andrilli","doi":"10.1055/s-0043-1777260","DOIUrl":"10.1055/s-0043-1777260","url":null,"abstract":"<p><strong>Background: </strong>Solitary fibrous tumors of the pleura (SFTPs) are primary pleural tumors originating from the mesenchymal tissue. Surgical treatment was the first choice for management of SFTPs. There were no defined guidelines for the follow-up of these tumors and the postoperative therapy due to the rarity of these tumors.</p><p><strong>Methods: </strong>We conducted a retrospective, multicenter study from two high-volume centers in Italy. Data of patients diagnosed with pleural solitary fibrous tumors between January 2003 and October 2022 were prospectively recorded and retrospectively analyzed. The aim of this study was to identify predictive prognostic factors and the correlation between tumor characteristics and recurrence.</p><p><strong>Results: </strong>In all, 107 patients undergoing R0 surgical resection of pleural solitary fibrous tumor were included in the study. Patients were divided in two groups: benign and malignant. All the patients were treated with surgery with the aim to obtain R0 resection. Lung resection was necessary when the tumor adhered strongly to the lung parenchyma or infiltrated it. Twenty of the 107 patients had tumor recurrence. At a multivariate analysis, histological characteristics (high mitotic index) and maximum standardized uptake values (maxSUV) were related to recurrence. The mean disease-free survival (DFS) was 143.3 ± 6.1 months.</p><p><strong>Conclusion: </strong>In our experience, histological features of malignancy and maxSUV are significantly related to recurrence, which can occur even years after the first diagnosis. Surgical excision with negative surgical margins results in good long-term outcomes. After surgery, a long-term and strict follow-up should be done, in order to detect recurrence early. R0 of the recurrence is associated with long-term survival.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"78-85"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Left Superior Vena Cava Correction: An Option for Left Ventricular Recruitment?","authors":"Frederike Bieling, Robert A Cesnjevar, Michela Cuomo, Annika Weigelt, Sven Dittrich, Ariawan Purbojo","doi":"10.1055/a-2531-3126","DOIUrl":"10.1055/a-2531-3126","url":null,"abstract":"<p><p>Left superior vena cava (LSVC)-related obstruction of mitral inflow is a rare condition in patients with complex cardiac anomalies like hypoplastic left heart complex. We report on the impact of establishing LSVC to right superior vena cava (RSVC) continuity on the growth of borderline hypoplastic left ventricular structures as an addendum to our previously published work.Twenty-two patients underwent LSVC to RSVC anastomosis, whereas six had LSVC ligation (<i>n</i> = 4) or clip closure (<i>n</i> = 2), all alongside congenital heart defect correction. The indication was LSVC-related obstruction of left ventricular inflow due to a dilated coronary sinus. Clinical data were systematically reviewed, with regular follow-up. Left ventricular end diastolic diameters (LVEDD), aortic valve diameters, and left ventricular outflow tract (LVOT) diameters were recorded using echocardiography.Follow-up showed 90% survival at 3.3 ± 0.4 years. Mean LVEDD Z-scores improved from -2.19 ± 0.35 to -1.24 ± 0.26 after repair (<i>p</i> < 0.01) and to -1.33 ± 0.56 at 6-month follow-up. In patients without mitral repair, LVEDD Z-scores improved from -2.11 ± 0.62 preoperatively to -1.85 ± 0.88 postoperatively (<i>p</i> < 0.05). LVOT Z-scores increased from -2.49 ± 0.48 to -0.87 ± 0.75 (<i>p</i> < 0.05) and aortic valve Z-scores improved from -1.08 ± 0.57 to 0.5 ± 0.39 over 24 months (<i>p</i> < 0.05).Anatomical LSVC correction may improve left ventricular filling and growth of the left ventricle, aortic valve, and LVOT in patients with borderline left ventricles and could be considered without as a potential recruitment strategy.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"73 S 03","pages":"e21-e30"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopic Management of Central Airway Obstruction in Children after Heart Surgery.","authors":"Omer Ayten, Cengiz Özdemir, Levent Dalar, Ali Riza Karaci","doi":"10.1055/a-2635-3320","DOIUrl":"10.1055/a-2635-3320","url":null,"abstract":"<p><p>Central airway stenosis following congenital heart malformation surgery is a rare but significant cause of postoperative weaning failure. In selected cases, bronchoscopic interventions are effective treatment options for managing these kind of airway obstructions and achieving successful weaning.The data of six pediatric patients who were unable to be weaned from mechanical ventilation due to central airway obstruction following congenital heart malformation surgery were retrospectively analyzed. Rigid and flexible bronchoscopies were performed under general anesthesia for six patients.Six patients (4 males and 2 females; age range: 4 months to 6 years) with an airway obstruction after surgery due to congenital heart malformations included the study. Three patients had an obstruction of the left main bronchus, two of the right main bronchus, and one of bilateral main bronchus. Balloon dilatation was applied to one patient, mechanical dilatation was applied to three patients, and airway stent was applied to two patients. Two of six patients died from nonprocedural causes (acute respiratory distress syndrome due to pneumonia and cardiac arrest due to severe heart failure) and four patients were weaned successfully from mechanical ventilation and they were still alive during the follow-up period. No procedural-related mortality was seen in the study population. In one patient, stent placement could not be performed due to desaturation and hemodynamic instability during the procedure, and in another patient, granulation tissue developed due to a covered metallic stent, and the metallic stent was removed and replaced with a biodegradable stent.In selected cases, bronchoscopic interventions offer efficient approach to managing airway obstructions due to congenital heart malformation surgery.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"73 S 03","pages":"e39-e45"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trilateral versus Bilateral Antegrade Cerebral Perfusion in Frozen Elephant Trunk: A Propensity Score Analysis.","authors":"Razan Salem, Arnaud Van Linden, Jan Hlavicka, Afsaneh Karimian-Tabrizi, Ina Ischewski, Thomas Walther, Tomas Holubec","doi":"10.1055/a-2228-7189","DOIUrl":"10.1055/a-2228-7189","url":null,"abstract":"<p><strong>Objective: </strong>Spinal cord injury (SCI) with subsequent paraplegia and/or stroke after arch repair with frozen elephant trunk (FET) remain the most devastating complications. In this study, we aim to examine the impact of different cerebral perfusion strategies on the neurological outcome comparing bilateral antegrade cerebral perfusion (bACP) and trilateral antegrade cerebral perfusion (tACP).</p><p><strong>Methods: </strong>Between 2009 and 2021, 88 patients underwent total arch replacement using a hybrid prosthesis in FET technique for acute (40.4%) and chronic (59.6%) aortic pathologies. After excluding 14 patients who underwent FET with unilateral ACP the remaining 74 patients were divided into two groups. Propensity score matching was performed based on pre- and perioperative patient characteristics resulting in 22 patients in each group. The primary endpoint was a combination of major cerebral event and SCI. Secondary end point was all-cause mortality.</p><p><strong>Results: </strong>Major cerebral events occurred in 9% of the patients in bACP versus 13.6% in tACP group (<i>p</i> = 0.63). No postoperative SCI was observed in patients with bACP and only one patient suffered SCI with tACP (<i>p</i> = 0.31). There was no significant difference in 30-day mortality between the two groups (22.7% in bACP vs. 13.6% in tACP; <i>p</i> = 0.43).</p><p><strong>Conclusion: </strong>In patients undergoing total aortic arch repair using FET technique, both perfusion strategies (bilateral and trilateral ACP) are safe and effective. The rates of neurological complications as well as mortalities are acceptably low in both groups. Further studies with larger patient cohorts are warranted.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"25-32"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138802884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 27-Year Experience with Atrioventricular Septal Defect Correction.","authors":"Mina Farag, Mireia Isern Hacker, Philippe Grieshaber, Elizabeth Fonseca Escalante, Matthias Karck, Raoul Arnold, Matthias Gorenflo, Tsvetomir Loukanov","doi":"10.1055/a-2536-8640","DOIUrl":"10.1055/a-2536-8640","url":null,"abstract":"<p><p>This single-center study investigated long-term outcomes after surgical correction of atrioventricular septal defect (AVSD).A total of 248 patients underwent biventricular repair for AVSD between 1995 and 2022. A total of 208 (83.9%) patients had complete (cAVSD), 29 (11.7%) partial (pAVSD), and 11 (4.4%) transitional AVSD (tAVSD). Associated cardiovascular anomalies were present in 88 (35.5%) cases and 61 (24.6%) patients were born prematurely. Median age at repair was 7.1 for cAVSD, 23.7 for pAVSD, and 13 months for tAVSD.Overall survival or reoperation incidence did not differ significantly between AVSD types and improved significantly over surgical eras. Survival of the entire cohort was 88.3% at 10, 83.8% at 15, and 79.6% at 25 years. Prematurity (hazard ratio [HR]: 2.43, <i>p</i> = 0.029), low weight (<4 kg) (HR: 3.05, <i>p</i> = 0.028), and partial cleft closure (HR: 2.43, <i>p</i> = 0.037) were independent risk factors for mortality. Forty-eight patients (19.4%) underwent a total of 64 reoperations over the study period. The main indication for reoperation was left atrioventricular valve regurgitation (LAVVR) with 55/64 procedures. However, 36% of procedures were performed to address several lesions, with left ventricular outflow tract obstruction being the second most common indication. Freedom from reoperation was 78.2, 75.8, and 72.5% at 10, 15, and 25 years, respectively. The incidence of reoperation increased significantly in association with early postoperative LAVVR ≥ I-II° (HR: 2.6, 95% confidence interval [CI]: 1.4-4.7, <i>p</i> = 0.002) and presence of residual cardiac defects (HR: 2.0, 95% CI: 1.1-3.6, <i>p</i> = 0.018).While LAVVR is the main indication for reoperation, a significant proportion of procedures address additional pathologies. Premature patients and those with associated cardiovascular anomalies should receive special attention during postoperative follow-up.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":"73 S 03","pages":"e11-e20"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11970461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}