JTCVS open最新文献

{"title":"Coronary sinus lactate at reperfusion: A predictor of atrial fibrillation after coronary artery bypass grafting","authors":"Arjun Verma BS,&nbsp;Borami Shin MD,&nbsp;Sameer Hirji MD, MPH,&nbsp;Michael Gilfeather BS,&nbsp;Tommaso Hinna Danesi MD,&nbsp;Ashraf A. Sabe MD,&nbsp;Thoralf M. Sundt MD (III),&nbsp;Sary F. Aranki MD","doi":"10.1016/j.xjon.2026.101971","DOIUrl":"10.1016/j.xjon.2026.101971","url":null,"abstract":"<div><h3>Objective</h3><div>Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass grafting (CABG). This study explored the association of coronary sinus (CS) lactate levels with POAF after CABG.</div></div><div><h3>Methods</h3><div>This was a single-center prospective cohort study of patients without a history of atrial fibrillation undergoing isolated CABG (December 2024 to February 2026). CS lactate was sampled before initiation of cardiopulmonary bypass (pre-CPB), before cross-clamp removal (pre-XC), and after cross-clamp removal (post-XC). POAF was defined as electrocardiogram-documented atrial fibrillation treated with amiodarone during the index hospitalization. Restricted cubic splines were used to define a binary cutoff of post-XC CS lactate at &gt;3 mmol/L. Multivariable logistic regression was performed to assess the association between CS lactate elevation and POAF.</div></div><div><h3>Results</h3><div>Of the 94 patients included, POAF occurred in 24 patients (26%). Patients with POAF were older and more commonly male but had similar median CPB time and XC duration. Patients with a post-XC lactate &gt;3 mmol/L (n = 13/94, 14%) had significantly greater rates of POAF compared with those without lactate elevation (62% vs 20%, <em>P</em> = .001). After risk adjustment, post-XC lactate &gt;3 mmol/L was associated with a 11.7-fold increase in odds of POAF (<em>P</em> = .010). Increasing age was also linked to greater likelihood of POAF. There was no significant association of POAF with CPB time, XC duration, pre-CPB CS lactate, or pre-XC CS lactate.</div></div><div><h3>Conclusions</h3><div>Elevated CS lactate after cardiac reperfusion was associated with increased likelihood of POAF. Our findings suggest that CS lactate may be used to guide POAF prophylaxis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101971"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214373","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":"Pilot safety and efficacy trial of amiodarone-infused biologic acellular biatrial patches to prevent new-onset postoperative atrial fibrillation","authors":"Mark S. Slaughter MD,&nbsp;Joshua G. Crane MD,&nbsp;Toyokazu Endo MD,&nbsp;Michele Gallo MD,&nbsp;Yash Vaidya MD,&nbsp;Siddharth V. Pahwa MD,&nbsp;Niv Ad MD,&nbsp;Clayton A. Kaiser MD,&nbsp;Jaimin R. Trivedi MBBS, MPH","doi":"10.1016/j.xjon.2026.102076","DOIUrl":"10.1016/j.xjon.2026.102076","url":null,"abstract":"<div><h3>Objective</h3><div>New onset postoperative atrial fibrillation (POAF) occurs in approximately 25% to 40% of patients undergoing heart surgery and is associated with increased perioperative morbidity and mortality. We evaluated the safety and exploratory efficacy of amiodarone-infused CardiaMend (Helios Cardio) biatrial patches for POAF prevention.</div></div><div><h3>Methods</h3><div>A single-center pilot clinical trial enrolled 40 patients after applying inclusions and exclusion criteria, randomized in 1:1 fashion. Patients in the treatment group received the CardiaMend patch, a porous acellular matrix derived from fetal bovine dermis, infused with 70 mg amiodarone, placed on both atria, whereas the control group received standard care. The primary end point was safety, defined as major adverse cardiovascular and cerebrovascular events. Secondary end points included POAF, length of hospital stay, 30-day readmission, and POAF duration.</div></div><div><h3>Results</h3><div>The 2 randomized groups had similar baseline characteristics. There were 2 major adverse cardiovascular and cerebrovascular events: 1 patient in the control group experienced an embolic stroke with full recovery before discharge, and 1 patient in the treatment group died from an acute abdominal event following intra-aortic balloon pump removal, deemed unrelated to the study device. The incidence of POAF (4 patients [20%] vs 8 patients [40%]; <em>P</em> = .30) and mean atrial fibrillation duration (2.5 ± 2.4 days vs 3.8 ± 4.1 days) were lower in the treatment group. Mean length of hospital stay was shorter in the treatment group (5.8 ± 1.2 days vs 9.3 ± 7.5 days; <em>P</em> = .07). At 30-day follow-up, Holter monitoring revealed no atrial fibrillation in the treatment group and 3 (15%) patients in the control group (<em>P</em> = .23), and readmission rates were also lower in the treatment group (5% vs 15%; <em>P</em> = .6).</div></div><div><h3>Conclusions</h3><div>This pilot randomized clinical trial showed that amiodarone-infused CardiaMend biatrial patches were safe, with no evidence of systemic amiodarone toxicity. Treatment with amiodarone-infused CardiaMend patches was associated with a clinically noticeable reduction in POAF, length of stay, and postdischarge atrial fibrillation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102076"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214374","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":"Prognostic and clinicopathologic divergence in pulmonary mucinous adenocarcinoma versus nonmucinous adenocarcinoma with a mucin-laden feature","authors":"Fujun Yang MD, PhD,&nbsp;Ke Sun MD,&nbsp;Zhaoxun Li MD,&nbsp;Aijun You MD,&nbsp;Zhen Yang MD,&nbsp;Yimu Wu MD,&nbsp;Mengxing Li MD,&nbsp;Yu Liu MD,&nbsp;Dongliang Bian MD,&nbsp;Junhong Guo MD,&nbsp;Gening Jiang MD","doi":"10.1016/j.xjon.2026.101964","DOIUrl":"10.1016/j.xjon.2026.101964","url":null,"abstract":"<div><h3>Background</h3><div>The discrepancies in clinicopathologic characteristics and prognosis between invasive mucinous adenocarcinoma (IMA) and nonmucinous lung adenocarcinoma with a mucin-laden feature (MNLA) remain unclear.</div></div><div><h3>Methods</h3><div>Data were collected retospectively for 978 consecutive patients with IMA/MNLA who underwent surgical resection between October 2017 and December 2019. Survival outcomes were estimated using the Kaplan-Meier method and compared using the log-rank test. The adjusted hazard ratio (aHR) with 95% confidence interval (CI) of the prognosticator was calculated using a multivariable Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Pure IMA was associated with a higher prevalence of <em>KRAS</em> mutation (51.5%), while MNLA was associated with higher prevalences of <em>EGFR</em> mutation (40.4%) and <em>EML4-ALK</em> rearrangement (19.1%). Regarding prognosis, compared to patients with pure IMA, patients with MNLA or mixed IMA had worse disease-free survival (MNLA: aHR, 2.620, 95% CI, 1.690-4.061; mixed IMA: aHR, 3.458, 95% CI, 1.704-7.016) and overall survival (MNLA: aHR, 2.229, 95% CI, 1.185-4.193; mixed IMA: aHR, 1.723, 95% CI, 0.632-4.698). Among patients who experienced recurrence, those with pure IMA had a higher incidence of intrathoracic-only recurrence compared to those with MNLA (80.8% vs 39.6%), demonstrating that extrathoracic-only recurrence was more prevalent in MNLA (35.1% vs 7.3%). The recurrence pattern of mixed IMA was different from that of pure IMA (pure IMA vs mixed IMA: intrathoracic-only, 80.8% vs 50.0%; both intrathoracic and extrathoracic, 11.5% vs 40.0%).</div></div><div><h3>Conclusions</h3><div>Although MNLA, pure IMA, and mixed IMA have consistent mucin-laden features, they appear to exhibit differences in prognosis, clinicopathologic characteristics, and molecular profiles.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101964"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214452","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":"Comparison of the performance of clinical classification systems for myasthenia gravis relapse after thymoma resection","authors":"Zhiheng Yao MD,&nbsp;Hongmu Li MD,&nbsp;Zhenyuan Yang MD,&nbsp;Yu Huang MD,&nbsp;Leqi Zhong MD,&nbsp;Zhenyu Zhao MD,&nbsp;Yiling Cai MD,&nbsp;Chun Chen MD,&nbsp;Bin Zheng MD","doi":"10.1016/j.xjon.2026.101980","DOIUrl":"10.1016/j.xjon.2026.101980","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize clinically significant myasthenia gravis (MG) relapse/exacerbation after thymoma resection and compare classification systems for risk stratification.</div></div><div><h3>Methods</h3><div>This multicenter retrospective cohort included 257 patients with thymoma-associated MG who underwent extended thymectomy at 3 centers from July 2009 through November 2025. The end point was new MG symptoms after postoperative complete stable remission, pharmacologic remission, or minimal manifestation status plus verifiable MG-related treatment escalation or rescue therapy. Death without MG relapse/exacerbation was treated as a competing event. Cumulative incidence functions were estimated with Aalen-Johansen and compared with Gray tests; predictors were assessed with Fine-Gray models.</div></div><div><h3>Results</h3><div>During median follow-up of 41.6 months, 69 relapse/exacerbation events and 21 competing deaths occurred. Cumulative incidence was 20.4% at 3 years and 29.0% at 5 years; 68% and 90% of events occurred within 3 and 5 years, respectively. Among 52 relapse/exacerbation events in patients who underwent surgery in 2018 or later with retrievable treatment-status data, 28 (53.8%) occurred during ongoing immunosuppression and 24 (46.2%) after withdrawal. The a/b phenotype-based grouping of the Myasthenia Gravis Foundation of America classification (1/A/B) showed the strongest separation (3-year cumulative incidences, 2.5%, 12.3%, and 56.4%; 5-year cumulative incidences, 7.6%, 29.6%, and 56.4% for groups 1, A, and B). Groups A and B were independently associated with relapse/exacerbation (subdistribution hazard ratio, 2.65; 95% CI, 1.18-5.91; and 10.55; 95% CI, 4.55-24.47).</div></div><div><h3>Conclusions</h3><div>Clinically significant MG relapse/exacerbation after thymoma resection clustered in the early postoperative years. The a/b phenotype-based grouping of the Myasthenia Gravis Foundation of America classification (1/A/B) provided the most informative risk stratification.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101980"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214415","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":"Hospital costs and early outcomes of robotic versus sternotomy mitral valve repair: A risk-score-matched analysis","authors":"Anh Nguyen MD, PhD,&nbsp;Gabriel Loor MD,&nbsp;Ravi Ghanta MD,&nbsp;Marc Moon MD,&nbsp;Todd Rosengart MD,&nbsp;Kenneth Liao MD, PhD","doi":"10.1016/j.xjon.2026.101982","DOIUrl":"10.1016/j.xjon.2026.101982","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101982"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214475","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":"Postoperative root size predicts regurgitation in supravalvular aortic stenosis repair","authors":"Dominic P. Recco MD,&nbsp;Lauren Marshall MS,&nbsp;Matthew Schildmeier BS,&nbsp;Kimberlee Gauvreau ScD,&nbsp;Joseph Confessore BS,&nbsp;Luis G. Quinonez MD,&nbsp;Pedro J. del Nido MD,&nbsp;Christopher W. Baird MD,&nbsp;Peter E. Hammer PhD,&nbsp;David M. Hoganson MD","doi":"10.1016/j.xjon.2026.101941","DOIUrl":"10.1016/j.xjon.2026.101941","url":null,"abstract":"<div><h3>Objective</h3><div>Supravalvular aortic stenosis (SVAS) repair carries a moderate risk for postoperative aortic regurgitation (AR). This may be related to the targeted sinotubular junction diameter z score (STJDZ) at reconstruction, traditionally sized to zero. We investigated relationships between achieved STJDZ and aortic valve function after repair.</div></div><div><h3>Methods</h3><div>Sixty-six children underwent patch repair from 2010 to 2024 at a median age of 1.2 years (interquartile range [IQR], 0.4, 3.5 years) via Brom (n = 53), Doty (n = 9), and McGoon (n = 4) techniques. Relationships between STJDZ and aortic valve function were assessed via Jonckheere-Terpstra nonparametric test for trend over median follow-up of 5.6 years (IQR, 2.4, 8.4 years).</div></div><div><h3>Results</h3><div>Preoperatively, AR was none/trivial in 52 (79%), left ventricular outflow tract obstruction (LVOTO) moderate or greater in 54 (82%), and median STJDZ −3.8 (IQR, −4.4, −2.9). At discharge, AR and LVOTO were mild or greater in 45 (68%) and 18 (27%), and median STJDZ was −0.3 (IQR, −1.3, −1.1). STJDZ increased by a median of 3.0 (IQR, 1.6, 4.4) preoperatively to postoperatively. Discharge AR was none/trivial at median STJDZ −1.3 (IQR, −1.8, −0.1) and worsened with increasing diameters (mild: 0.4 [IQR, −1.0, 1.8], mild+: 0.0 [IQR, −1.2, 1.5]; <em>P</em> = .038), with similar results at follow-up (<em>P</em> = .048). LVOTO worsened with lower median STJDZ (none/trivial: 0.2 [IQR, −1.2, 1.5], mild: −1.3 [IQR, −3.2, −0.1]; <em>P</em> = .015). Subanalysis of those with none/trivial preoperative AR (n = 52) showed that increase in STJDZ by ≥4 demonstrated worse follow-up AR (<em>P</em> = .016).</div></div><div><h3>Conclusions</h3><div>Achieving STJDZ zero using patch repair techniques to relieve SVAS obstruction demonstrated mild or greater postoperative AR compared with none/trivial regurgitation at median z score −1.3. Mild LVOTO was noted with median z score −1.3. Targeting STJDZ of −1 in pediatric SVAS repair appears appropriate to balance residual regurgitation and LVOTO. Further follow-up is required to understand the long-term impact of this target on aortic growth.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101941"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214478","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":"Improvement in health-related quality of life after complex biventricular repair","authors":"Kathryn O. Stack MD,&nbsp;Kimberlee Gauvreau ScD,&nbsp;Sarah Campos PA,&nbsp;Michael S. Bamgbose MPH,&nbsp;Elizabeth D. Blume MD,&nbsp;Sitaram M. Emani MD,&nbsp;Ryan L. Kobayashi MD,&nbsp;Rebecca S. Beroukhim MD","doi":"10.1016/j.xjon.2026.101961","DOIUrl":"10.1016/j.xjon.2026.101961","url":null,"abstract":"<div><h3>Objective</h3><div>Complex biventricular (BiV) and one-and-a-half ventricle (1.5V) repairs are alternatives to single ventricle palliation. We describe 1 domain of the health-related quality of life of patients undergoing BiV and 1.5V repairs.</div></div><div><h3>Methods</h3><div>This single-center study included children (≤ 18 years) who underwent BiV or 1.5V repairs between October 1, 2022, and July 7, 2024. Parents completed Pediatric Quality of Life Inventory Infant Scales or Pediatric Quality of Life Inventory 3.0 Cardiac Modules; physical function and physical symptom scores for patients younger than 2 years and heart problems and treatment scores for patients 2 years and older were evaluated.</div></div><div><h3>Results</h3><div>Seventy-three patients, 36 younger than 2 years and 37 ages 2 years and older, were included. Forty-one patients (56%) underwent BiV surgery, and 32 (44%) underwent 1.5V surgery. Preoperatively, patients younger than 2 years had a mean physical symptom score of 76 ± 14 and a mean physical function score of 70 ± 20; patients ages 2 years and older had a mean heart problems and treatment score of 64 ± 20. Thirty-six patients, 10 younger than 2 years and 26 ages 2 years and older, had paired pre- and postoperative health-related quality of life data. Following repair, physical symptom scores improved among infants ages 0 to 12 months (mean, 67 vs 79; <em>P</em> = .033), and heart problems and treatment scores improved (ages 2 to 4 years, 69 vs 84; <em>P</em> = .002; ages 5 to 7 years, 57 vs 86; <em>P</em> = .044). For patients ages 2 years and older, 5 symptoms drove score improvement: exertional dyspnea, chest pain, tachycardia, cyanosis, and fatigue.</div></div><div><h3>Conclusions</h3><div>Six months after surgery, parents reported improvement in children's health-related quality of life following complex BiV or 1.5V repairs. Further work is needed to better understand long-term outcomes in this vulnerable population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101961"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214479","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":"Tricuspid aortic valve morphology predicts favorable midterm outcomes after aortic valve neocuspidization in children","authors":"Guanxi Wang MD, PhD,&nbsp;Sen Zhang MD, PhD,&nbsp;Kai Ma MD, PhD,&nbsp;Kunjing Pang MD,&nbsp;Benqing Zhang MD, PhD,&nbsp;Keming Yang MD, PhD,&nbsp;Shoujun Li MD","doi":"10.1016/j.xjon.2026.101958","DOIUrl":"10.1016/j.xjon.2026.101958","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the midterm outcomes of the aortic valve neocuspidalization (AVNeo) procedure for aortic valve reconstruction in 83 pediatric patients with complex aortic valve disease and to identify risk factors associated with the outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on pediatric patients who underwent the AVNeo procedure between January 2017 and June 2025. The composite primary end point included all-cause mortality, reoperation, or moderate-to-severe aortic valve dysfunction (regurgitation or stenosis). Univariate and multivariate Cox proportional hazards models were used to identify risk factors.</div></div><div><h3>Results</h3><div>Among the 83 patients (mean age 7.0 ± 3.7 years; 67.5% male) included in the analysis, the predominant preoperative pathology was moderate-to-severe aortic regurgitation (88.0%). Single-leaflet reconstruction (65.1%) using autologous pericardium (94.0%) was the most common surgical approach. Over a mean follow-up of 28.4 ± 23.9 months, 27 patients (32.5%) met the composite end point, including 2 late deaths, 18 cases of moderate-to-severe regurgitation, and 9 cases of moderate-to-severe stenosis; 10 patients underwent reoperation. The probability of freedom from the primary end point was 83.6%, 64.5%, and 54.4% at 1, 3, and 6 years, respectively. Multivariable analysis identified tricuspid aortic valve morphology as an independent protective factor against the primary end point (hazard ratio, 0.408; 95% CI, 0.178-0.935, <em>P</em> = .034), whereas the use of autologous pericardium showed a strong protective trend (hazard ratio, 0.284; 95% CI, 0.078-1.037, <em>P</em> = .057).</div></div><div><h3>Conclusions</h3><div>AVNeo provides midterm outcomes that support its use as an alternative strategy. Tricuspid aortic valve morphology is a strong predictor of favorable outcomes, and the use of autologous pericardium demonstrates significant potential as a protective factor.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101958"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214484","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":"Risk factors and outcomes of tricuspid valve surgery in hypoplastic left heart syndrome patients with tricuspid regurgitation","authors":"Elizabeth M. Cordoves PhD,&nbsp;Gerardo Ramos-Lemos BS,&nbsp;Vincent R. LaSala MD,&nbsp;Halil Beqaj MD,&nbsp;Paul Trackey BS,&nbsp;Andrew B. Goldstone MD, PhD,&nbsp;Stephanie Levasseur MD,&nbsp;Amee Shah MD,&nbsp;Ganga Krishnamurthy MD,&nbsp;Emile A. Bacha MD,&nbsp;David M. Kalfa MD, PhD","doi":"10.1016/j.xjon.2026.102070","DOIUrl":"10.1016/j.xjon.2026.102070","url":null,"abstract":"<div><h3>Objective</h3><div>The management of patients with hypoplastic left heart syndrome with tricuspid regurgitation remains controversial. We evaluate risk factors for mortality/transplant/Fontan takedown in patients with hypoplastic left heart syndrome with tricuspid regurgitation and the effect of tricuspid valve surgery on clinical trajectories.</div></div><div><h3>Methods</h3><div>A retrospective chart review was performed for all hypoplastic left heart syndrome primary surgical Norwood recipients at our center who had moderate or greater tricuspid regurgitation (2006-2023). Freedom from a primary outcome of combined mortality/transplant/Fontan takedown was compared between those who underwent tricuspid valve surgery (N = 30, 67%) and those who did not (N = 15, 33%; Cox regression, log-rank). Among those who developed tricuspid regurgitation anytime post-Norwood (N = 37), tricuspid valve repair efficacy was assessed (Wilcoxon signed-rank, McNemar's test). Cumulative incidence of recurrent tricuspid regurgitation and right ventricle dysfunction was estimated (Aalen-Johansen estimator, death/transplant as competing risks).</div></div><div><h3>Results</h3><div>Patients with pre-Norwood tricuspid regurgitation experienced a mortality-dominated trajectory (5-year freedom from mortality 37.5%), whereas patients with post-Norwood/pre-Glenn tricuspid regurgitation experienced a transplant-dominated trajectory (5-year freedom from mortality 88.5%, composite outcome 55.9%). On univariable Cox regression, pre-Norwood right ventricle dysfunction (hazard ratio, 9.75, <em>P</em> &lt; .001) was associated with the primary outcome; pre-Norwood tricuspid regurgitation tended toward association (hazard ratio, 2.40, <em>P</em> = .10). On multivariable analysis, pre-Norwood right ventricle dysfunction (hazard ratio, 12.79 [3.16-51.80], <em>P</em> &lt; .001) and pre-Norwood tricuspid regurgitation (hazard ratio, 3.10 [1.03-9.31], <em>P</em> = .04) were both independently associated with the primary outcome. Among those with post-Norwood tricuspid regurgitation who underwent tricuspid valve surgery, tricuspid regurgitation severity decreased, with 43% achieving preserved freedom from moderate or greater tricuspid regurgitation.</div></div><div><h3>Conclusions</h3><div>Pre-Norwood right ventricle dysfunction and pre-Norwood tricuspid regurgitation were found to be associated with the primary outcome. In those with post-Norwood tricuspid regurgitation, tricuspid valve repair reduced tricuspid regurgitation but was not associated with improved survival.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 102070"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214490","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":"Waitlist mortality and post transplant survival amongst non-extracorporeal membrane oxygenation high-urgency heart transplant recipients before and after the 2018 policy change","authors":"John P. White BA,&nbsp;Joseph Song BS,&nbsp;Samuel T. Kim MD,&nbsp;Hedwig Zappacosta BS,&nbsp;Peter D. Cho BS,&nbsp;Stephanie McKay MS,&nbsp;Akanksha Girish MD,&nbsp;Alexey Abramov MD,&nbsp;Malini Daniel MD,&nbsp;Donatello Telesca PhD,&nbsp;Majid Husain MD,&nbsp;Abbas Ardehali MD","doi":"10.1016/j.xjon.2026.101936","DOIUrl":"10.1016/j.xjon.2026.101936","url":null,"abstract":"<div><h3>Objective</h3><div>The adult heart allocation policy changed from a 3- to 6-tiered system in 2018, more precisely stratifying high-urgency patients. Many studies examined the effects on patients classified as Status 1 or those with implantable devices, especially extracorporeal membrane oxygentation (ECMO), however, few have analyzed other high-urgency cohorts. This study's purpose is to compare waitlist and midterm outcomes of non-ECMO high-urgency patients before and after the policy change.</div></div><div><h3>Methods</h3><div>All high-risk (Status 1A, 1, 2, 3) non-ECMO adult patients listed for isolated heart transplantation were identified using the United Network for Organ Sharing database and split based on the October 18, 2018, policy change date into era 1 (7/2014-7/2018) and era 2 (1/2019-1/2023). Categorical and continuous variables were assessed using χ² and <em>t</em> tests, respectively. Waitlist mortality was analyzed using competing risk regression whereas Kaplan-Meier curves assessed posttransplant survival.</div></div><div><h3>Results</h3><div>Candidates from era 2 demonstrated greater rates of comorbidities like pulmonary hypertension (65% vs 67%, <em>P</em> = .007) and greater need for support with inotropes (39% vs 47%, <em>P</em> &lt; .001) and intra-aortic balloon pump (12% vs 42%, <em>P</em> &lt; .001). Yet, candidates from era 2 had significantly decreased waitlist time (71 vs 19 days, <em>P</em> &lt; .001) and waitlist mortality (19% vs 7%, <em>P</em> &lt; .001) whereas Kaplan-Meier 3-year survival (86% vs 85%, <em>P</em> = .42) remained similar.</div></div><div><h3>Conclusions</h3><div>Among non-ECMO high-urgency heart transplant recipients, candidates from era 2 demonstrated greater clinical acuity but improved waitlist mortality and equivalent midterm survival. These findings reassure that the 2018 policy change did not compromise outcomes amongst this high-urgency cohort, despite favoring patients bridged with ECMO.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"33 ","pages":"Article 101936"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214520","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}