Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Force Profiles of Single Ventricle Atrioventricular Leaflets in Response to Annular Dilation and Leaflet Tethering","authors":"Sumanth Kidambi MD ,&nbsp;Stephen C. Moye BS ,&nbsp;James Lee BA ,&nbsp;Teaghan H. Cowles BS ,&nbsp;E. Brandon Strong MS ,&nbsp;Rob Wilkerson BS ,&nbsp;Michael J. Paulsen MD ,&nbsp;Y. Joseph Woo MD ,&nbsp;Michael R. Ma MD","doi":"10.1053/j.semtcvs.2022.09.012","DOIUrl":"10.1053/j.semtcvs.2022.09.012","url":null,"abstract":"<div><p><span>We sought to understand how leaflet forces change in response to annular dilation and leaflet tethering (LT) in single ventricle<span> physiology. Explanted fetal bovine tricuspid valves<span> were sutured onto image-derived annuli and ventricular mounts. Control valves (CON) were secured to a size-matched hypoplastic left heart syndrome (HLHS)-type annulus and compared to: (1) normal tricuspid valves secured to a size-matched saddle-shaped annulus, (2) HLHS-type annulus with LT, (3) HLHS-type annulus with annular dilation (dilation valves), or (4) a combined disease model with both dilation and tethering (disease valves). The specimens were tested in a systemic heart simulator at various single ventricle physiologies. Leaflet forces were measured using optical strain sensors sutured to each leaflet edge. Average force in the anterior leaflet was 43.2% lower in CON compared to normal tricuspid valves (</span></span></span><em>P &lt;</em> 0.001). LT resulted in a 6.6% increase in average forces on the anterior leaflet (<em>P =</em> 0.04), 10.7% increase on the posterior leaflet (<em>P =</em> 0.03), and 14.1% increase on the septal leaflet (<em>P &lt;</em> 0.001). In dilation valves, average septal leaflet forces increased relative to the CON by 42.2% (<em>P =</em> 0.01). In disease valves, average leaflet forces increased by 54.8% in the anterior leaflet (<em>P &lt;</em> 0.001), 37.6% in the posterior leaflet (<em>P =</em> 0.03), and 79.9% in the septal leaflet (<em>P &lt;</em> 0.001). The anterior leaflet experiences the highest forces in the normal tricuspid annulus under single ventricle physiology conditions. Annular dilation resulted in an increase in forces on the septal leaflet and LT resulted in an increase in forces across all 3 leaflets. Annular dilation and LT combined resulted in the largest increase in leaflet forces across all 3 leaflets.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 216-229"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AATS 2021 Virtual Annual Meeting","authors":"","doi":"10.1053/j.semtcvs.2022.09.014","DOIUrl":"10.1053/j.semtcvs.2022.09.014","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 228-229"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefit of adjuvant chemotherapy for resected pathologic N1 non-small cell lung cancer is unrecognized: A subgroup analysis of the JBR10 trial","authors":"Omar Toubat PhD ,&nbsp;Li Ding MD, MPH ,&nbsp;Keyue Ding PhD ,&nbsp;Sean C. Wightman MD ,&nbsp;Scott M. Atay MD ,&nbsp;Takashi Harano MD ,&nbsp;Anthony W. Kim MD ,&nbsp;Elizabeth A. David MD, MAS","doi":"10.1053/j.semtcvs.2022.10.005","DOIUrl":"10.1053/j.semtcvs.2022.10.005","url":null,"abstract":"<div><p><span>Adjuvant chemotherapy is underutilized in clinical practice, in part, because its anticipated survival benefit is limited. We evaluated the impact of AC on overall and recurrence-free survival among completely resected pN1 </span>NSCLC<span><span><span> patients enrolled in the North American Intergroup phase III (JBR10) trial. A post-hoc subgroup analysis of pN1 NSCLC patients was performed. Participants were randomized to cisplatin+vinorelbine (AC) (n = 118) or observation (n = 116) following complete resection. The primary endpoint was overall survival (OS). The secondary endpoint was recurrence free survival (RFS). Kaplan-Meier methods were used to compare OS and RFS between the two </span>treatment groups. </span>Cox regression was used to identify factors associated with OS and RFS endpoints. Both groups had similar baseline characteristics. AC patients had improved 5-year OS (AC 61.4% vs observation 41.0%, log-rank p = .008) and 5-year RFS (AC 56.2% vs observation 39.9%, log-rank p = .011) rates compared to observation. Cox regression analyses confirmed the OS (HR 0.583, 95% CI 0.402-0.846, p = .005) and RFS (HR 0.573, 95% CI 0.395-0.830, p = .003) benefit associated with AC. AC was associated with a lower risk (HR 0.648, 95% CI 0.435-0.965, p = .0326) and a lower cumulative incidence (Subdistribution Hazard Ratio [SHR], 0.67, 95% CI 0.449-0.999, p = .0498) of lung cancer deaths. In the JBR10 trial, treatment with AC conferred a significant OS and RFS advantage over observation for pN1 NSCLC patients. These data suggest that pN1 NSCLC patients may experience a disproportionately greater clinical benefit from AC than the 6% survival advantage estimated by the LACE meta-analysis.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 261-270"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Intervention in Acute Type B Aortic Penetrating Ulcer and Intramural Hematoma","authors":"Michele Piazza MD ,&nbsp;Francesco Squizzato MD ,&nbsp;Luca Porcellato MD,&nbsp;Eugenia Casali MD,&nbsp;Franco Grego MD,&nbsp;Michele Antonello PhD","doi":"10.1053/j.semtcvs.2022.07.009","DOIUrl":"10.1053/j.semtcvs.2022.07.009","url":null,"abstract":"&lt;div&gt;&lt;p&gt;We aimed to investigate predictors of intervention of acute type B aortic penetrating ulcer (PAU) and intramural hematoma (IMH). We conducted a retrospective chart review of all patients admitted for acute type B PAU or IMH in a tertiary referral hospital. Indications to intervention were “complicated” (rupture, impending rupture, malperfusion) or “high risk for unfavorable outcome” (refractory hypertension and/or pain despite best medical treatment, morphologic aortic evolution, transition to a new aortic syndrome, or increase in IMH/PAU depth &gt;5 mm) during the acute/subacute phase. The primary outcomes were overall mortality, aortic-related mortality, and freedom from intervention. Time-dependent outcomes were estimated with Kaplan-Meier curves. Cox proportional hazards models&lt;span&gt;&lt;span&gt; were used to identify predictors of intervention and mortality. There were 54 acute aortic syndromes, 37 PAUs and 17 IMHs. Mean age was 69 ± 14 years and 33 patients (62.2%) were male. Six (11.5%) patients had complicated aortic syndromes and underwent urgent repair. Two (3.7%) additional patients developed an impending rupture during the acute phase. Eleven (21.1%) patients were classified as at “high risk” during the initial hospitalization. Overall, 22 (40.7%) patients required an aortic intervention during the initial admission (n = 16, 72.7% during the acute phase; n = 6, 27.3% during the subacute phase). In-hospital mortality was 5.5% (1 PAU and 2 IMH), and was aorta-related in all cases. For IMH, disease extension in &gt;3 aortic zones (HR 1.94, 95%CI 1.17–32.6; p = 0.038) and presence of ulcer-like projections (ULPs) (HR 1.23, 95%CI 1.02–9.41; p = 0.042) were associated with the need for intervention. There were no aortic-related deaths or intervention during the chronic phase. PAU width &gt;20 mm (HR 1.68, 95%CI 1.07–16.08; p = 0.014), PAU depth &gt;15 mm (HR 6.74, 95%CI 1.31–34.18; p = 021), PAU depth/total aortic diameter &gt;0.3 (HR 4.31, 95%CI 1.17–20.32; p = 0.043), and location at the level of the paravisceral aorta (HR 2.24, 95%CI 1.23–4.70; p = 0.035) were significantly associated with need for intervention. Six additional (16.2%) PAUs required intervention during the chronic phase owing to PAU growth. Maximum aortic diameter &gt;35 mm was significantly associated with intervention (HR 1.45, 95%CI 1.00–2.32; p = 0.037). Acute symptomatic type B IMHs and PAUs are characterized by a high risk of complications during the first month from presentation. Morphologic features associated with intervention were IMH with ULPs or extension in more than 3 aortic zones, as well as PAUs with depth&gt;15 mm, width &gt;20 mm, or depth/aortic diameter ratio&gt;0.3. A strict follow-up protocol or consideration for early intervention within 30 days from presentation should be taken into account for these high-risk patients. During the chronic phase imaging follow-up is particularly important for PAUs in order to identify progression to &lt;/span&gt;saccular","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 1-10"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Staged Ventricular Septation in Double-Inlet Ventricle - A Strategy to Avoid Fontan?","authors":"Anagha Prasanna AB ,&nbsp;Rebecca S. Beroukhim MD ,&nbsp;Sunil Ghelani MD ,&nbsp;Eric N. Feins MD ,&nbsp;Pedro J. del Nido MD ,&nbsp;Sitaram M. Emani MD","doi":"10.1053/j.semtcvs.2022.08.014","DOIUrl":"10.1053/j.semtcvs.2022.08.014","url":null,"abstract":"<div><p><span><span><span>Single-stage ventricular septation for double-inlet left or right ventricle<span><span> (DILV or DIRV) has historically been associated with poor outcomes. We hypothesize that staged ventricular septation may demonstrate favorable clinical outcomes to be an alternative to Fontan palliation. This single-center retrospective study reviewed patients with DILV or DIRV who underwent staged ventricular septation between 2015–2021. The strategy involves </span>pulmonary artery banding or </span></span>Norwood procedure<span><span> during infancy (stage 1), followed by partial ventricular septation to anchor the septum, while maintaining systemic RV pressure to avoid septal shift (stage 2). Residual septal defects are closed with pulmonary artery band removal at stage 3. Results are reported as median (interquartile range). Twelve patients underwent partial ventricular septation. At a median follow-up time of 17 months (8–30) after stage 2, there were no interstage deaths or cardiac transplants; LV dysfunction was observed in one patient. </span>Hemodynamic evaluation after stage 2 demonstrated median </span></span>left atrial pressure of 9.5 mm Hg (8.9–11.5), cardiac index of 3.4 L/min/m</span>² (3.2–3.6), and RV and LV indexed end-diastolic volumes of 52 ml/m² (41–67) and 105 ml/m²<span> (81–115), respectively. Five patients have progressed to stage 3; one required pacemaker for complete heart block. Unplanned reintervention was required in 4 patients after stage 1, 2 patients after stage 2, and 3 patients after stage 3. Staged ventricular septation is an alternative to single-ventricle palliation in a subset of double-inlet ventricle patients and is associated with acceptable early outcomes. Further studies are necessary to determine long-term outcomes.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 91-101"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Evaluation of Endo-Aortic Balloon Occlusion Compared to External Clamping in Minimally Invasive Mitral Valve Surgery","authors":"Husam H. Balkhy MD ,&nbsp;Eugene A. Grossi MD ,&nbsp;Bob Kiaii MD ,&nbsp;Douglas Murphy MD ,&nbsp;Arnar Geirsson MD ,&nbsp;Sloane Guy MD ,&nbsp;Clifton Lewis MD","doi":"10.1053/j.semtcvs.2022.11.016","DOIUrl":"10.1053/j.semtcvs.2022.11.016","url":null,"abstract":"<div><p><span><span><span><span><span>We compare outcomes of endo-aortic balloon occlusion (EABO) vs external </span>aortic clamping (EAC) </span>in patients<span> undergoing minimally invasive mitral valve surgery (MIMVS) in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. Adults undergoing mitral valve surgery (July 2017–December 2018) were identified within the STS database (N = 60,607). Total 7,978 patients underwent a minimally invasive approach (including robotically assisted). About 1,163 EABO patients were 1:1 propensity-matched to EAC patients using exact matching on age, sex, and type of mitral procedure, and propensity score average matching for 16 other risk indicators. Early outcomes were compared. Categorical variables were compared using </span></span>logistic regression; hospital and </span>intensive care unit<span> length of stay were compared using negative binomial regression. In the matched cohort, mean age was 62 years; 35.9% were female, and 86% underwent mitral valve repair<span>. Cardiopulmonary bypass time was shorter for EABO vs EAC group (125.0 ± 53.0 vs 134.0 ± 67.0 minutes, </span></span></span><em>P</em><span> = 0.0009). There was one aortic dissection in the EAC group and none in the EABO group (</span><em>P</em><span> value &gt; 0.31), and no statistically significant differences in cross-clamp time, major intraoperative bleeding, perioperative mortality, stroke, new onset of atrial fibrillation, postoperative acute kidney injury, success of repair. Median hospital LOS was shorter for EABO vs EAC procedures (4 vs 5 days, </span><em>P</em> &lt; 0.0001). In this large, retrospective, STS database propensity-matched analysis ofpatients undergoing MIMVS, we observed similar safety outcomes for EABO and EAC, including no aortic dissections in the EABO group. The EABO group showed slightly shorter CPB times and hospital LOS.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 27-36"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9222167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.semtcvs.2024.02.001","DOIUrl":"10.1053/j.semtcvs.2024.02.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages e1-e3"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1043067924000017/pdfft?md5=6decfc849910eae63db73de7f0f8dafa&pid=1-s2.0-S1043067924000017-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: How Far Will We Go?","authors":"S. Ram Kumar MD, PhD, FACS","doi":"10.1053/j.semtcvs.2022.11.005","DOIUrl":"10.1053/j.semtcvs.2022.11.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 80-81"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10344486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Sustained Reduction of Functional Mitral Regurgitation Impact Survival?","authors":"Tessa M.F. Watt MD, MSc ,&nbsp;Alexander A. Brescia MD, MSc ,&nbsp;Shannon L. Murray MSH ,&nbsp;Liza M. Rosenbloom BA ,&nbsp;Alexander Wisnielwski BS ,&nbsp;David Burn PhD ,&nbsp;Matthew A. Romano MD ,&nbsp;Steven F. Bolling MD","doi":"10.1053/j.semtcvs.2023.04.003","DOIUrl":"10.1053/j.semtcvs.2023.04.003","url":null,"abstract":"<div><p>Functional mitral regurgitation (FMR) is associated with increased mortality and has been considered a marker for advanced heart disease, yet the value of mitral valve repair (MVr) in this population remains unclear. This study aims to evaluate the impact of reducing FMR burden through surgical MVr on survival. Patients with severe FMR who underwent MVr with an undersized, complete, rigid, annuloplasty between 2004 and 2017 were assessed (n = 201). Patients were categorized based on grade of recurrent FMR (0-4). Time-to-event Kaplan-Meier estimations of freedom from death or reoperation were performed using the log-rank test. Cox proportional hazards models evaluated all-cause mortality and reported in hazards ratios (HR) and 95% confidence intervals (CI). Patients were categorized by postoperative recurrent FMR: 45% (91/201) of patients had grade 0, 29% (58/201) grade 1, 20% (40/201) grade 2, 2% (4/201) grade 3%, and 4% (8/201) grade 4. The cumulative incidence of reoperation with death as a competing risk was higher in patients with grades ≥3 recurrent FMR compared to grades ≤2 (44.6% vs 14.6%, subhazard ratio 3.69 [95% CI, 1.17-11.6]; <em>P</em> = 0.026). Overall freedom from death or reoperation was superior for recurrent FMR grades ≤2 compared to grades ≥3 (log-rank <em>P</em> &lt; 0.001). Increasing recurrent FMR grade was independently associated with mortality (HR 1.30 [95% CI, 1.07-1.59] <em>P</em> = 0.009). Reduced postoperative FMR grade resulted in an incrementally lower risk of death or reoperation after MVr. These results suggest that achieving a durable reduction in FMR burden improves long-term survival.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 37-46"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1043067923000874/pdfft?md5=706cec2afa2a6cc3d0e8caef22049958&pid=1-s2.0-S1043067923000874-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10065941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Experience With Reverse Double Switch Operation for the Borderline Left Heart","authors":"Brandi Braud Scully MD, MS ,&nbsp;Eric N. Feins MD ,&nbsp;Wayne Tworetzky MD ,&nbsp;Sunil Ghelani MD ,&nbsp;Rebecca Beroukhim MD ,&nbsp;Pedro J. del Nido MD ,&nbsp;Sitaram M. Emani MD","doi":"10.1053/j.semtcvs.2022.09.009","DOIUrl":"10.1053/j.semtcvs.2022.09.009","url":null,"abstract":"<div><p><span><span><span>This study reviews our early experience with the “reverse” double switch operation (R-DSO) for borderline left hearts. A retrospective review of children with borderline left hearts who underwent R-DSO between 2017 and 2021 was conducted. Patient characteristics<span> and early hemodynamic<span> and clinical outcomes were collected. R-DSO was performed in 8 patients with no operative or postoperative deaths; 5 underwent decompressing bidirectional Glenn. Left ventricular (LV) poor-compliance was the dominant pathophysiology<span>. Four patients had undergone staged LV recruitment but were not candidates for anatomical biventricular circulation due to LV hypoplasia<span><span> and/or diastolic dysfunction. 7/8 patients had risk factors for Fontan circulation including </span>pulmonary vein stenosis<span><span>, pulmonary hypertension, and pulmonary artery stenosis. Median age at R-DSO was 3.7 years (19 months-12 years). All patients were in </span>sinus rhythm at discharge. At median follow-up of 15 months (57 days-4.1 years) no mortalities, </span></span></span></span></span></span>reoperations<span><span> or heart transplants had occurred. All patients had normal morphologic LV </span>systolic function. In one patient, pre-existing pulmonary hypertension (HTN) resolved after R-DSO. Reinterventions included transcatheter </span></span>mitral valve replacement<span> for residual mitral stenosis<span> and neo-pulmonary balloon valvuloplasty<span>. In 4 patients follow-up catheterization done at a median of 519 days (320 days-4 years) demonstrated median cardiac index of 3.2 L/min/m</span></span></span></span>²<span> (2.2-4); median sub-pulmonary left ventricular end diastolic pressure<span><span><span> was 9 mm Hg (7-15); median inferior vena cava/baffle pressure was 8 mm Hg (7-13). R-DSO is an alternative to anatomical biventricular repair or single ventricle </span>palliation </span>in patients<span> with borderline left hearts and can result in low inferior vena cava pressures and favorable early results. This approach can also relieve pulmonary HTN and allow future transplant candidacy.</span></span></span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 67-79"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}