Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.031
Paolo Berretta MD, PhD , Torsten Doenst MD, PhD , Mauro Rinaldi MD, PhD , Jörg Kempfert MD, PhD , Joseph Lamelas MD, PhD , Marc Gerdisch MD, PhD , Frank Van Praet MD, PhD , Antonios Pitsis MD, PhD , Antonio Fiore MD, PhD , Pietro G. Malvindi MD, PhD , Manuel Wilbring MD, PhD , Nguyen Hoang Dinh MD, PhD , Davide Pacini MD, PhD , Giovanni D. Cresce MD, PhD , Nikolaos Bonaros MD, PhD , Pierluigi Stefano MD, PhD , Tristan Yan MD, PhD , Tom C. Nguyen MD, PhD , Marco Di Eusanio MD, PhD
Objective
To evaluate the incidence, echocardiographic patterns, operative strategies, and results of patients receiving a second cross-clamping in the large population of the Mini Mitral International Registry.
Methods
We examined 4577 patients with degenerative mitral regurgitation (MR) who underwent less invasive mitral repair. Patients with nondegenerative disease, planned valve replacement, and surgery without cross-clamping were excluded. Multivariable logistic regression model was applied to investigate predictors of second cross-clamping and the relationship between second cross-clamping and outcomes.
Results
Second cross-clamping was used in 128 cases (2.8%). Reasons for re-cross-clamping included residual pathology in 71.9% of the patients (n = 92) and systolic anterior motion (SAM) in 28.1% (n = 36). Re-repair was performed in 104 patients (81.3%), and replacement was performed in 24 (18.7%). After re-repair, 92 patients (94.9%) had no or mild MR, 4 patients (4.1%) had moderate MR, and 1 patient (1%) had severe MR. A residual SAM was observed in 2 patients (2.3%). Bileaflet prolapse (odds ratio [OR], 2.21) and predicted risk of SAM (OR, 3.04) were identified as risk factors for second cross-clamping. No association between second cross-clamping and mortality or major postoperative complications was found; however, second cross-clamping was associated with an increased risk of respiratory insufficiency (OR, 4.6) and longer intensive care unit (ICU) stay (β = 0.35).
Conclusions
Second cross-clamping after less invasive mitral repair is infrequent but may be required, particularly in patients with bileaflet pathology or at increased risk of SAM. Most re-repairs were successful, with <20% of patients requiring replacement. Second cross-clamping was associated with higher risk of respiratory insufficiency and prolonged ICU stay.
{"title":"Second cross-clamp in less invasive mitral valve repair for degenerative mitral regurgitation: Predictors and outcomes","authors":"Paolo Berretta MD, PhD , Torsten Doenst MD, PhD , Mauro Rinaldi MD, PhD , Jörg Kempfert MD, PhD , Joseph Lamelas MD, PhD , Marc Gerdisch MD, PhD , Frank Van Praet MD, PhD , Antonios Pitsis MD, PhD , Antonio Fiore MD, PhD , Pietro G. Malvindi MD, PhD , Manuel Wilbring MD, PhD , Nguyen Hoang Dinh MD, PhD , Davide Pacini MD, PhD , Giovanni D. Cresce MD, PhD , Nikolaos Bonaros MD, PhD , Pierluigi Stefano MD, PhD , Tristan Yan MD, PhD , Tom C. Nguyen MD, PhD , Marco Di Eusanio MD, PhD","doi":"10.1016/j.jtcvs.2025.07.031","DOIUrl":"10.1016/j.jtcvs.2025.07.031","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence, echocardiographic patterns, operative strategies, and results of patients receiving a second cross-clamping in the large population of the Mini Mitral International Registry.</div></div><div><h3>Methods</h3><div>We examined 4577 patients with degenerative mitral regurgitation (MR) who underwent less invasive mitral repair. Patients with nondegenerative disease, planned valve replacement, and surgery without cross-clamping were excluded. Multivariable logistic regression model was applied to investigate predictors of second cross-clamping and the relationship between second cross-clamping and outcomes.</div></div><div><h3>Results</h3><div>Second cross-clamping was used in 128 cases (2.8%). Reasons for re-cross-clamping included residual pathology in 71.9% of the patients (n = 92) and systolic anterior motion (SAM) in 28.1% (n = 36). Re-repair was performed in 104 patients (81.3%), and replacement was performed in 24 (18.7%). After re-repair, 92 patients (94.9%) had no or mild MR, 4 patients (4.1%) had moderate MR, and 1 patient (1%) had severe MR. A residual SAM was observed in 2 patients (2.3%). Bileaflet prolapse (odds ratio [OR], 2.21) and predicted risk of SAM (OR, 3.04) were identified as risk factors for second cross-clamping. No association between second cross-clamping and mortality or major postoperative complications was found; however, second cross-clamping was associated with an increased risk of respiratory insufficiency (OR, 4.6) and longer intensive care unit (ICU) stay (β = 0.35).</div></div><div><h3>Conclusions</h3><div>Second cross-clamping after less invasive mitral repair is infrequent but may be required, particularly in patients with bileaflet pathology or at increased risk of SAM. Most re-repairs were successful, with <20% of patients requiring replacement. Second cross-clamping was associated with higher risk of respiratory insufficiency and prolonged ICU stay.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 400-407.e2"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.036
Zhihao Lei PhD
{"title":"“High C-index, low events?” Reassessing AI claims in valve repair prediction","authors":"Zhihao Lei PhD","doi":"10.1016/j.jtcvs.2025.07.036","DOIUrl":"10.1016/j.jtcvs.2025.07.036","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page e35"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.006
Dimitrios E. Magouliotis MD, PhD , Serge Sicouri MD , Andrew Xanthopoulos MD, PhD , Basel Ramlawi MD, FACS
{"title":"Why the aortic organ fails longitudinally: A molecular mirror to biomechanical insight","authors":"Dimitrios E. Magouliotis MD, PhD , Serge Sicouri MD , Andrew Xanthopoulos MD, PhD , Basel Ramlawi MD, FACS","doi":"10.1016/j.jtcvs.2025.07.006","DOIUrl":"10.1016/j.jtcvs.2025.07.006","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages e33-e34"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.08.009
Aaron M. Cheng MD, FACS
{"title":"Commentary: The pressure to get it right: Will this reduce cardiac surgery-associated acute kidney injury?","authors":"Aaron M. Cheng MD, FACS","doi":"10.1016/j.jtcvs.2025.08.009","DOIUrl":"10.1016/j.jtcvs.2025.08.009","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 463-464"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To analyze clinical outcomes and prognosis under different treatment strategies for myocardial bridging (MB) patients, providing evidence to optimize clinical decision-making.
Methods
A retrospective study was conducted on 243 patients diagnosed with MB by coronary angiography at our institution. Of them, 77 patients underwent surgery (group A), and were divided into group A1 (n = 31, compression ≥70%) and group A2 (n = 46, combined with other heart surgeries). The remaining 166 patients underwent medical treatment and were divided into group B1 (n = 125, compression <70%) and group B2 (n = 41, compression ≥70%). The quality of life, mortality, and major adverse cardiac events were analyzed for each group.
Results
Mean follow-up was 55.6 months in Group A and 85.3 months in Group B. The10-year cumulative survival rates for group A1, A2, B1, B2 were 95%, 92.1%, 93.4%, and 88.2%, and the 10-year rates of freedom from major adverse cardiac events in these groups were 89.7%, 85.0%, 74.4%, and 67.8%, respectively. For patients with isolated MB and systolic compression ≥70%, the incidence of major adverse cardiac events was significantly higher than in group B2, compared with group A1 (P = .01). Seattle Angina Questionnaire (SAQ) scores improved significantly after treatment across all groups (P < .01).
Conclusions
For patients with isolated MB and systolic coronary compression ≥70%, and refractory to medical therapy, myotomy had better outcomes than medical therapy. In cases with MB coexisting with other cardiac diseases, myotomy with other cardiac surgeries can achieve satisfactory outcomes. For symptomatic patients with isolated MB and systolic coronary compression <70%, medical treatment can yield good outcomes.
{"title":"Symptomatic myocardial bridge: Long-term outcomes and strategies","authors":"Mingkui Zhang MD, Qingyu Wu MD, Zhengjie Zhang MD, Yuheng Jiang MD, Hongyin Li MD, Hui Xue MD, Zhonghua Xu MD, Yongqiang Jin MD, Xiaoya Zhang MD","doi":"10.1016/j.jtcvs.2025.08.008","DOIUrl":"10.1016/j.jtcvs.2025.08.008","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze clinical outcomes and prognosis under different treatment strategies for myocardial bridging (MB) patients, providing evidence to optimize clinical decision-making.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on 243 patients diagnosed with MB by coronary angiography at our institution. Of them, 77 patients underwent surgery (group A), and were divided into group A1 (n = 31, compression ≥70%) and group A2 (n = 46, combined with other heart surgeries). The remaining 166 patients underwent medical treatment and were divided into group B1 (n = 125, compression <70%) and group B2 (n = 41, compression ≥70%). The quality of life, mortality, and major adverse cardiac events were analyzed for each group.</div></div><div><h3>Results</h3><div>Mean follow-up was 55.6 months in Group A and 85.3 months in Group B. The10-year cumulative survival rates for group A1, A2, B1, B2 were 95%, 92.1%, 93.4%, and 88.2%, and the 10-year rates of freedom from major adverse cardiac events in these groups were 89.7%, 85.0%, 74.4%, and 67.8%, respectively. For patients with isolated MB and systolic compression ≥70%, the incidence of major adverse cardiac events was significantly higher than in group B2, compared with group A1 (<em>P</em> = .01). Seattle Angina Questionnaire (SAQ) scores improved significantly after treatment across all groups (<em>P</em> < .01).</div></div><div><h3>Conclusions</h3><div>For patients with isolated MB and systolic coronary compression ≥70%, and refractory to medical therapy, myotomy had better outcomes than medical therapy. In cases with MB coexisting with other cardiac diseases, myotomy with other cardiac surgeries can achieve satisfactory outcomes. For symptomatic patients with isolated MB and systolic coronary compression <70%, medical treatment can yield good outcomes.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 419-426.e1"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.07.043
Zhou Liu MD , Hongkai Zhang MD , Maozhou Wang MD , Yue Ren MD , Jiajun Liang MMed , Shuanglei Zhao MD , Ruifei Liu MMed , Jie Han MD , Hongyu Ye MD , Hongjia Zhang MD , Lei Xu MD , Wenjian Jiang MD
Objectives
Rheumatic mitral disease remains a significant health issue, especially in developing regions. Although mitral valve (MV) repair improves outcomes, residual mild mitral regurgitation (MR) is common. This study aims to identify clinical and anatomical factors associated with residual mild MR after MV repair and to assess its impact on MR progression and survival.
Methods
A dual-center, retrospective cohort study was undertaken of 580 patients with rheumatic mitral disease who underwent MV repair successfully at 2 high-volume centers in China. Patients were classified as having no MR (n = 371) or residual mild MR (n = 209) on the basis of postoperative echocardiography. Cardiac computed tomography was used to assess MV anatomy and calcification. Logistic regression identified factors associated with residual mild MR. Long-term follow-up analyzed MR progression and survival, with propensity score matching to adjust for confounders.
Results
The mean age was 57.6 ± 7.5 years, and 73.8% were female. Patients with residual mild MR exhibited greater rates of MV calcification (56.0% vs 43.9%, P = .007) and subvalvular fusion (27.3% vs 19.7%, P = .045). Atrial fibrillation, systolic pulmonary artery pressure, calcification volume, and papillary muscle or chordae tendineae fusion were independently associated with residual mild MR. After 7 years, the residual mild MR group had lower freedom from progression to moderate/severe MR (66.2% vs 84.9%, P = .017) but no difference in survival (97.1% vs 96.7%, P = .98).
Conclusions
Residual mild MR after MV repair is associated with an increased risk of MR progression but does not impact long-term survival during limited follow-up. Preoperative cardiac computed tomography provides valuable guidance by identifying patients at greater risk for residual mild MR.
目的：风湿性二尖瓣病（RMD）仍然是一个重要的健康问题，特别是在发展中地区。虽然二尖瓣（MV）修复可以改善预后，但残留的轻度二尖瓣返流（MR）是常见的。本研究旨在确定MV修复后残留轻度MR的临床和解剖学因素，并评估其对MR进展和生存的影响。方法：一项双中心、回顾性队列研究，对580名在中国两个大容量中心成功接受中压修复的RMD患者进行研究。根据术后超声心动图将患者分为无MR （n=371）和剩余轻度MR （n=209）。心脏CT评估正中解剖和钙化。Logistic回归确定了与残余轻度MR相关的因素，长期随访分析MR进展和生存，用倾向评分匹配来调整混杂因素。结果：患者平均年龄57.6±7.5岁，女性占73.8%。残余轻度MR患者表现出较高的MV钙化率（56.0%比43.9%,p = 0.007）和瓣下融合率（27.3%比19.7%,p = 0.045）。房颤、肺动脉收缩压、钙化体积、乳头肌或腱索融合与残余轻度MR独立相关。7年后，残余轻度MR组进展为中/重度MR的自由度较低（66.2% vs. 84.9%, p=0.017），但生存率无差异（97.1% vs. 96.7%, p=0.98）。结论：中压修复后残留的轻度MR与MR进展的风险增加有关，但在有限的随访期间不影响长期生存。术前心脏CT通过识别残留轻度MR风险较高的患者提供了有价值的指导。
{"title":"Predictors and prognosis of mild regurgitation after rheumatic mitral valve repair: A dual-center cohort analysis on the basis of cardiac computed tomography","authors":"Zhou Liu MD , Hongkai Zhang MD , Maozhou Wang MD , Yue Ren MD , Jiajun Liang MMed , Shuanglei Zhao MD , Ruifei Liu MMed , Jie Han MD , Hongyu Ye MD , Hongjia Zhang MD , Lei Xu MD , Wenjian Jiang MD","doi":"10.1016/j.jtcvs.2025.07.043","DOIUrl":"10.1016/j.jtcvs.2025.07.043","url":null,"abstract":"<div><h3>Objectives</h3><div>Rheumatic mitral disease remains a significant health issue, especially in developing regions. Although mitral valve (MV) repair improves outcomes, residual mild mitral regurgitation (MR) is common. This study aims to identify clinical and anatomical factors associated with residual mild MR after MV repair and to assess its impact on MR progression and survival.</div></div><div><h3>Methods</h3><div>A dual-center, retrospective cohort study was undertaken of 580 patients with rheumatic mitral disease who underwent MV repair successfully at 2 high-volume centers in China. Patients were classified as having no MR (n = 371) or residual mild MR (n = 209) on the basis of postoperative echocardiography. Cardiac computed tomography was used to assess MV anatomy and calcification. Logistic regression identified factors associated with residual mild MR. Long-term follow-up analyzed MR progression and survival, with propensity score matching to adjust for confounders.</div></div><div><h3>Results</h3><div>The mean age was 57.6 ± 7.5 years, and 73.8% were female. Patients with residual mild MR exhibited greater rates of MV calcification (56.0% vs 43.9%, <em>P</em> = .007) and subvalvular fusion (27.3% vs 19.7%, <em>P</em> = .045). Atrial fibrillation, systolic pulmonary artery pressure, calcification volume, and papillary muscle or chordae tendineae fusion were independently associated with residual mild MR. After 7 years, the residual mild MR group had lower freedom from progression to moderate/severe MR (66.2% vs 84.9%, <em>P</em> = .017) but no difference in survival (97.1% vs 96.7%, <em>P</em> = .98).</div></div><div><h3>Conclusions</h3><div>Residual mild MR after MV repair is associated with an increased risk of MR progression but does not impact long-term survival during limited follow-up. Preoperative cardiac computed tomography provides valuable guidance by identifying patients at greater risk for residual mild MR.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 385-397.e8"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.09.022
Joseph C. Cleveland Jr. MD
{"title":"Commentary: Heart healthy after procurement","authors":"Joseph C. Cleveland Jr. MD","doi":"10.1016/j.jtcvs.2025.09.022","DOIUrl":"10.1016/j.jtcvs.2025.09.022","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Page 454"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.09.044
Matteo Ponzoni MD , Jamal Saleh MD , Rajiv R. Chaturvedi MD, PhD , Anne I. Dipchand MD , Israel Valverde MD, PhD , Mike Seed MD , Shi-Joon Yoo MD , John Coles MD , Osami Honjo MD, PhD , Christopher Z. Lam MD
Objective
The study objective was to investigate the association between extracardiac conduit restriction, as assessed by magnetic resonance imaging, Fontan hemodynamics, exercise capacity, laboratory tests, and liver fibrosis in adolescent Fontan patients.
Methods
We retrospectively analyzed 93 Fontan patients who underwent fasting heart-liver magnetic resonance imaging between 2018 and 2022. Extracardiac conduit minimal diameter and cross-sectional area were measured, and liver fibrosis was graded on delayed gadolinium enhancement sequences. Correlations between magnetic resonance imaging and clinical/functional/laboratory data were explored using Spearman's correlation and Mann–Whitney test. Multivariable regression was performed to assess the effect of extracardiac conduit size on liver fibrosis development.
Results
After a median of 10.2 (interquartile range, 8.1-12.7) years post-Fontan, extracardiac conduit diameter had a median reduction of 27.3% (22.7%-31.8%) from its original size. Minimal extracardiac conduit diameter correlated with peak oxygen consumption (ρ = .324, P = .004) and peak oxygen consumption at anaerobic threshold (ρ = .372, P = .002). Patients with protein-losing enteropathy exhibited smaller extracardiac conduit diameters (14.0 [13.0-15.5] mm vs 16.0 [14.0-17.0] mm; P = .020) compared with those without protein-losing enteropathy. Patients with more than mild liver fibrosis had smaller extracardiac conduit diameters (14.0 [13.8-15.3] mm vs 16.0 [15.0-17.0] mm, P < .001) compared with those with none-mild fibrosis. At multivariable regression analysis, 1-mm increase in extracardiac conduit minimal diameter decreased the risk of more than mild liver fibrosis by 54.3% (odds ratio, 0.457, 95% CI, 0.264-0.791, P = .005).
Conclusions
Extracardiac conduit restriction is associated with increased liver fibrosis, protein-losing enteropathy, and reduced exercise tolerance in adolescent Fontan patients. These findings suggest that conduit upsizing strategies may be considered to alleviate hepatic congestion and improve functional capacity.
{"title":"Extracardiac conduit restriction is associated with increased liver fibrosis in adolescent Fontan patients","authors":"Matteo Ponzoni MD , Jamal Saleh MD , Rajiv R. Chaturvedi MD, PhD , Anne I. Dipchand MD , Israel Valverde MD, PhD , Mike Seed MD , Shi-Joon Yoo MD , John Coles MD , Osami Honjo MD, PhD , Christopher Z. Lam MD","doi":"10.1016/j.jtcvs.2025.09.044","DOIUrl":"10.1016/j.jtcvs.2025.09.044","url":null,"abstract":"<div><h3>Objective</h3><div>The study objective was to investigate the association between extracardiac conduit restriction, as assessed by magnetic resonance imaging, Fontan hemodynamics, exercise capacity, laboratory tests, and liver fibrosis in adolescent Fontan patients.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 93 Fontan patients who underwent fasting heart-liver magnetic resonance imaging between 2018 and 2022. Extracardiac conduit minimal diameter and cross-sectional area were measured, and liver fibrosis was graded on delayed gadolinium enhancement sequences. Correlations between magnetic resonance imaging and clinical/functional/laboratory data were explored using Spearman's correlation and Mann–Whitney test. Multivariable regression was performed to assess the effect of extracardiac conduit size on liver fibrosis development.</div></div><div><h3>Results</h3><div>After a median of 10.2 (interquartile range, 8.1-12.7) years post-Fontan, extracardiac conduit diameter had a median reduction of 27.3% (22.7%-31.8%) from its original size. Minimal extracardiac conduit diameter correlated with peak oxygen consumption (ρ = .324, <em>P =</em> .004) and peak oxygen consumption at anaerobic threshold (ρ = .372, <em>P =</em> .002). Patients with protein-losing enteropathy exhibited smaller extracardiac conduit diameters (14.0 [13.0-15.5] mm vs 16.0 [14.0-17.0] mm; <em>P =</em> .020) compared with those without protein-losing enteropathy. Patients with more than mild liver fibrosis had smaller extracardiac conduit diameters (14.0 [13.8-15.3] mm vs 16.0 [15.0-17.0] mm, <em>P < .</em>001) compared with those with none-mild fibrosis. At multivariable regression analysis, 1-mm increase in extracardiac conduit minimal diameter decreased the risk of more than mild liver fibrosis by 54.3% (odds ratio, 0.457, 95% CI, 0.264-0.791, <em>P =</em> .005).</div></div><div><h3>Conclusions</h3><div>Extracardiac conduit restriction is associated with increased liver fibrosis, protein-losing enteropathy, and reduced exercise tolerance in adolescent Fontan patients. These findings suggest that conduit upsizing strategies may be considered to alleviate hepatic congestion and improve functional capacity.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 328-337.e5"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.09.037
Ryan Thomas BS , Arjune Dhanekula MD , Christopher Burke MD
{"title":"Reply: Dacron – The graft that sank the aorta?","authors":"Ryan Thomas BS , Arjune Dhanekula MD , Christopher Burke MD","doi":"10.1016/j.jtcvs.2025.09.037","DOIUrl":"10.1016/j.jtcvs.2025.09.037","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages e32-e33"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.jtcvs.2025.11.004
Luke J. Burchill MBBS, PhD
{"title":"Commentary: The 60-year legacy of Fontan: Redefining survival and future possibilities in heart failure","authors":"Luke J. Burchill MBBS, PhD","doi":"10.1016/j.jtcvs.2025.11.004","DOIUrl":"10.1016/j.jtcvs.2025.11.004","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 2","pages":"Pages 326-327"},"PeriodicalIF":4.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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