JTCVS open最新文献

{"title":"Type-entry-malperfusion classification in a 13-year cohort of surgically treated type A acute aortic syndromes: Impact on planning and outcomes","authors":"Jacques Tomasi MD, PhD,&nbsp;Pierre Escrig MD,&nbsp;Jean Philippe Verhoye MD, PhD","doi":"10.1016/j.xjon.2026.101614","DOIUrl":"10.1016/j.xjon.2026.101614","url":null,"abstract":"<div><h3>Objectives</h3><div>The Stanford classification helps rapidly triage patients with type A acute aortic syndrome, but it overlooks key elements like proximal entry tear and malperfusion. The newer type, entry, malperfusion classification addresses these gaps to improve management.</div></div><div><h3>Methods</h3><div>We conducted a retrospective monocentric study of all patients operated for type A acute aortic syndrome between 2010 and 2023.</div></div><div><h3>Results</h3><div>Among 334 included patients, hospital mortality was 16.5%. Entry tear was located in the ascending aorta in 69%, the arch in 19%, and the descending aorta in 3.6%. Malperfusion occurred in 75% of patients; 35% had at least 1 clinical malperfusion. Arch or distal entry tears were significantly associated with more extensive arch resections. Coronary malperfusion led to more associated procedures (coronary artery bypass grafting, reimplantation), more frequent root replacements (M1−), and greater extracorporeal life support use (M1+). Clinical malperfusions were associated with greater mortality and complication rates. Patients who were M3+ displayed the most severe multiorgan complications.</div></div><div><h3>Conclusions</h3><div>The type, entry, malperfusion classification offers valuable preoperative insights, helping to anticipate surgical strategy and identify high-risk patients. However, its ability to differentiate malperfusion severity remains limited.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101614"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720465","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":"Moderate or severe aortic valve disease in patients with successful rheumatic mitral and tricuspid valve repair: Efforts to repair valve","authors":"Zhou Liu MD ,&nbsp;Chuang Liu MD ,&nbsp;Ruifei Liu MM ,&nbsp;Yazhe Zhang MM ,&nbsp;Jiajun Liang MM ,&nbsp;Jie Han MD ,&nbsp;Xu Meng MD ,&nbsp;Meili Wang PhD ,&nbsp;Hongjia Zhang MD ,&nbsp;Wenjian Jiang MD","doi":"10.1016/j.xjon.2026.101599","DOIUrl":"10.1016/j.xjon.2026.101599","url":null,"abstract":"<div><h3>Objective</h3><div>The management of aortic valve (AV) disease in patients with rheumatic heart disease (RHD) undergoing multivalve surgery remains uncertain. This study aimed to compare the long-term outcomes of AV repair versus AV replacement in patients with RHD undergoing combined mitral and tricuspid valve repair.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 288 patients with RHD who underwent combined mitral and tricuspid valve repair with either AV repair (n = 122) or AV replacement (n = 166) at Beijing Anzhen Hospital from January 2015 to August 2024. The primary outcomes were overall survival and freedom from valve-related events. Kaplan-Meier survival analysis and inverse probability of treatment weighting were used to adjust for baseline differences and compare the groups.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 56.4 ± 9.8 years, and 33.3% were male. The AV repair group was younger and had less-severe baseline AV disease. After AV repair, 91.8% of patients achieved improved valve function. AV repair was associated with shorter cardiopulmonary bypass (147.6 vs 168.2 minutes) and aortic crossclamp times (117.9 vs 134.1 minutes), as well as lower postoperative mean AV gradients (13.1 vs 18.8 mm Hg). Residual aortic regurgitation occurred in 81.1% of the repair group, but severe AV dysfunction or reoperation was rare (4/122). Kaplan-Meier analysis revealed no significant difference in overall survival (<em>P</em> = .56) and freedom from valve-related events (<em>P</em> = .21) between the 2 groups, with curves adjusted by inverse probability of treatment weighting showing consistent results.</div></div><div><h3>Conclusions</h3><div>AV repair is a feasible and safe alternative to replacement in selected patients with RHD undergoing multivalve surgery, offering favorable early hemodynamics and comparable midterm outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101599"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720555","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":"Modifying a traditional femoral venoarterial extracorporeal membrane oxygenation cannulation strategy and circuit to improve distal limb hemodynamics","authors":"Joshua G. Crane MD ,&nbsp;Isabelle R. Lytle BS ,&nbsp;Connor T. Eckholdt MD ,&nbsp;Mark S. Slaughter MD ,&nbsp;Steven C. Koenig PhD ,&nbsp;Gretel Monreal PhD","doi":"10.1016/j.xjon.2026.101710","DOIUrl":"10.1016/j.xjon.2026.101710","url":null,"abstract":"<div><h3>Objective</h3><div>There have been many varied approaches to support patients on femoral venoarterial extracorporeal membrane oxygenation (ECMO), yet limb ischemia remains a significant problem. Using a dynamic mock flow loop model, we modified a historically traditional cannulation strategy and circuit (TC) to a proposed “hemodynamically ideal” configuration (HIC) to improve distal limb hemodynamics.</div></div><div><h3>Methods</h3><div>A dynamic mock flow loop model was tuned to simulate heart failure. Two femoral venoarterial ECMO configurations were tested: (1) For TC, 19-Fr arterial cannula (right common femoral artery) with ipsilateral venous cannulation (right femoral vein), and an 8-Fr introducer sheath as the distal perfusion catheter (right superficial femoral artery) with its line T'd from the arterial cannula's Luer port. (2) Proposed HIC: A smaller arterial cannula (15 Fr, right common femoral artery) with contralateral venous cannulation (left femoral vein), and a 10-Fr pediatric arterial cannula as the distal perfusion catheter (right superficial femoral artery) with its line Y'd from the ECMO circuit. Experiments were performed at baseline and with ECMO support at 0, 1000, 2000, and 3000 rpm.</div></div><div><h3>Results</h3><div>The proposed HIC reduced ventricular afterload and provided greater pulsatility and flows to the distal limbs, particularly to the cannulated right superficial femoral artery. The HIC also provided 390% more distal perfusion catheter flow than the TC.</div></div><div><h3>Conclusions</h3><div>The proposed HIC provided more favorable hemodynamics compared with a TC that may offer significant clinical benefits, including less congestion, reduced risk of limb ischemic, and improved patient outcomes, warranting further clinical investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101710"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720621","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 edge-to-edge repair in symptomatic patients with severe tricuspid regurgitation and prior heart valve surgery","authors":"Stephen H. McKellar MD ,&nbsp;Brian K. Whisenant MD ,&nbsp;Gagan D. Singh MD ,&nbsp;Susheel Kodali MD ,&nbsp;Samir Kapadia MD ,&nbsp;Shamir R. Mehta MD ,&nbsp;David M. Lasorda DO ,&nbsp;Nadira Hamid MD ,&nbsp;Vinod Thourani MD ,&nbsp;Zexu Lin PhD ,&nbsp;Kelli Peterman MPH ,&nbsp;Rebecca T. Hahn MD ,&nbsp;Gilbert H.L. Tang MD, MBA, MS ,&nbsp;Paul Sorajja MD ,&nbsp;David H. Adams MD","doi":"10.1016/j.xjon.2026.101613","DOIUrl":"10.1016/j.xjon.2026.101613","url":null,"abstract":"<div><h3>Background</h3><div>Tricuspid valve surgery for tricuspid regurgitation (TR) following prior valve surgery carries increased risk. This study evaluated 2-year outcomes of tricuspid transcatheter edge-to-edge repair (T-TEER) in patients with severe TR and prior valve surgery.</div></div><div><h3>Methods</h3><div>TRILUMINATE Pivotal is an international randomized trial comparing T-TEER with the TriClip (device group) to medical therapy (control group) in patients with symptomatic severe TR, with a concurrent single-arm cohort (device) for anatomically complex patients. Echocardiograms were assessed in a core laboratory, and outcomes were adjudicated by an independent clinical events committee.</div></div><div><h3>Results</h3><div>Among the 469 patients in the device group, 113 had prior valve surgery and 356 did not. Baseline characteristics were comparable in the 2 groups: mean age, 77 years versus 79 years; female sex, 64% versus 59%; atrial fibrillation, 87% versus 86%; and heart failure hospitalization (HFH) within 1 year prior to T-TEER, 26% versus 25%. The T-TEER success rate was 99% in both groups, with no in-hospital deaths, a median hospital stay of 1 day, and 97% discharged home. Thirty-day adverse event rates were low and similar: rates of all-cause mortality, stroke, and new pacemaker implantation were all &lt;2%, and the rate of major bleeding was &lt;4%. At 2 years, outcomes remained favorable and comparable: ≤ moderate TR was achieved in 81% versus 80% (<em>P</em> = .93), New York Heart Association class I/II was observed in 74% versus 84% (<em>P</em> = .11), and KCCQ scores improved by a mean of 15 ± 21 points versus 16 ± 23 points (<em>P</em> = .66). Both groups experienced a significant reduction in HFH (79% vs 31%; <em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>In patients with prior valve surgery, T-TEER was safe and resulted in significant TR reduction and symptom improvement.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101613"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720622","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":"Regional travel distance is not associated with operative mortality in acute type A aortic dissection","authors":"Anthony V. Norman MD, MSc ,&nbsp;Raymond J. Strobel MD, MSc ,&nbsp;Sanjana Challa BS ,&nbsp;Kristen Wells PhD, MPH ,&nbsp;Andrew M. Young MD ,&nbsp;Alexander M. Wisniewski MD, MSc ,&nbsp;Raza M. Ahmad MD ,&nbsp;Michael A. Mazzeffi MD ,&nbsp;Alan M. Speir MD ,&nbsp;Mohammed A. Quader MD ,&nbsp;Jared P. Beller MD ,&nbsp;Leora T. Yarboro MD ,&nbsp;John A. Kern MD ,&nbsp;Kenan W. Yount MD, MBA ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.xjon.2026.101708","DOIUrl":"10.1016/j.xjon.2026.101708","url":null,"abstract":"<div><h3>Objectives</h3><div>Few data are available to examine the impact of travel distance on outcomes in acute type A aortic dissection (ATAAD). We hypothesized that longer travel would increase mortality after ATAAD repair.</div></div><div><h3>Methods</h3><div>We studied the impact of travel distance ≤100 miles before ATAAD repair between July 2011 and September 2022 using a regional collaborative database. Patients were stratified into quartiles, and the longest and shortest distance quartiles were compared. High-volume centers were defined as those averaging &gt;10 ATAAD repairs annually. Multivariable and hierarchical logistic regression models were fit to identify preoperative and intraoperative risk factors associated with operative mortality.</div></div><div><h3>Results</h3><div>We identified 1285 patients who underwent ATAAD repair: 320 in the longest-distance quartile and 335 in the shortest. The longest-distance quartile had greater hospital transfer rates (76% vs 26%, <em>P</em> &lt; .001). There was no difference in major morbidity (52% vs 53%, <em>P</em> = .78) or operative mortality (22% vs 22%, <em>P</em> = .95). High-volume centers were associated with lower mortality (odds ratio [OR], 0.68; 95% CI, 0.46-0.99; <em>P</em> = .048). Age (OR, 1.03; 95% CI, 1.01-1.04, <em>P</em> &lt; .001), cardiopulmonary resuscitation (OR, 2.73; 95% CI, 1.31-5.69, <em>P</em> = .007), cardiogenic shock (OR, 1.99; 95% CI, 1.24-3.22, <em>P</em> = .005), longer cardiopulmonary bypass time (OR, 1.01; 95% CI, 1.01-1.01, <em>P</em> &lt; .001), greater temperature nadir (OR, 1.05; 95% CI, 1.01-1.09, <em>P</em> = .006), and intraoperative blood transfusion (OR, 1.16; 95% CI, 1.08-1.24, <em>P</em> &lt; .001) were associated with greater mortality. Distance (OR, 0.99; 95% CI, 0.98-1.00; <em>P</em> = .073) and hospital transfers (OR, 1.08 95% CI, 0.74-1.58; <em>P</em> = .69) were nonsignificant.</div></div><div><h3>Conclusions</h3><div>Hospital transfers and travel distances up to 100 miles for ATAAD repair did not increase operative mortality.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101708"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720790","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":"Clinical outcomes of pediatric heart transplantation: A 25-year follow-up experience in a Japanese institute","authors":"Jun Narita MD ,&nbsp;Ryo Ishii MD ,&nbsp;Atsuko Kato MD, PhD ,&nbsp;Masaki Hirose MD ,&nbsp;Yuka Hayashida MD ,&nbsp;Hiroki Nagano MD ,&nbsp;Yosuke Kugo MD ,&nbsp;Motoki Komori MD ,&nbsp;Takashi Kido MD, PhD ,&nbsp;Takayoshi Ueno MD, PhD ,&nbsp;Shigetoyo Kogaki MD ,&nbsp;Shigeru Miyagawa MD, PhD ,&nbsp;Yasuji Kitabatake MD, PhD ,&nbsp;Hidekazu Ishida MD, PhD","doi":"10.1016/j.xjon.2026.101713","DOIUrl":"10.1016/j.xjon.2026.101713","url":null,"abstract":"<div><h3>Objective</h3><div>Advances in medical management have markedly improved early and late outcomes after pediatric heart transplantation. Although survival data are well established in Western countries, evidence from Asia remains limited.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the records of 75 patients who underwent heart transplantation younger than 18 years and received posttransplant care at The University of Osaka Hospital, Japan, between 2000 and 2024.</div></div><div><h3>Results</h3><div>The cohort included 35 male patients, with a median age of 6 years at transplantation. Forty-six patients (61%) underwent transplantation in Japan and 29 (39%) underwent transplantation in other countries. Underlying diagnoses were dilated cardiomyopathy in 42 patients (56%), restrictive cardiomyopathy in 23 (31%), and congenital heart disease in 4 (5%). Overall survival was 96% at 5 and 10 years, 86% at 15 years. Major posttransplant complications included posttransplant lymphoproliferative disease (n = 9), rejection requiring intensified immunosuppression (n = 14), cardiac allograft vasculopathy (n = 5), and renal failure requiring kidney transplantation or dialysis (n = 9). Among the 38 patients who reached adulthood, 15 (39%) were employed, 14 (37%) were pursuing higher education, and 9 (24%) were neither employed nor in education.</div></div><div><h3>Conclusions</h3><div>Pediatric heart transplantation at our institution yielded long-term survival rates comparable with international registry data. Most patients achieved stable school attendance and successful adult social reintegration.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101713"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720855","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":"Birth day of the week is associated with surgical timing and postoperative brain injury in neonates with congenital heart disease","authors":"Jennifer M. Lynch MD, PhD ,&nbsp;Marin Jacobwitz PhD, CRNP ,&nbsp;J. William Gaynor MD ,&nbsp;Susan C. Nicolson MD ,&nbsp;Daniel J. Licht MD","doi":"10.1016/j.xjon.2026.101700","DOIUrl":"10.1016/j.xjon.2026.101700","url":null,"abstract":"<div><h3>Objectives</h3><div>White matter injury (WMI) is a common neurologic complication in neonates with critical congenital heart disease (CHD) and is associated with adverse neurodevelopmental outcomes. Although intraoperative and perioperative risk factors have been extensively studied, emerging evidence suggests that preoperative factors, including time from birth to surgery, may play a critical role in neurologic injury. We hypothesize that birth day of the week is associated with time to surgery and thus neurologic injury.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of 192 neonates born at term with critical CHD, 167 of whom underwent pre- and postoperative magnetic resonance imaging of the brain as part of a prospective observational study. The birth day of week and time to surgery were analyzed in relation to neurologic injury and patient demographics.</div></div><div><h3>Results</h3><div>The birth day of the week was found to significantly impact time to surgery (<em>P</em> = .002), with neonates born on Wednesdays having the longest time from birth until surgery (median [interquartile range] 5 [5, 6] days) and the greatest incidence of postoperative WMI (n = 22, 82%). Birth day of the week predicted incidence of postoperative WMI (<em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>The day of week of birth may be an underrecognized contributor for neurologic injury in neonates with CHD. Given that surgical scheduling practices may contribute to the association between day of birth and time-to-surgery, optimizing delivery timing and surgical access may reduce the burden of WMI in this vulnerable population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"30 ","pages":"Article 101700"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147720856","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":"Comparison of robotic and anterolateral minithoracotomy mitral valve repair: Experience in China","authors":"Zheng Qu PhD,&nbsp;Ping Li PhD,&nbsp;Jichao Zhang PhD,&nbsp;Bin You MD","doi":"10.1016/j.xjon.2025.101569","DOIUrl":"10.1016/j.xjon.2025.101569","url":null,"abstract":"<div><h3>Objective</h3><div>Nonsternotomy mitral valve repair is a popular treatment for degenerative mitral regurgitation. Data on the safety and effectiveness of anterolateral minithoracotomy and robotic mini-invasive mitral valve repair are lacking in China. This study compared the safety and efficacy of robotic mini-invasive and nonrobotic minithoracotomy mitral valve repair using a retrospective cohort study.</div></div><div><h3>Methods</h3><div>We included 348 patients with degenerative mitral regurgitation who underwent robotic mini-invasive (n = 200) or anterolateral minithoracotomy mitral valve repair (n = 148) between June 2014 and January 2023. Relationships between surgical approach, surgical characteristics, and outcomes were evaluated using linear and logistic regression.</div></div><div><h3>Results</h3><div>Among 348 patients who underwent mitral valve repair, mean age was 50.69 ± 14.13 years (63.2% men). Compared with anterolateral minithoracotomy repair, robotic mini-invasive repair had a shorter intensive care unit stay (β = −17.16; 95% confidence interval [CI], −34.18, −0.15; <em>P</em> = .049) but longer surgery duration (β = 0.41; 95% CI, 0.08-0.74; <em>P</em> = .014) and had 50% decreased risk of red blood cell use (odds ratio, 0.50; 95% CI, 0.32-0.81; <em>P</em> = .004) and 71% of plasma use (odds ratio, 0.29; 95% CI, 0.17-0.49; <em>P</em> &lt; .001). Surgical approach was not associated with complications or heart-related outcomes during follow-up. Robotic mini-invasive mitral valve repair cost was 175,343.1 (158,300.4-191,835.0) Ren Min Bi (Chinese currency); anterolateral minithoracotomy repair cost was 141,065.0 (125,796.7-175,575.5) Ren Min Bi (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Robotic mini-invasive mitral valve repair possesses distinctive advantages and demonstrated equivalent and stable clinical efficacy compared with anterolateral minithoracotomy repair. Although not widely used in China, this approach may improve medical resource use.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101569"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412069","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":"Ten-year outcomes of pulmonary endarterectomy in Switzerland: The Zurich experience","authors":"Bianca Battilana MD ,&nbsp;Kathrin Chiffi PhD ,&nbsp;Tobias Renner MD ,&nbsp;Rea Andermatt MD ,&nbsp;Thomas Frauenfelder MD ,&nbsp;Milan Miladinovic BMed ,&nbsp;Monika Hebeisen MSc ,&nbsp;Gilbert Puippe MD ,&nbsp;Mona Lichtblau MD ,&nbsp;Reto Schüpbach MD ,&nbsp;Dominique Bettex MD ,&nbsp;Silvia Ulrich MD ,&nbsp;Isabelle Opitz MD","doi":"10.1016/j.xjon.2025.11.025","DOIUrl":"10.1016/j.xjon.2025.11.025","url":null,"abstract":"<div><h3>Objective</h3><div>Pulmonary endarterectomy (PEA) is the gold standard for operable chronic thromboembolic pulmonary hypertension (CTEPH), an often underdiagnosed and undertreated disease. Before 2015, Swiss patients had limited access to PEA and were operated abroad, highlighting the need for a CTEPH center in Switzerland despite its small population. We herein summarize our 10-year PEA experience, its influence on patient outcomes, and analyze potential prognosticators for complications and long-term outcomes.</div></div><div><h3>Methods</h3><div>Prospectively collected records of patients with CTEPH undergoing PEA at our institution (January 2015-December 2024) were retrospectively analyzed for perioperative and long-term outcome parameters, prognosticators for complications, and hemodynamic improvement. A benchmark analysis compared our center's results with the International CTEPH Registry.</div></div><div><h3>Results</h3><div>Our cohort included 141 patients with CTEPH undergoing PEA, with 85 (60.3%) male patients and a median age of 62 years (range, 51-71 years). We observed significant improvements in mean pulmonary arterial pressure (mean difference, 16.6 mm Hg; <em>P</em> &lt; .0001), pulmonary vascular resistance (mean difference, 3.7 WU; <em>P</em> &lt; .0001), 6-minute walk test (mean difference, 68.8 m; <em>P</em> &lt; .0001), oxygen requirement (χ² = 6.3%; <em>P</em> = .018), New York Heart Association functional classification (rank difference statistic = −8%; <em>P</em> &lt; .0001), and quality of life (Lin coefficient = 13.7 points; <em>P</em> = .004) after PEA. In-hospital and 90-day mortality were 2.8% (n = 4). Jamieson IV (odds ratio, 4.22; <em>P</em> = .039) and N-terminal pro B-type natriuretic peptide (odds ratio, 1.5; <em>P</em> = .039) were associated with postoperative complications. A stronger immediate postoperative decrease in mean pulmonary arterial pressure (mean difference, 0.7 mm Hg; <em>P</em> &lt; .0001) and pulmonary vascular resistance (mean difference, 0.4 WU; <em>P</em> &lt; .0001) predicted better long-term hemodynamic outcomes. Benchmark analysis showed comparable results with International CTEPH Registry data.</div></div><div><h3>Conclusions</h3><div>Establishing a PEA program in Switzerland enabled timely, gold standard care for patients with CTEPH. Despite being a small-volume program, outcomes were comparable with high-volume centers. N-terminal pro B-type natriuretic peptide, Jamieson IV, and initial hemodynamic improvements emerged as prognosticators, warranting prospective validation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101542"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412529","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":"Improved outcomes with pulsatile paracorporeal ventricular assist device support in children: A single-center experience","authors":"Valerii Iaprintsev MD ,&nbsp;Tyson A. Fricke MBBS, PhD, FRACS ,&nbsp;Edward Buratto MD, PhD, FRACS ,&nbsp;Alexey Zubritskiy MD, PhD ,&nbsp;Stephanie Perrier MD ,&nbsp;Lucas Eastaugh MBBS, FRACP ,&nbsp;Chris Barnes MBBS, FRACP, FRCPA ,&nbsp;Bennett Sheridan MBBS, FRACP ,&nbsp;Phillip S. Naimo MD, PhD, FRACP ,&nbsp;Christian P. Brizard MD, MS ,&nbsp;Jacob Mathew MBBS, FRACP ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1016/j.xjon.2025.10.027","DOIUrl":"10.1016/j.xjon.2025.10.027","url":null,"abstract":"<div><h3>Objective</h3><div>The Berlin Heart EXCOR (BHE) remains the only long-term mechanical circulatory support option for small children, yet it carries a high risk of morbidity and mortality, most notably from cerebrovascular accidents (CVAs). This study evaluates how the outcomes of children supported with BHE changed with evolving management.</div></div><div><h3>Methods</h3><div>All consecutive patients receiving BHE at our institution from 2009 to 2024 were included.</div></div><div><h3>Results</h3><div>BHE support was used in 75 patients (median age 1 year). Median support duration was 128 days. Transplantation was achieved in 64% (48/75) of patients. BHE was removed because of recovery in 13.3% (10/75), and 21.3% (16/75) died while on BHE support. Overall survival was 87.7%, 80.9%, and 65.9% at 1, 6, and 12 months, respectively. Survival improved significantly after 2019 (hazard ratio, 0.14; 95% confidence interval, 0.03-0.72; <em>P</em> = .02), whereas the risk of death was greater in patients with CVA (hazard ratio, 3.08; 95% confidence interval, 0.99-9.47; <em>P</em> = .05). A total of 36 CVAs occurred in 23 patients (31%). Freedom from CVA at 1, 6, and 9 months was 81.8%, 67.5%, and 59.1%, respectively. Overall CVA incidence and freedom from CVA did not differ between eras, but fatal CVA incidence decreased (54% vs 10%, <em>P</em> = .03), coinciding with increased rate of successful outcomes (transplantation and explantation: 70.8% vs 92.6%, <em>P</em> = .03). Key differences between eras included the introduction of bivalirudin, decreased threshold for cannula/pump interventions (1.4 vs 5.8 per patient, <em>P</em> &lt; .001), and more proactive timing of support, with fewer patients progressing to preimplantation cardiogenic shock (<em>P</em> = .02) and reduced pre-BHE extracorporeal membrane oxygenation (<em>P</em> = .04) and pre-BHE centrifugal pump support (<em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>Modern BHE management significantly reduces incidence of fatal strokes and improves survival, despite increased duration of support.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101507"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412532","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}