JTCVS open最新文献

{"title":"Severe obesity increases risk of graft loss in pediatric heart transplantation","authors":"Joshua D. Sparks MD ,&nbsp;Sarah J. Wilkens MD ,&nbsp;Andrea Nicole Lambert MD ,&nbsp;Deborah Kozik DO ,&nbsp;Jaimin R. Trivedi MBBS, MPH ,&nbsp;Bahaaldin Alsoufi MD","doi":"10.1016/j.xjon.2025.04.023","DOIUrl":"10.1016/j.xjon.2025.04.023","url":null,"abstract":"<div><h3>Objectives</h3><div>Severe obesity is an established risk factor for adverse cardiovascular events and heart transplantation (HT) outcomes in adults. However, the effect of severe obesity on children after HT is not well studied. We aimed to examine the prevalence and effect of severe obesity on pediatric HT.</div></div><div><h3>Methods</h3><div>We evaluated children (&gt;8 years) listed for HT using the United Network for Organ Sharing database. Severe obesity was defined per Centers for Disease Control and Prevention criteria using body mass index. Our study comprised 2 groups: a severe obesity group (n = 212, 8%) and a control group (n = 2417, 92%) consisting of the remaining children. We compared characteristics and outcomes between the 2 groups.</div></div><div><h3>Results</h3><div>After listing, there was no difference in transplant rate or waitlist mortality between the severe obesity and control groups (<em>P</em> = .89). Children with severe obesity were less likely to have congenital heart disease and more likely to be Black, have greater levels of creatinine, be supported with a left ventricular assist device, and receive grafts from older donors. Waitlist duration was comparable (<em>P</em> = .23). Incidences of primary graft dysfunction (<em>P</em> = .91), stroke (<em>P</em> = .36), dialysis (<em>P</em> = .18), and acute rejection (<em>P</em> = .4) were similar. However, severe obesity group had significant survival disadvantage (10 years: 47% vs 64%, <em>P</em> = .01), particularly in children older than 11 years, with diverging outcomes starting around 4 years posttransplant in those older than 15 years. Cox regression identified severe obesity as independent mortality risk factor (hazard ratio, 1.88; <em>P</em> = .0003), along with age, gender, race, congenital heart disease, creatinine, extracorporeal membrane oxygenation, and donor age.</div></div><div><h3>Conclusions</h3><div>There is a pressing need to improve assessment and treatment of obesity in children with end-stage heart failure awaiting transplantation. Although early survival rates are comparable, med- and long-term outcomes are concerning for severely obese children after heart transplant. Though unclear, the pathophysiologic effects are likely due to accelerated allograft vasculopathy from the metabolic derangement of obesity. Particularly in older children and adolescents, severe obesity should be considered a modifiable risk factor and aggressively managed before and after transplantation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 207-217"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912821","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":"Objective performance indicators provide a novel, quantitative method to evaluate surgeon proficiency in robotic lobectomy training","authors":"James Nawalaniec MD ,&nbsp;Mallory Shields PhD ,&nbsp;Hugh Auchincloss MD ,&nbsp;Chi-Fu Jeffrey Yang MD ,&nbsp;Lana Schumacher MD","doi":"10.1016/j.xjon.2025.02.011","DOIUrl":"10.1016/j.xjon.2025.02.011","url":null,"abstract":"<div><h3>Objective</h3><div>Current evaluation of robotic surgeon proficiency relies on subjective assessment. The robotic platform collects highly granular kinematic data on surgeon activity, known as objective performance indicators (OPIs). We sought to compare surgeon proficiency during lobectomies across training levels using OPIs.</div></div><div><h3>Methods</h3><div>Under institutional review board approval, we analyzed robotic lobectomies between November 2022 and February 2023 performed by 2 expert robotic thoracic surgeons (&gt;200 robotic lobectomies) and their trainees using OPI recorders. A professional annotator segmented each case into standardized steps, and an operating surgeon (trainee or attending) was assigned to that step on the basis of the active console. Kinematic data were compared between surgeon groups. A subgroup analysis was performed dividing the trainee group into junior (postgraduate year 3-5) and senior residents (postgraduate year 6-8).</div></div><div><h3>Results</h3><div>In total, 26 lobectomies with 410 discrete tasks performed by attending surgeons and 344 by trainees were included. In the attending group, there were significantly greater rates of camera clutching per minute compared with trainees (2.94 vs 2.52, respectively; <em>P</em> = .0005). The ratio of right to left hand use was significantly greater in the trainee group (1.52 vs 1.48, <em>P</em> = .0047). Average instrument speed was faster in the attending group (1.24 vs 1.13 meters/min, <em>P</em> = .0061). Differences in clutching and speed, but not hand dexterity, remained significant when the trainee group was subdivided into beginner and intermediate robotic surgeons.</div></div><div><h3>Conclusions</h3><div>There are significant differences in objective performance indicators between expert and beginner robotic surgeons. These results demonstrate the feasibility of incorporating kinematic performance data into thoracic surgeon assessment in a clinical setting.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 299-305"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912929","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":"Is segmentectomy actually superior to lobectomy for early-stage lung cancer? A discrepancy between the JCOG0802 trial and real-world practice","authors":"Hiroyuki Tsuchida MD ,&nbsp;Masaya Yotsukura MD ,&nbsp;Tomohiro Haruki MD ,&nbsp;Yukihiro Yoshida MD ,&nbsp;Kimiteru Ito MD ,&nbsp;Hirokazu Watanabe MD ,&nbsp;Tomonori Mizutani MD ,&nbsp;Yasushi Yatabe MD ,&nbsp;Shun-ichi Watanabe MD","doi":"10.1016/j.xjon.2025.05.005","DOIUrl":"10.1016/j.xjon.2025.05.005","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether results of the JCOG0802/WJOG4607L trial, which demonstrated the superiority of segmentectomy over lobectomy in terms of overall survival for patients with peripheral small-sized lung cancer, are applicable to clinical practice.</div></div><div><h3>Methods</h3><div>In this single-center retrospective analysis, we categorized patients who underwent lobectomy or segmentectomy during the enrollment period of the JCOG0802/WJOG4607L trial into 3 groups: patients enrolled in the trial (Cohort A), patients who were eligible but not enrolled (Cohort B), and ineligible patients (Cohort C). We assessed whether trial participants reflected typical patients seen in clinical practice (representativeness) and whether trial results could be applied in routine practice (generalizability) by comparing patient characteristics and survival between cohorts, using Cohort A as the reference.</div></div><div><h3>Results</h3><div>Cohorts A, B, and C included 91, 163, and 81 patients, respectively. Overall survival at 5 years was 91.2% (95% confidence interval [CI], 83.1%-95.5%), 93.9% (95% CI, 88.5%-96.8%), and 87.7% (95% CI, 77.7%-93.4%), respectively, with no significant different among the 3 cohorts (<em>P</em> = .269). Hazard ratios for segmentectomy over lobectomy were 0.125 (95% CI, 0.015-0.987) in Cohort A, 0.281 (95% CI, 0.036-2.147) in Cohort B, and 1.806 (95% CI, 0.573-5.690) in Cohort C, indicating that the results observed in Cohort A were not replicated in Cohort B.</div></div><div><h3>Conclusions</h3><div>In this single-center retrospective study, segmentectomy was associated with numerically improved overall survival rates than lobectomy in JCOG0802-eligible patients not enrolled in the trial, although the difference was not statistically significant. Given the study's retrospective nature and underpowered statistics with a small sample size, these findings should be interpreted cautiously.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 234-241"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912819","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":"An alternative approach to repair of giant paraesophageal hernia in selected patients with minimal history of reflux: Analysis of outcomes in more than 100 patients","authors":"Shuyin Liang MD ,&nbsp;James D. Luketich MD ,&nbsp;Edgar Aranda-Michel MD, PhD ,&nbsp;Nicholas Baker MD ,&nbsp;Evan Alicuben MD ,&nbsp;Ryan M. Levy MD ,&nbsp;Omar Awais DO ,&nbsp;William E. Gooding MS ,&nbsp;Hong Wang PhD ,&nbsp;Inderpal Sarkaria MD ,&nbsp;Neil A. Christie MD ,&nbsp;Matthew J. Schuchert MD ,&nbsp;Arjun Pennathur MD ,&nbsp;University of Pittsburgh/UPMC Paraesophageal Hernia Study Group","doi":"10.1016/j.xjon.2025.04.019","DOIUrl":"10.1016/j.xjon.2025.04.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Laparoscopic repair of giant paraesophageal hernia (LGPEHR) is a complex operation and typically includes an antireflux procedure (ARS); however, some patients without a history of reflux may be able to avoid an ARS. The objective of this study was to evaluate an alternative approach for giant paraesophageal hernia (GPEH) repair with restoration of the normal anatomy and an extended gastropexy in selected patients with minimal reflux symptoms.</div></div><div><h3>Methods</h3><div>Patients who underwent GPEH repair with an extended gastropexy were reviewed retrospectively. The procedure was not a “simple gastropexy.” The LGPEHR included complete mediastinal dissection, hernia-sac reduction that restored anatomic intra-abdominal positioning of the stomach with careful preservation of the crura and vagal nerves, and tension-free crural repair. Then, an extended gastropexy was performed by placing a series of horizontal mattress sutures along the line of the short gastric vessels to the left crus and diaphragm. Perioperative outcomes, symptomatic improvement, recurrence, need for reoperation, and quality of life (Gastroesophageal Reflux Disease-Health-Related Quality of Life questionnaire) were evaluated.</div></div><div><h3>Results</h3><div>A total of 114 patients (median age 77.4 years) underwent GPEH repair with gastropexy (elective n = 81; urgent/emergent n = 33). Perioperative complications occurred in 11 patients (9.6%). Dysphagia improved significantly (<em>P</em> &lt; .01), and the median Gastroesophageal Reflux Disease-Health-Related Quality of Life score after GPEH repair was 2 (considered excellent). Imaging follow-up was performed at a median time of 14 months, with recurrence of hiatal hernia in 4 patients; 2 required reoperation.</div></div><div><h3>Conclusions</h3><div>LGPEHR with restoration of the normal anatomy and an extended gastropexy appears to be safe with good outcomes when key elements of repair are incorporated. If further validated, this option may be considered in selected high-risk patients who are not candidates for an ARS.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 243-254"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912923","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":"Study on the remodeling of distal residual dissection after surgery in patients with type A aortic dissection and Marfan syndrome","authors":"Junyu Wang MBBS ,&nbsp;Huiwen Gao MBBS ,&nbsp;Xuelan Zhang PhD ,&nbsp;Kai Tang MD ,&nbsp;Hui Han MD ,&nbsp;Chang Shu MD ,&nbsp;Xiangyang Qian MD ,&nbsp;MingYao Luo MD","doi":"10.1016/j.xjon.2025.06.011","DOIUrl":"10.1016/j.xjon.2025.06.011","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the remodeling of the distal aorta and outcomes after aortic surgery for type A aortic dissection (TAAD) in patients with Marfan syndrome and investigate whether morphologic characteristics of the dissection can predict negative remodeling.</div></div><div><h3>Methods</h3><div>Between 2013 and 2021, we performed total arch with a frozen elephant trunk for 325 patients with Marfan syndrome with DeBakey type I aortic dissection. Mean age was 47.13 ± 7.33 years, and 204 were men (63%). Follow-up was complete in 91.1% (296 out of 325) at a mean of 48.3 ± 13.1 months. Four-year incidence of death was 8.6% and reoperation rate was 10.4%. Negative remodeling was defined as an average growth rate &gt;5 mm/year or &gt;10% at any segment detected by computed tomography angiography.</div></div><div><h3>Results</h3><div>After surgery, negative remodeling occurred in 19.3% and 26.7% at TAAD follow-up at a mean of 13.6 and 38.3 months, respectively. There were 15.2% (12 out of 79) late deaths and 26.6% (21 out of 79) distal reoperations for those patients. The positive remodeling patients share a low rate of late death and distal reoperations of 6.5% (14 out of 217) and 7.8% (17 out of 217) (<em>P</em> &lt; .01). Maximal aortic sizes before discharge for negative remodeling patients were 43.2, 35.1, and 32.5 mm, and growth rates were 4.5 ± 1.52, 3.1 ± 1.14, and 3.5 ± 1.33 mm/year at the level of diaphragm, celiac trunk, and renal artery respectively, which is larger and expands more quickly than the patients with positive remodeling (<em>P</em> &lt; .01). Distal maximal aortic size (<em>P</em> &lt; .01), number of entry tears (<em>P</em> = .03), and average entry tears size (<em>P</em> = .02) predicted rate of negative remodeling.</div></div><div><h3>Conclusions</h3><div>Our results suggest that TAAD has a high rate of negative aortic remodeling in patients with Marfan syndrome. Distal maximal aortic size, number of entry tears, and average entry tears size were associated with the rate of negative aortic remodeling in patients with TAAD and Marfan syndrome.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 15-21"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913129","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":"Transcatheter versus minimally invasive surgical aortic valve replacement: A propensity score-matched analysis in low-risk patients","authors":"Mark R. Lutz BA ,&nbsp;Shaelyn M. Cavanaugh MD, MPH ,&nbsp;Samuel J. Martin BS ,&nbsp;Anna Gleboff MPH ,&nbsp;Karikehalli Dilip MD ,&nbsp;Ahmad Nazem MD ,&nbsp;Anton Cherney MD ,&nbsp;Zhandong Zhou MD ,&nbsp;Charles Lutz MD","doi":"10.1016/j.xjon.2025.05.001","DOIUrl":"10.1016/j.xjon.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>Minimally invasive aortic valve replacement (MIAVR) and transcatheter aortic valve replacement (TAVR) represent less-invasive alternatives to conventional surgical aortic valve replacement. In contrast to Society of Thoracic Surgeons (STS) Database data revealing &lt;10% of all surgical aortic valve replacement procedures are performed via a minimally invasive approach, our center performs a high volume of MIAVR procedures. This propensity-score matched study aims to compare the outcomes of MIAVR versus TAVR in low-risk patients (STS Predicted Risk of Mortality &lt;4%).</div></div><div><h3>Methods</h3><div>We identified 476 low-risk patients who underwent MIAVR via a right anterolateral minithoracotomy and 679 low-risk patients who underwent TAVR at our institution between 2017 and 2024. In a total of 1155 cases, propensity score analysis performed at a ratio of 1:1 yielded 295 matched pairs.</div></div><div><h3>Results</h3><div>The matched groups had similar baseline characteristics aside from a higher proportion of tricuspid valves in the TAVR group and greater rates of aortic regurgitation in the MIAVR group. The baseline STS scores were also higher in the TAVR group (1.84 vs 1.69; <em>P</em> = .030), although still below the low-risk threshold (STS-PROM &lt;4.0). Postoperatively, patients in the MIAVR group experienced lower rates of permanent pacemaker implantation (0.4% vs 7.8%; <em>P</em> &lt; .001), aortic regurgitation (0.3% vs 5.4%; <em>P</em> &lt; .001), and paravalvular leak (0.0% vs 5.8%; <em>P</em> &lt; .001). Patients undergoing MIAVR had longer hospital lengths of stay (6.23 vs 2.07; <em>P</em> &lt; .001) and higher aortic valve mean gradients (7.29 vs 6.04 mm Hg; <em>P</em> = .004). There was no significant difference in early mortality or stroke rates between the 2 groups.</div></div><div><h3>Conclusions</h3><div>To our knowledge, this is the first propensity-score matched comparison of clinical outcomes in low-risk patients undergoing MIAVR versus TAVR, revealing that MIAVR could provide lower rates of permanent pacemaker implantation, paravalvular leak, and aortic regurgitation, without any increase in short-term mortality or stroke. Future prospective or randomized controlled trials are needed to validate these results.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 75-84"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913232","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":"Imaging surveillance for thoracic aortic aneurysms in Medicare beneficiaries","authors":"Roxanne S. Steijn MD ,&nbsp;Hechuan Hou MS ,&nbsp;Nicholas S. Burris MD ,&nbsp;Joost van Herwaarden MD, PhD ,&nbsp;Himanshu J. Patel MD ,&nbsp;Michael P. Thompson PhD","doi":"10.1016/j.xjon.2025.05.004","DOIUrl":"10.1016/j.xjon.2025.05.004","url":null,"abstract":"<div><h3>Background</h3><div>Regular imaging surveillance is guideline-recommended for the management of thoracic aortic aneurysm (TAA) but has not been well described in clinical practice. Here we evaluated the frequency of imaging procedures and associated outcomes, procedures, and healthcare costs in patients with TAA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of inpatient and professional claims for 28,459 Medicare beneficiaries age ≥65 years with a diagnosis of TAA between 2017 and 2019 was performed. Imaging types (computed tomography, magnetic resonance angiography, or transthoracic echocardiography) were identified from professional claims for beneficiaries with TAA during the 2 calendar years and categorized as any (yes vs no) and number of imaging procedures. Multivariable logistic regression was used to evaluate the association of patient and clinical factors with undergoing any imaging and to compare clinical outcomes (surgical intervention, all-cause mortality, and hospitalization) across imaging types.</div></div><div><h3>Results</h3><div>A total of 12,968 beneficiaries (45.6%) underwent imaging during the study period, including 24.9% with 1 image, 13.07% with 2 images, and 7.6% with ≥3 images. Younger age, female sex, white race/ethnicity, and lower comorbidity score were independently associated with undergoing any imaging. Compared to receiving no imaging and after risk adjustment, beneficiaries with ≥3 images had more frequent surgical interventions (0.4% vs 6.6%; <em>P</em> &lt; .001) and all-cause hospitalization (41.6% vs 75.9%; <em>P</em> &lt; .001) but lower mortality (16.4% vs 13.3%; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Imaging for TAA is underutilized among Medicare beneficiaries, and more frequent imaging is associated with more frequent surgical intervention, hospitalization, and lower mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 44-51"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913235","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":"Commentator Discussion: Objective performance indicators provide a novel, quantitative method to evaluate surgeon proficiency in robotic lobectomy training","authors":"","doi":"10.1016/j.xjon.2025.03.003","DOIUrl":"10.1016/j.xjon.2025.03.003","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 337-338"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912818","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":"Cavernous hemangioma of the mediastinum originating from a left persistent superior vena cava","authors":"Mo'men Alashwas ,&nbsp;Wedad Alashwas ,&nbsp;Ahmad Dalal ,&nbsp;Natalie Khamashta ,&nbsp;Hamad Madi MD","doi":"10.1016/j.xjon.2025.05.007","DOIUrl":"10.1016/j.xjon.2025.05.007","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 288-291"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912927","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":"Outcomes of the Fontan operation in patients with Ebstein anomaly: An Australia and New Zealand Fontan registry study","authors":"Michael Daley MD, MSurg ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS ,&nbsp;Julian Ayer MBBS, PhD, FRACP ,&nbsp;Ajay Iyengar MBBS, PhD, FRACS ,&nbsp;David Celermajer MBBS, PhD, FRACP ,&nbsp;Rachael Cordina MBBS, PhD, FRACP ,&nbsp;Terry Robertson MBBS, FRACP ,&nbsp;Aditya Patukale MCh ,&nbsp;Nelson Alphonso MBBS, FRACS ,&nbsp;Yves d’Udekem MD, PhD, FRACS","doi":"10.1016/j.xjon.2025.06.004","DOIUrl":"10.1016/j.xjon.2025.06.004","url":null,"abstract":"<div><h3>Objectives</h3><div>We sought to review the outcomes of patients with Ebstein anomaly (EA) after the Fontan operation.</div></div><div><h3>Methods</h3><div>Patients with EA were identified from a large binational registry about the Fontan operation. Data were collected from hospital records, registry data, and clinical correspondence.</div></div><div><h3>Results</h3><div>Of the 1601 patients who underwent a contemporary Fontan operation from 1991 to 2023, 34 patients had EA. Seven patients (21%) had concomitant congenitally corrected transposition of great arteries. Prior Starnes procedure was performed in 18 (53%) patients. Survival after Fontan operation in patients with EA was 92% (95% CI, 70%-98%) and freedom from Fontan failure was 80% (95% CI, 53%-92%) at 10 years. Patients with EA had worse long-term survival (<em>P =</em> .01) after Fontan operation and lower freedom from Fontan failure (<em>P =</em> .004) compared with other patients with left-ventricle dominance. Patients with EA, who underwent prior Starnes procedure, had 100% survival and freedom from Fontan failure, albeit at a shorter follow-up (median, 4.2 years; range, 13 days-17.7 years), with no difference between patients with prior Starnes and patients with tricuspid atresia (<em>P</em> = .76 and <em>P</em> = .69, respectively), although comparison was hindered by low numbers. Of the 7 patients with congenitally corrected transposition of great arteries and EA, there were no mortalities; however, 2 patients had Fontan failure at 7.0 and 9.8 years post-Fontan.</div></div><div><h3>Conclusions</h3><div>Patients with EA have worse long-term outcomes after the Fontan operation compared with other patients with left ventricular dominance. Patients with a prior Starnes procedure appear to have good post-Fontan outcomes, although bias may occur due to small numbers.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"26 ","pages":"Pages 160-165"},"PeriodicalIF":1.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913300","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}