ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

{"title":"Ross procedure: Evidence for pulmonary autograft and early outcomes.","authors":"Meilynn Shi, Christopher K Mehta, Robert O Bonow, Jyothy J Puthumana, Mohamed Mh Al-Kazaz, Olga Kislitsina, Tom Liu, Alexis Attinoto, Seokyung An, S Chris Malaisrie","doi":"10.1177/02184923261441658","DOIUrl":"10.1177/02184923261441658","url":null,"abstract":"<p><p>BackgroundRenewed interest in the Ross procedure in young adults has been tempered by questions over safety and early outcomes. This paper examines our institution's 1-year outcomes of the Ross procedure.MethodsFrom November 2019 to February 2025, 136 consecutive adult patients underwent a Ross procedure at an urban tertiary center. The first 50 patients had follow-up beyond 1 year and constitute the study group of this case series.ResultsMedian age was 41 years (IQR: 30, 47). The majority were male (<i>n</i> = 34, 68%). The most common indication for surgery was aortic stenosis with or without aortic regurgitation (AR) (<i>n</i> = 34, 68%), followed by pure AR (<i>n</i> = 14, 28%), then aortic aneurysm with valve dysfunction (<i>n</i> = 2, 4%). Valve morphology was bicuspid in 22 (44%) patients, unicuspid in 21 (42%), and tricuspid in 5 (10%). Primary etiology was congenital in 42 (84%) patients, degenerative in 2 (4%), failed mechanical valve in 2 (4%), healed endocarditis in 1 (2%), rheumatic disease in 1 (2%), radiation-induced in 1 (2%), and unknown in 1 (2%). Redo sternotomy was performed in 2 (4%) patients, ascending aorta replacement in 43 (86%), hemiarch replacement in 22 (44%), and external aortic annuloplasty ring in 23 (46%). In-hospital and 30-day mortality was 0%, with 2 (4%) permanent strokes post-operatively but with no or minimal residual deficits. There was 1 mortality at 1.1 years, 1 autograft re-intervention at 1.8 years, 1 autograft re-intervention at 4.1 years, and 1 homograft re-intervention at 2.7 years.ConclusionThis paper demonstrates early safety of the Ross procedure for adults. More longitudinal data is needed to determine long-term efficacy and durability.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"346-354"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A modified David V: Technique and outcomes from a large single centre experience.","authors":"Robert Fleck, Melissa G Medina, Christopher K Mehta, Beth Whippo, Yunda Wang, Anirudha S Chandrabhatla, Kira Gerweck, Meilynn Shi, S Chris Malaisrie","doi":"10.1177/02184923261433401","DOIUrl":"10.1177/02184923261433401","url":null,"abstract":"<p><p>IntroductionReplacement of the aortic root with a composite valve-graft and coronary reimplantation is the most widely performed operation for patients requiring aortic root replacement; however valve sparing operations have been developed to preserve the aortic valve in certain populations. Since they were first introduced, the remodeling and reimplantation techniques have undergone many refinements and modifications. We describe the technical steps and outcomes of a modified David V procedure, adapted from the Stanford modification, performed at our institution.MethodsBetween November 2007 and March 2025, 417 patients underwent valve-sparing aortic root replacement at our institution. Of those, 185 patients underwent an adapted Stanford modification of valve-sparing aortic root replacement. A retrospective review of these patients was performed from a prospectively maintained institutional database.ResultsMean age was 47.6 ± 15.7 years and 81% were male. About 20.5% of patients had a heritable thoracic aortic disorder and 22.1% had a bicuspid aortic valve. The technique of our modified David V procedure is described. There was one post-operative mortality (0.5%) and no 30-day reinterventions. Early postoperative echocardiographic follow-up within 90 days was available in 91% of patients (<i>n</i> = 168), with no cases of greater than moderate aortic insufficiency. Survival at 1, 5, and 10 years was 99%, 98%, and 92%, respectively. Freedom from aortic valve or aortic re-operation at 1, 5, and 10 years was 99%, 97%,and 94%, respectively.ConclusionWhile the specific type and size of graft used in valve-sparing aortic root replacement appears to matter less than meticulous technique and valve assessment, our series of 185 patients undergoing a modified David V procedure shows favorable early and midterm results.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"329-337"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147692663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refined suturing technique for graft-to-aorta anastomoses.","authors":"Ahmad Walid Izzat, Mohammad Bashar Izzat","doi":"10.1177/02184923261439235","DOIUrl":"10.1177/02184923261439235","url":null,"abstract":"<p><p>BackgroundSecuring hemostasis at graft-to-aorta anastomoses represents a challenging feature of the surgical management of aortic pathologies, and can impact postoperative morbidity and mortality. A new refined suturing technique was developed to address this challenge.MethodsA Dacron tube graft of appropriate size is secured within the aortic lumen using a horizontal 4-0 Prolene U-stay suture, and its two arms are used to complete the anastomosis continuously. With every bite, the needle is driven horizontally across an outer circumferential felt strip and aorta (out-in), through the graft at a 2-3-mm distance from its edge (out-in), back through the graft at a 7-8-mm distance from its edge (in-out), and finally bridging over the aortic edge back to its outer aspect without piercing the aortic wall. The two running sutures are firmly tightened and knotted, and Bioglue is applied.ResultsThe described technique was used in 175 patients who underwent ascending aortic replacement for aortic aneurysm or acute dissection. We have found its application to be associated with improved hemostasis and reduced intraoperative and postoperative blood loss. Additional sutures were rarely needed for hemostasis at suture lines, and there were no incidents of false aneurysm formation at anastomosis lines on long-term follow-up.ConclusionsThe described technique is associated with improved hemostasis, reduced blood loss, and decreased operating time, ultimately bringing significant benefits to patients undergoing surgical management of aortic pathologies.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"400-403"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive versus conventional techniques for proximal aortic surgery: A systematic review and meta-analysis of reconstructed patient-level data.","authors":"Nikolaos Schizas, Thomas Karagkounis, Ioannis Zoupas, Sofia Sarantou, Georgia Nazou, Panagiotis Dedeilias, Dimitrios C Iliopoulos","doi":"10.1177/02184923261438944","DOIUrl":"10.1177/02184923261438944","url":null,"abstract":"<p><p>ObjectiveMinimally invasive techniques represent a safe alternative to full sternotomy in proximal aortic surgery. This meta-analysis evaluates their efficacy in aortic root, ascending aortic, and aortic arch procedures compared with the conventional approach.MethodsA PRISMA-compliant systematic review and meta-analysis of matched cohorts was conducted, comparing minimally invasive surgery with full sternotomy. MEDLINE was searched for eligible studies. Continuous variables were analyzed using standardized mean differences and categorical data with odds ratios. Kaplan-Meier-derived individual patient data were used to assess survival. Subgroup analysis for elective cases was performed.ResultsSeventeen studies with 3113 matched patients were included. Mean age was 58.1 ± 13.3 years for minimally invasive group versus 58.1 ± 12.8 years in full-sternotomy group (p = 0.29). Postoperative blood loss (612.5 versus 883.2 mL, p < 0.01), number of red blood cell units transfused (1.0 versus 2.2, p < 0.01) and postoperative ventilation time (15.3 versus 19.2 h, p < 0.01) were significantly lower in the minimally invasive group. Similarly, overall hospital (8.4 versus 9.4 days, p < 0.01) and intensive care unit stay (1.5 versus 1.8 days, p < 0.01) were decreased in minimally invasive group. Overall survival was significantly improved in minimally invasive patients (Hazard Ratio: 0.54, p = 0.045), which was not confirmed by two-stage meta-analysis (Hazard Ratio: 0.72, p = 0.29). Bypass and cross-clamp times, reinterventions, bleeding events and wound infections were comparable between the two groups.ConclusionMinimally invasive proximal aortic surgery reduces perioperative morbidity, hospitalization and transfusion requirements compared with full sternotomy. While a survival benefit requires further confirmation, these findings support minimally invasive approaches as an effective and safe alternative in selected patients.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"387-399"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-generation extracorporeal membrane oxygenation for multi-organ recovery after refractory cardiac arrest.","authors":"Friedhelm Beyersdorf","doi":"10.1177/02184923261436888","DOIUrl":"10.1177/02184923261436888","url":null,"abstract":"<p><p><b>Introduction:</b> Survival after cardiac arrest and prolonged conventional cardiopulmonary resuscitation remains poor, with out-of-hospital survival rates of only 2%-10%. Conventional veno-arterial extracorporeal membrane oxygenation or extracorporeal cardiopulmonary resuscitation can restore circulation but provides uncontrolled reperfusion, fails to prevent ischemia-reperfusion injury and offers limited physiological monitoring, resulting in inconsistent neurological outcomes. Experimental evidence indicates that tissue viability after prolonged ischemia depends not only on its duration but critically on how reperfusion is performed. <b>Methods:</b> Controlled reperfusion strategies, such as controlled automated reperfusion of the whole body, achieve superior preservation of neurological and multi-organ function. Building on prior single-organ reperfusion research, controlled automated reperfusion of the whole body was developed as a next-generation, portable extracorporeal membrane oxygenation-based platform for multi-organ recovery after cardiac arrest and prolonged conventional cardiopulmonary resuscitation. <b>Results:</b> It integrates (1) advanced extracorporeal circulation with high pressure, high flow, pulsatility and rapid hypothermia; (2) a cytoprotective regimen targeting ischemia and reperfusion injury; (3) real-time hemodynamic, metabolic and temperature monitoring; and (4) a mobile design for rapid deployment. In experimental studies, controlled automated reperfusion of the whole body achieved up to 90% survival with intact neurological function after 20 min of cardiac arrest in porcine models. First clinical applications (since 2017) demonstrated favorable outcomes even after 120 min of conventional cardiopulmonary resuscitation. A recent multicenter European study (<i>n</i> = 69) reported 42% overall survival, with 79% of survivors achieving favorable neurological recovery (Cerebral Performance Category 1-2) at 90 days, particularly in in-hospital cardiac arrest and pre-hospital cannulation subgroups. <b>Conclusion:</b> Controlled automated reperfusion of the whole body thus represents a major advance in resuscitation science, enabling controlled multi-organ recovery after prolonged whole-body ischemia.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"338-345"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in extracorporeal technology: Current applications and future directions-A narrative review.","authors":"Anshuman Darbari, Trasha Shetty","doi":"10.1177/02184923261432687","DOIUrl":"10.1177/02184923261432687","url":null,"abstract":"<p><p>Artificial intelligence (AI) has rapidly emerged as a transformative force across multiple scientific and clinical domains, demonstrating remarkable capabilities in data analysis, pattern recognition, and predictive modeling. In the realm of healthcare, AI offers the potential to revolutionize patient management, diagnostics, and therapeutic strategies. Among its many applications, extracorporeal technology-encompassing cardiopulmonary bypass (CPB), extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VADs)-stands to benefit significantly from AI-driven innovations. By integrating real-time physiological data, predictive algorithms, and automated decision-support systems, AI can enhance the safety, precision, and efficiency of extracorporeal circulation, potentially reducing complications and improving patient outcomes. This article provides a comprehensive overview of the fundamental concepts of AI, tracing its historical development and examining its core subfields, including machine learning, deep learning, and cognitive computing. Furthermore, it highlights current applications of AI in extracorporeal technology and explores future possibilities for integrating intelligent systems into perfusion practice, aiming to optimize clinical performance and support personalized patient care.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"368-379"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147582411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From phthalates to microplastics: Emerging and unresolved biocompatibility risks in extracorporeal circulation.","authors":"Ignazio Condello, Youssef El Dsouki","doi":"10.1177/02184923261438205","DOIUrl":"10.1177/02184923261438205","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundExtracorporeal circulation (ECC) is increasingly supported by biomaterials engineered to minimize chemical leaching, and many biomedical manufacturers have now removed or substantially reduced phthalate plasticizers particularly di(2-ethylhexyl) phthalate (DEHP) from tubing and circuit components. Nevertheless, emerging evidence highlights a parallel and underexplored concern: the generation of microplastic particles, especially during manual cutting and customization of circuit segments in the operating room. While screen and depth filters used in CPB and ECMO circuits efficiently remove particles above defined size thresholds, the fate of smaller microplastics potentially capable of transiting through current filtration systems remains largely unknown. This raises new biocompatibility questions in an area where evidence is sparse and risk assessment remains incomplete.Materials and methodsA structured narrative review was conducted using PubMed and Web of Science, supplemented by manual reference screening. Search terms included \"phthalates,\" \"DEHP-free circuits,\" \"microplastics,\" \"extracorporeal circulation,\" \"cardiopulmonary bypass,\" \"ECMO,\" \"biomaterials,\" and \"particle shedding.\" Studies published between 1989 and 2025 addressing chemical migration, particulate release, biomaterial-blood interactions, or clinical exposure were eligible. After screening titles, abstracts, and full texts, 15 relevant studies were identified and included for qualitative synthesis.ResultsAcross included studies, phthalate reduction strategies such as the adoption of DEHP-free materials (e.g., TOTM-based tubing) demonstrably decreased chemical migration during ECC. However, the shift toward alternative materials does not preclude the mechanical generation of microplastic particles. Evidence from biomaterial studies suggests that shear stress, handling, and intraoperative cutting may contribute to particulate release. Unlike phthalates, microplastic contamination has not been systematically quantified in ECC settings, and current filters are optimized for macro- and microdebris but not necessarily for sub-micron or small-microplastic fractions. This gap contrasts with the well-characterized exposure profiles of phthalates, leaving the particulate dimension of ECC biocompatibility largely uncharted. Preliminary mechanistic data indicate that microplastics may act as carriers for residual plasticizers or other adsorbed molecules, potentially amplifying biological interactions.ConclusionsAlthough phthalate exposure has decreased with industry-wide adoption of alternative plasticizers, microplastic release particularly from manual circuit preparation represents an emerging and insufficiently characterized risk in ECC. Existing filtration technologies may not capture the smallest particles, and no standardized monitoring or exposure-reduction protocols currently address this issue. These findings underscore critical knowledge gaps and highlight the nee","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"380-386"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of endovascular repair for Kommerell's diverticulum with commercial fenestrated endograft.","authors":"Keita Sasaki, Shuhei Nishijima, Nobuhiro Mochizuki, Tomonori Koga, Norifumi Otani, Takashi Ueda","doi":"10.1177/02184923261439237","DOIUrl":"10.1177/02184923261439237","url":null,"abstract":"<p><p>Kommerell's diverticulum is a rare aortic arch anomaly associated with an increased risk of rupture and aortic dissection. We report a case of an elderly patient with Kommerell's diverticulum and a right-sided aortic arch who was successfully treated using thoracic endovascular aortic repair with a commercially available semi-customized fenestrated endograft (Najuta). Limited supra-aortic debranching was performed to preserve branch perfusion. Postoperative type II endoleak from the left subclavian artery was managed with coil embolization. The patient recovered uneventfully. This case suggests that fenestrated endovascular repair using a commercial device may be a feasible option in selected high-risk patients.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"363-367"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular aortic repair with the custom-made cook fenestrated device for the treatment of complex abdominal aortic aneurysms.","authors":"Davide Esposito, Martina Bastianon, Fabio Grimaldi, Enrica Bosisio, Mattia Pobbe, Giovanni Pratesi","doi":"10.1177/02184923261434634","DOIUrl":"10.1177/02184923261434634","url":null,"abstract":"<p><p>BackgroundFenestrated endovascular aneurysm repair (FEVAR) has become an essential option for the treatment of complex abdominal aortic aneurysms (AAA). While technological advances and growing operator experience have expanded its applicability, outcomes remain heterogeneous across centers and patient subsets. Evaluating real-world results is crucial to better define the effectiveness, safety, and durability of FEVAR in current practice.MethodsThis is a single-center, retrospective, observational study. Consecutive patients treated with FEVAR for complex AAA with a custom-made Cook device from January 2015 to October 2025 were included. Outcomes accessed included technical success, early major systemic complications, overall survival, freedom from reinterventions, target vessel instability, endoleaks, and sac expansion.ResultsSixty-four consecutive patients were treated with FEVAR Cook, of which 23 (35.9%) for juxtarenal AAA, 35 (54.7%) pararenal AAA and 6 (9.4%) thoraco-abdominal type IV aortic aneurysm. All but three patients were treated electively (95.3%). Two hundred twenty-two target vessels were successfully cannulated and treated with a bridging stent. Technical success was 98.4%. Early major systemic complications rate was 14.1%. Median follow-up was 29.5 months (IQR 47). Overall survival estimates at 1 and 4 years were 86.9% and 71.3%, respectively. Estimates at 4 years of freedom from reinterventions and target vessel instability were 90.9% and 93.8%, respectively. Freedom from type I/Ic and III/IIIc endoleak was 95.3% at 4 years. Sac regression, stability, and expansion at follow-up occurred in 29.5%, 63.9%, and 6.6%, respectively.ConclusionsFEVAR emerges as an appropriate and effective treatment option for complex aortic aneurysms. In our experience, the procedure provides high technical success and durable target-vessel preservation, with very satisfactory outcomes even at mid- to long-term follow-up.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"355-362"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Fontan operation in adults: Challenges and early outcomes in adults at a tertiary cardiac centre in India.","authors":"Anand Kumar Mishra, Sanketh Edem, Lasya Reddy, Manojkumar K Rohit, Akshay Kheni, Vivek Jaswal, Tsering Sangdup, Harkant Singh","doi":"10.1177/02184923261422607","DOIUrl":"10.1177/02184923261422607","url":null,"abstract":"<p><p>BackgroundThe Fontan operation is the definitive palliation for single-ventricle physiology. In low- and middle-income countries, delayed diagnosis and limited paediatric cardiac services often result in adults presenting for primary Fontan rather than staged completion.MethodsAdults (≥18 years) undergoing extracardiac or lateral-tunnel Fontan between January 2021 and June 2025 were retrospectively reviewed. Variables included demographics, conduit and fenestration, cardiopulmonary bypass and cross-clamp times, re-exploration, extubation time, intensive care unit (ICU) stay, pulmonary-artery pressure, atrioventricular valve regurgitation, pleural effusion >14 days, arrhythmia and survival.ResultsTwenty-four adults (median age 20.5 years (interquartile range 19-22); 17 males (71%)) underwent primary Fontan: 18 (75%) extracardiac and 6 (25%) lateral tunnel. Fenestration was created in 14 (58%). Mean pulmonary-artery pressure increased from 12.6 ± 3.2 to 13.7 ± 3.5 mmHg (<i>p</i> = .12). Systemic oxygen saturation improved significantly from 79 ± 4% to 92.8 ± 3.1% (<i>p</i> < .001). Atrioventricular-valve regurgitation decreased significantly (<i>p</i> = .03), and New York Heart Association (NYHA) I-II class increased from 25% to 88% (<i>p</i> < .001). Pleural effusion >14 days occurred in nine (38%) and arrhythmia in three (13%) patients. Kaplan-Meier survival was 100% at 2 years and 95.8% at 3 years (95% confidence interval [83-100]).ConclusionsPrimary Fontan beyond childhood can be performed safely in adults with favourable haemodynamics, achieving excellent early survival and functional improvement. Standardised technique and vigilant postoperative care are central to recovery in low- and middle-income country settings.</p>","PeriodicalId":35950,"journal":{"name":"ASIAN CARDIOVASCULAR & THORACIC ANNALS","volume":" ","pages":"235-241"},"PeriodicalIF":0.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}