JTCVS open最新文献

{"title":"Association of dysautonomia with refractory ventricular tachyarrhythmia in patients requiring thoracoscopic surgical cardiac sympathetic denervation","authors":"Andrei Gurau MD, MHS, MS ,&nbsp;Dianela Perdomo BS ,&nbsp;Hamza Khan MD ,&nbsp;Kelsey Melinosky MD ,&nbsp;Anna Chudnovets MD ,&nbsp;Jacob Blum BA ,&nbsp;Mahmoud Kutmah BA ,&nbsp;Victor Yang BA ,&nbsp;Albert Leng BA ,&nbsp;Arjun Menta BS, BBA ,&nbsp;Xiyu Zhao BS ,&nbsp;Suguru Yamauchi MD, PhD ,&nbsp;Kristen Rodgers BS ,&nbsp;Kathryn Ecoff BS ,&nbsp;Errol Bush MD ,&nbsp;Andreas S. Barth MD, PhD ,&nbsp;Malcolm Brock MD ,&nbsp;Frank Bosmans PharmD, PhD ,&nbsp;Jinny S. Ha MD","doi":"10.1016/j.xjon.2024.11.020","DOIUrl":"10.1016/j.xjon.2024.11.020","url":null,"abstract":"<div><h3>Objective</h3><div>Although cardiac sympathetic denervation (CSD) effectively manages refractory ventricular tachyarrhythmias (RVTs) in long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia, the link between dysautonomia and RVT from broader etiologies is understudied. We hypothesized that dysautonomia is linked to RVT regardless of etiology in patients requiring CSD. We aimed to determine whether these patients have a high burden of dysautonomia symptoms using the Composite Autonomic Symptom Score-31 (COMPASS-31).</div></div><div><h3>Methods</h3><div>COMPASS-31 surveys were administered to 37 patients with RVT who underwent CSD and 37 matched healthy controls. COMPASS-31 scores were compared using Mann-Whitney <em>U</em> tests. Comparisons were made between patients with and without structural heart disease, and multivariable regression identified predictors for COMPASS-31 scores and CSD response.</div></div><div><h3>Results</h3><div>Common operative indications were idiopathic ventricular arrhythmias (49%) and arrhythmogenic right ventricular cardiomyopathy (30%). Patients with RVT had significantly greater COMPASS-31 scores (median 25.3) compared with control patients (median 8.6, <em>P</em> &lt; .001), with greater scores in the gastrointestinal, secretomotor, orthostasis, pupillomotor, and vasomotor domains. Sensitivity analysis confirmed these findings, showing significantly greater COMPASS-31 scores in cases versus controls (estimate: 14.5; 95% confidence interval, 9.2-19.8, <em>P</em> &lt; .001). No differences were found between patients with and without structural heart disease, and no predictors for COMPASS-31 score were identified. One year post-CSD, 78.4% of patients remained free of implantable cardioverter-defibrillator shocks.</div></div><div><h3>Conclusions</h3><div>Dysautonomia symptoms are significantly associated with RVT requiring CSD, regardless of underlying etiology. This association, in the context of CSD efficacy in RVT across structural and nonstructural etiologies, highlights autonomic dysfunction as a common pathophysiologic link warranting further investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 120-127"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464457","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":"Temporal trends in the utilization, costs, and outcomes of concomitant left atrial appendage closure across a statewide collaborative","authors":"Yas Sanaiha MD ,&nbsp;Bob Kiaii MD, FRCRC, FACS ,&nbsp;Jack C. Sun MD ,&nbsp;Michael Madani MD ,&nbsp;Tom C. Nguyen MD ,&nbsp;Richard J. Shemin MD ,&nbsp;Peyman Benharash MD ,&nbsp;University of California Cardiac Surgery Consortium","doi":"10.1016/j.xjon.2024.10.030","DOIUrl":"10.1016/j.xjon.2024.10.030","url":null,"abstract":"<div><h3>Objective</h3><div>With the rising incidence of atrial fibrillation, left atrial appendage closure (LAAC) at the time of cardiac surgery remains an important adjunct. The present study characterized trends, associated resource utilization, and potential disparities in the use of left atrial appendage exclusion.</div></div><div><h3>Methods</h3><div>Using a Society of Thoracic Surgeons regional academic collaborative database, we queried all adult patients undergoing coronary and valve procedures with concomitant LAAC between 2015 and 2021. Trends in LAAC, as well as the technique for closure, were evaluated. Multilevel hierarchical logistic modeling was applied to delineate factors associated with LAAC, accounting for patient and operative characteristics. Generalized linear models were developed to perform risk-adjusted incremental cost analysis.</div></div><div><h3>Results</h3><div>Of the 8699 patients who met the study criteria, 1377 underwent left atrial appendage closure. Over the study period, the annual rate of LAAC increased from 16.7% to 30.8% (<em>P</em> &lt; .001). LAAC patients were older, but less commonly insulin-dependent diabetics or on dialysis. Female sex, redo, and urgent operative status had lower risk-adjusted odds of LAAC. Although LAAC was associated with longer bypass time, there was no significant association with 30-day mortality or 30-day readmission. LAAC was associated with an incremental increase in adjusted costs by $10,602 (95% confidence interval, $4078-$17,126).</div></div><div><h3>Conclusions</h3><div>Rates of LAAC are increasing but less common among female patients, as well as those requiring urgent/emergent interventions. LAAC did not significantly impact short-term mortality. Our results suggest that LAAC may be a high-value intervention among patient populations that have the greatest potential to derive its benefits.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 176-189"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465001","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":"Phrenic nerve infiltration: A good practice to combine pulmonary expansion and pain control in patients with high risk of prolonged air leak","authors":"Beatrice Trabalza Marinucci MD ,&nbsp;Antonio D'Andrilli MD ,&nbsp;Cecilia Menna MD ,&nbsp;Silvia Fiorelli MD, PhD ,&nbsp;Alessandra Siciliani MD ,&nbsp;Claudio Andreetti MD ,&nbsp;Anna Maria Ciccone MD ,&nbsp;Giulio Maurizi MD ,&nbsp;Camilla Vanni MD ,&nbsp;Matteo Tiracorrendo MD ,&nbsp;Domenico Massullo MD ,&nbsp;Erino Angelo Rendina MD ,&nbsp;Mohsen Ibrahim MD","doi":"10.1016/j.xjon.2024.10.026","DOIUrl":"10.1016/j.xjon.2024.10.026","url":null,"abstract":"<div><h3>Objective</h3><div>Prolonged air leak due to residual air space after lung resection is a main challenge. To date, few surgical options have been described to prevent this complication. The aim of this study is to investigate the safety and the efficacy of intraoperative phrenic nerve infiltration with long-acting anesthetics in producing transient hemidiaphragm paralysis in patients at high risk for prolonged air leak, thus improving pulmonary expansion after surgery and reducing air leaks, while controlling postoperative pain.</div></div><div><h3>Methods</h3><div>Between January 2021 and 2023, 65 consecutive patients at risk for prolonged air leak (defined in accordance with “2019 Society of Thoracic Surgery score criteria of prolonged air leak”) who underwent lung resection (lobectomy or anatomic segmentectomy) for malignancy were prospectively included in the study. They were randomly (1:2 ratio) assigned to receive (group A, 22 patients) intraoperative phrenic nerve infiltration with ropivacaine 10 mg/mL in the peri-neurotic fat on the pericardium or not to receive intraoperative phrenic nerve infiltration (group B, 43 patients). Five patients in group B were excluded because they did not undergo anatomic resection. Data on pulmonary reexpansion, prolonged air leaks, pain at 24 and 72 hours postsurgery, referred shoulder pain, length of hospital stay, and length of chest tube permanence were collected and compared.</div></div><div><h3>Results</h3><div>Hemidiaphragm elevation (<em>P</em> = .006) and pulmonary expansion (<em>P</em> = .000) were significantly higher in group A. Patients in group A showed lower pain at 24 and 72 hours compared with group B (<em>P</em> = .004). Shoulder pain (0.001) and prolonged air leak (0.000) were higher in group B. Length of chest tube was longer in group B. No difference in hospital stay length was observed.</div></div><div><h3>Conclusions</h3><div>This is the first study to investigate 2 combined effects of phrenic nerve anesthetic infiltration (hemidiaphragm elevation and pain control), with potential enhancement of a patient's recovery after surgery. Intraoperative phrenic nerve infiltration in patients with a risk for prolonged air leak appears to be a safe and effective clinical practice to improve pulmonary expansion in this set of patients, reducing postoperative air leak. This result is associated with an additional improvement in pain control, especially for shoulder pain.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 349-357"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465076","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":"Type A intramural hematoma over 21 years: A single center's experience","authors":"Jennifer Lynn Kim MD ,&nbsp;Michael Baiocchi PhD ,&nbsp;Matthew Leipzig BS ,&nbsp;Matthew Duda MD ,&nbsp;Edgar Aranda-Michel MD, PhD ,&nbsp;Emily Tognozzi MS ,&nbsp;Kelly Higa MD, PhD ,&nbsp;Yuanjia Zhu MD, PhD ,&nbsp;John Ward MacArthur MD ,&nbsp;Y. Joseph Woo MD ,&nbsp;Michael P. Fischbein MD, PhD","doi":"10.1016/j.xjon.2024.09.033","DOIUrl":"10.1016/j.xjon.2024.09.033","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the differences in short- and mid-term outcomes for intramural hematoma in the type A distribution (TAIMH) and acute type A aortic dissection (ATAAD) patients treated at a single institution between 2000 and 2020 to provide insight into whether an emergent surgical treatment strategy for TAIMH is an acceptable treatment option.</div></div><div><h3>Methods</h3><div>Between January 2000 and December 2020, a total of 903 patients were treated for acute aortic syndrome at Stanford Hospital. Baseline characteristics, operative details, short-term postoperative outcomes, mid-term survival, and reoperation rates were examined for this cohort. Cardinality matching was used to control for baseline characteristics and presentation symptoms. Fine balance matching was used to control for cannulation strategy.</div></div><div><h3>Results</h3><div>A total of 187 TAIMH patients were treated surgically and 27 were managed medically. The ATAAD arm included 642 patients who underwent surgery and 47 who were managed nonoperatively. ATAAD operative patients were more commonly male and younger compared to the TAIMH operative patients; however, other baseline medical history was similar in the 2 arms. ATAAD patients presented with higher rates of malperfusion and aortic regurgitation. Cross-clamp and cardiopulmonary bypass times were longer in the ATAAD arm, and these patients underwent more root replacements. Short-term postoperative outcomes were similar in the 2 arms, and there was no significant difference in unadjusted long-term survival and freedom from reoperation. With cardinality matching for preoperative history and presentation symptoms, mid-term survival was better for TAIMH patients. With fine balance matching for cannulation strategy, there was no significant difference between the groups in mid-term survival or stroke.</div></div><div><h3>Conclusions</h3><div>In conclusion, a surgical management strategy for acute TAIMH results in excellent postoperative outcomes and supports an aggressive emergent operative strategy in aortic centers of excellence.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 1-18"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465185","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":"The impact of extent of nodal involvement on stage IIIA (N2) non−small cell lung cancer outcomes","authors":"Lye-Yeng Wong MD ,&nbsp;Lillian L. Tsai MD ,&nbsp;Hao He PhD ,&nbsp;Irmina A. Elliott MD ,&nbsp;Mark F. Berry MD","doi":"10.1016/j.xjon.2024.11.018","DOIUrl":"10.1016/j.xjon.2024.11.018","url":null,"abstract":"<div><h3>Objective</h3><div>Stage IIIA (N2) non−small cell lung cancer (NSCLC) treatment can depend on the extent of nodal involvement, with surgery considered for limited disease and definitive chemoradiation preferred for bulky or multi-station disease. Evidence to support management is limited. This study evaluated the impact of the extent of stage IIIA (N2) nodal involvement on outcomes after surgery.</div></div><div><h3>Methods</h3><div>Patients who underwent surgical resection of T1-2N2M0 NSCLC in the Surveillance, Epidemiology, and End Results database from 2004 to 2019 were stratified as having limited (1 positive node) versus more extensive (&gt;1 positive node) nodal disease, and survival was evaluated with Kaplan-Meier and Cox analyses.</div></div><div><h3>Results</h3><div>Of the 6933 patients identified surgical patients, 2129 (30.7%) had limited nodal disease whereas 4804 (69.3%) had more extensive nodal involvement. The limited nodal group had greater 5-year overall survival than the more extensive node group (39.3% vs 30.3%, <em>P</em> &lt; .001), and more extensive nodal involvement (hazard ratio, 1.26; <em>P</em> &lt; .001) was independently associated with worse survival in Cox analysis. Surgical patients had a greater 5-year overall survival than 1644 comparable N2 patients with extensive nodal involvement who received definitive chemoradiation (30.9% vs 18.9%, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Increasing nodal involvement is associated with worse survival for patients with stage IIIA (N2) NSCLC but select patients with more extensive nodal disease may still benefit from surgery compared to chemoradiation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 256-265"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465269","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":"National race and socioeconomic disparities in access to minimally invasive lung resection for early-stage lung cancer: Impact on mortality","authors":"Aminah Sallam MD ,&nbsp;Qiudong Chen MD ,&nbsp;Andrew Brownlee MD ,&nbsp;Woo Sik Yu MD ,&nbsp;Kellie Knabe NP ,&nbsp;Sevannah Soukiasian ,&nbsp;Lucas Weiser MD ,&nbsp;Joanna Chikwe MD ,&nbsp;Harmik Soukiasian MD","doi":"10.1016/j.xjon.2024.10.035","DOIUrl":"10.1016/j.xjon.2024.10.035","url":null,"abstract":"<div><h3>Background</h3><div>Adoption of minimally invasive surgery (MIS) for early-stage non–small cell lung cancer (NSCLC) is increasing in the United States. We examined the relationship between sociodemographic factors and receipt of MIS among these patients.</div></div><div><h3>Methods</h3><div>Patients undergoing surgical resection for stage I and II NSCLC between 2010 and 2018 were identified in the National Cancer Database and stratified by surgical approach. Patients were excluded if they had nonanatomic or palliative resection, received neoadjuvant therapy, or lacked relevant clinical and demographic factors or follow-up. Multivariate analysis adjusted for baseline characteristics. The primary outcome was receipt of MIS; secondary outcomes were 30-and 90-day mortality.</div></div><div><h3>Results</h3><div>A total of 130,452 patients underwent open (n = 67,046; 51%), video-assisted thoracic surgery (VATS; n = 43,849; 34%), or robotic (n = 19,557; 15%) surgery. Non-Hispanic black patients were less likely than non-Hispanic white patients to undergo MIS (adjusted odds ratio [aOR], 0.895; 95% CI, 0.858-0.934; <em>P</em> &lt; .001). This was not significant after adjusting for census-tract income (aOR, 0.967; 95% CI, 0.926-1.011; <em>P</em> = .1374). Non-Hispanic black patients were significantly more likely reside in lower income census-tracts and be underinsured; these factors were significantly associated with decreased access to MIS. Open surgery was associated with worse adjusted 30-day mortality (1.89% for open, 1.25% for VATS, 1.24% for robotic) and 90-day mortality (3.4% for open, 2.17% for VATS, 2.08% for robotic) compared to MIS (<em>P</em> &lt; .001). Mortality was significantly associated with census-tract income level and insurance status (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Racial disparities in receipt of MIS among early-stage NSCLC patients are mediated by census-tract income and insurance status. Access to MIS and insurance status are associated with improved 30- and 90-day mortality. Policy efforts are needed to improve access and outcomes for these patients.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 358-368"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465077","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":"Distal anastomotic new entry tears and aortic remodeling following type A dissection repair: A systematic review","authors":"Ryaan El-Andari MD ,&nbsp;Nicholas M. Fialka MD ,&nbsp;Abdullah Alshehri MD ,&nbsp;Ali Fatehi Hassanabad MD, PhD ,&nbsp;Sabin J. Bozso MD, PhD ,&nbsp;Michael C. Moon MD","doi":"10.1016/j.xjon.2024.11.004","DOIUrl":"10.1016/j.xjon.2024.11.004","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 89-100"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464400","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":"Selective antegrade cerebral perfusion: Still favored?","authors":"Safak Alpat MD, PhD, MEBCTS","doi":"10.1016/j.xjon.2024.11.008","DOIUrl":"10.1016/j.xjon.2024.11.008","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 222-223"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465182","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":"Reply: Which cerebral perfusion strategy is best? Only time will tell","authors":"W. Hampton Gray MD,&nbsp;Katherine Sprouse MD,&nbsp;Luz A. Padilla MD, MSPH","doi":"10.1016/j.xjon.2024.12.005","DOIUrl":"10.1016/j.xjon.2024.12.005","url":null,"abstract":"","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Page 224"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465183","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":"Surgical removal of pulmonary flow restrictors in children with congenital heart disease: What the outcomes reveal","authors":"Raymond N. Haddad MD, MHSc ,&nbsp;Jamie Bentham MD ,&nbsp;Carlos Pardo MD ,&nbsp;Rasha Alloush MD ,&nbsp;Mahmoud Al Soufi MD ,&nbsp;Osama Jaber MD ,&nbsp;Mohamed Kasem MD ,&nbsp;Issam El Rassi MD","doi":"10.1016/j.xjon.2024.11.011","DOIUrl":"10.1016/j.xjon.2024.11.011","url":null,"abstract":"<div><h3>Objective</h3><div>Pulmonary flow restrictors (PFRs) are interesting devices, but their surgical removal outcomes are poorly understood.</div></div><div><h3>Methods</h3><div>Retrospective review of clinical data from children with bilateral PFRs who underwent device removal during follow-up surgery.</div></div><div><h3>Results</h3><div>Thirty-four PFRs were explanted from 17 patients (41.2% boys) at a median of 2 months (interquartile range [IQR], 1.2-5.2 months) postimplantation, with a median patient age of 2.5 months (IQR, 1.6-5.8 months). One patient experienced life-threatening bilateral pulmonary artery (PA) aneurysms 2 months after PFR implantation, necessitating urgent surgery. Two PFRs were found migrated across the left PA's upper lobe branch origin. Twenty-six were removed intact, 1 in 2 fragments, and 7 piecemeal. No thrombus was noted. Neoendothelium was observed on 11 PFRs. Seven PFRs caused endothelial damage, requiring sharp and blunt dissection for removal. Six right and 4 left PA arteriotomies were patched. Hegar dilators, with median sizes of 7 mm (IQR, 6.8-8.3 mm) for right PA and 7 mm (IQR, 7-8 mm) for left PA, confirmed branch patency. At a median follow-up of 14.8 months (IQR, 10.2-18.3 months), echocardiographic maximum velocities in 13 biventricular patients and 2 awaiting future biventricular repair were 1.5 m/second (IQR, 1.4-1.7 m/second) for the left PA and 1.6 m/second (IQR, 1.4-1.7 m/second) for the right PA. One patient with deferred Norwood had normal PAs and well-positioned PFRs on prestage-II catheterization. A patient who underwent stage-II Norwood 3.2 months post-PFR implantation died from sepsis 1 month later, but post-Glenn angiogram revealed no stenosis.</div></div><div><h3>Conclusions</h3><div>PFR removal is safe and effective. Complications are manageable, with no PA stenosis observed.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"23 ","pages":"Pages 235-244"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465267","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}