Pub Date : 2026-03-01Epub Date: 2025-11-18DOI: 10.1016/j.jtcvs.2025.11.008
Mikaela Dolk MD , Indra Schütz MD , Erik Herou MD, PhD , Felicia Nordenstam MD, PhD , Gunnar Bergman MD, PhD , Mats Synnergren MD, PhD , Annika Rydberg MD, PhD , Petru Liuba MD, PhD , Kiet Tran MD, PhD , Jan Sunnegårdh MD, PhD , Katarina Hanséus MD, PhD , Karin Tran-Lundmark MD, PhD
Objective
To characterize patients with protein-losing enteropathy (PLE) diagnosed before age 18 years within a nationwide Swedish Fontan cohort.
Methods
Surgical records and medical charts were reviewed for all patients born after January 1, 1993, who underwent Fontan completion before January 1, 2021.
Results
Among 573 reviewed patients, 28 (4.8%) developed PLE. The median time to onset of PLE after Fontan was 1.5 years (interquartile range, 0.5-5.5 years). Right ventricular morphology was associated with PLE (odds ratio, 2.3; 95% confidence interval, 1.04-5.0). Twenty-three patients (82%) received PLE-directed therapies, including pulmonary vasodilators (n = 17; 61%), subcutaneous heparin (n = 14; 50%), and/or long-term corticosteroids (n = 13; 46%). Eleven patients (39%) underwent a total of 18 catheter interventions, including 1 fenestration and 1 lymphatic intervention. Three pacemaker procedures were performed after a PLE diagnosis. Eight patients underwent heart transplant (26%). Patients with an early onset of PLE (<2 years from Fontan completion) frequently had a history of pulmonary venous congestion. Five-year overall survival was 88%, and 5-year transplant-free survival was 79%.
Conclusions
PLE remains a serious complication following Fontan, with notable mortality. Patients with right ventricular morphology of the systemic ventricle had a higher risk of PLE. Previous pulmonary venous congestion was common when PLE was diagnosed early after Fontan. Catheter-based interventions were frequently used to optimize hemodynamics; lymphatic interventions are likely to become more common. In therapy-refractory patients, heart transplantation remains an option.
目的：在瑞典全国范围内的Fontan队列中，对18岁前诊断为蛋白质丢失性肠病（PLE）的患者进行特征分析。方法：回顾1993年1月1日以后出生、2021年1月1日前行Fontan成形术的所有患者的手术记录和病历。结果：573例患者中，28例（4.8%）发生了PLE。从Fontan到PLE发病的中位时间为1.5年（IQR为0.5-5.5年）。右心室形态与PLE相关：（OR 2.3, 95% CI 1.04-5.0）。23名患者（82%）接受了针对ple的治疗：肺血管扩张剂（n=17, 61%）、皮下肝素（n=14, 50%）和/或长期使用皮质类固醇（n=13, 46%）。11例患者（39%）总共接受了18次导管介入，包括一次开窗和一次淋巴介入。在PLE诊断后进行了三次起搏器手术。移植8例（26%）。结论：PLE仍然是丰坦治疗后的一个严重并发症，死亡率显著。系统心室形态为右心室的患者发生PLE的风险较高。既往肺静脉充血常见于丰坦术后早期诊断的PLE。导管干预经常用于优化血流动力学；淋巴干预可能会变得更加普遍。对于治疗抵抗的患者，心脏移植仍然是一种选择。
{"title":"Protein-losing enteropathy following Fontan completion: A 30-year national cohort study in Sweden","authors":"Mikaela Dolk MD , Indra Schütz MD , Erik Herou MD, PhD , Felicia Nordenstam MD, PhD , Gunnar Bergman MD, PhD , Mats Synnergren MD, PhD , Annika Rydberg MD, PhD , Petru Liuba MD, PhD , Kiet Tran MD, PhD , Jan Sunnegårdh MD, PhD , Katarina Hanséus MD, PhD , Karin Tran-Lundmark MD, PhD","doi":"10.1016/j.jtcvs.2025.11.008","DOIUrl":"10.1016/j.jtcvs.2025.11.008","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize patients with protein-losing enteropathy (PLE) diagnosed before age 18 years within a nationwide Swedish Fontan cohort.</div></div><div><h3>Methods</h3><div>Surgical records and medical charts were reviewed for all patients born after January 1, 1993, who underwent Fontan completion before January 1, 2021.</div></div><div><h3>Results</h3><div>Among 573 reviewed patients, 28 (4.8%) developed PLE. The median time to onset of PLE after Fontan was 1.5 years (interquartile range, 0.5-5.5 years). Right ventricular morphology was associated with PLE (odds ratio, 2.3; 95% confidence interval, 1.04-5.0). Twenty-three patients (82%) received PLE-directed therapies, including pulmonary vasodilators (n = 17; 61%), subcutaneous heparin (n = 14; 50%), and/or long-term corticosteroids (n = 13; 46%). Eleven patients (39%) underwent a total of 18 catheter interventions, including 1 fenestration and 1 lymphatic intervention. Three pacemaker procedures were performed after a PLE diagnosis. Eight patients underwent heart transplant (26%). Patients with an early onset of PLE (<2 years from Fontan completion) frequently had a history of pulmonary venous congestion. Five-year overall survival was 88%, and 5-year transplant-free survival was 79%.</div></div><div><h3>Conclusions</h3><div>PLE remains a serious complication following Fontan, with notable mortality. Patients with right ventricular morphology of the systemic ventricle had a higher risk of PLE. Previous pulmonary venous congestion was common when PLE was diagnosed early after Fontan. Catheter-based interventions were frequently used to optimize hemodynamics; lymphatic interventions are likely to become more common. In therapy-refractory patients, heart transplantation remains an option.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 722-731.e3"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558157","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 : 2026-03-01DOI: 10.1016/j.jtcvs.2026.01.014
Mariya Geube, Nikolaos Skubas, Andra Duncan
{"title":"Reply: Not so fast! The case against a definitive shift to vasopressin.","authors":"Mariya Geube, Nikolaos Skubas, Andra Duncan","doi":"10.1016/j.jtcvs.2026.01.014","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2026.01.014","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327993","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 : 2026-03-01Epub Date: 2025-09-07DOI: 10.1016/j.jtcvs.2025.08.007
Santiago Villar MD , Jeffrey S. Heinle MD , Yishay Orr MD, PhD
{"title":"Reply: Nature versus suture: Distinct pathophysiology for left atrioventricular valve stenosis following atrioventricular septal defect repair?","authors":"Santiago Villar MD , Jeffrey S. Heinle MD , Yishay Orr MD, PhD","doi":"10.1016/j.jtcvs.2025.08.007","DOIUrl":"10.1016/j.jtcvs.2025.08.007","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages e67-e68"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008573","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 : 2026-03-01Epub Date: 2025-08-22DOI: 10.1016/j.jtcvs.2025.07.038
Ovidio A. García-Villarreal MD
{"title":"The primary driver of survival after mitral valve surgery in functional mitral regurgitation: The role of concomitant coronary artery bypass grafting","authors":"Ovidio A. García-Villarreal MD","doi":"10.1016/j.jtcvs.2025.07.038","DOIUrl":"10.1016/j.jtcvs.2025.07.038","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Page e55"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976772","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 : 2026-03-01Epub Date: 2025-09-23DOI: 10.1016/j.jtcvs.2025.09.023
Jonathan Chinea DO, Daniel T. Engelman MD
{"title":"Commentary: When rescue fails: Beyond the core 4, the case for STS+5","authors":"Jonathan Chinea DO, Daniel T. Engelman MD","doi":"10.1016/j.jtcvs.2025.09.023","DOIUrl":"10.1016/j.jtcvs.2025.09.023","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 701-702"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151504","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 : 2026-03-01Epub Date: 2025-10-21DOI: 10.1016/j.jtcvs.2025.10.018
William T. Brinkman MD
{"title":"Commentary: Engineering a better Ross is our mission","authors":"William T. Brinkman MD","doi":"10.1016/j.jtcvs.2025.10.018","DOIUrl":"10.1016/j.jtcvs.2025.10.018","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Page 577"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356640","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}
We introduced several modifications to the anastomosis technique of tracheal resection and anastomosis (TRA), including the use of a continuous technique instead of the traditional interrupted method, omission of traction sutures, application of polydioxanone sutures instead of polyglactin (Vicryl; Ethicon), and a reduction in tracheal release maneuvers. Here, we aimed to comprehensively compare these 2 techniques.
Methods
In this cohort study, patients who underwent type I TRA (no laryngeal involvement) for tracheal stenosis between April 2018 and October 2024 were divided into 2 groups based on anastomosis technique, including continuous TRA (cTRA) and interrupted TRA (iTRA). Postoperative outcomes such as anastomotic complications (dehiscence, granulation, and recurrence), and surgical site issues were assessed through follow-up and bronchoscopy. Propensity score matching was applied, and comparative analyses were conducted using standard statistical methods.
Results
Of 334 patients undergoing type I TRA, 321 were analyzed (62 cTRA, 259 iTRA). After propensity score matching, 48 pairs were compared. Baseline characteristics were similar. Anastomosis time was 20.9 ± 3.1 versus 40.4 ± 5.4 minutes, after propensity score matching (95% CI, 18.2-20.7; P < .001, standardized mean difference, 4.15; 95% CI, 3.18-5.13). The overall rate of anastomotic complications did not differ significantly between groups (odds ratio, 0.72; 95% CI, 0.29-1.80; P = .64). Recurrence rates and the need for reintervention or reoperation were also similar. No statistically significant difference was observed in the granulation tissue formation, dehiscence, recurrence, wound infections, seroma/hematoma, or vocal cord paralysis across matched groups.
Conclusions
Continuous polydioxanone sutures for TRA type I, offer similar outcomes as the traditional methods with significantly reduced operative time and improved procedural convenience.
目的：我们介绍了气管切除吻合术（TRA）吻合技术的几种改进，包括使用连续技术代替传统的中断方法，省略牵引缝合线，使用聚二氧杂环酮（PDS）缝合线代替聚乳酸（Vicryl），以及减少气管释放动作。在这里，我们的目的是全面比较这两种技术。方法：本队列研究将2018年4月至2024年10月期间因气管狭窄行I型TRA（不累及喉）的患者根据吻合技术分为连续（cTRA）和间断（iTRA）两组。通过随访和支气管镜检查评估吻合口并发症（裂开、肉芽肿、复发）和手术部位问题等术后结果。采用倾向评分匹配，采用标准统计学方法进行对比分析。结果：在334例I型TRA患者中，分析了321例（cTRA 62例，iTRA 259例）。经PSM后，比较48对。基线特征相似。PSM术后吻合时间分别为20.9±3.1 min和40.4±5.4 min （95%CI: 18.2 ~ 20.7, p）。结论：连续PDS缝合治疗ⅰ型TRA与传统方法吻合效果相近，明显缩短手术时间，提高手术方便性。
{"title":"Comparison of continuous and interrupted sutures in tracheal resection and anastomosis: A cohort study with propensity score matching","authors":"Azizollah Abbasi Dezfouli MD , Arman Hasanzade MD , Mojtaba Mokhber Dezfuli MD , Salman Soleimani MD , Mohammad Behgam Shadmehr MD , Hasan Alhalboni MD , Kambiz Sheikhy MD , Abolghasem Daneshvar Kakhki MD , Saviz Pejhan MD , Fatemeh Sadat Hosseini-Baharanchi PhD , Fariba Ghorbani MD, PhD, MPH","doi":"10.1016/j.jtcvs.2025.10.015","DOIUrl":"10.1016/j.jtcvs.2025.10.015","url":null,"abstract":"<div><h3>Objectives</h3><div>We introduced several modifications to the anastomosis technique of tracheal resection and anastomosis (TRA), including the use of a continuous technique instead of the traditional interrupted method, omission of traction sutures, application of polydioxanone sutures instead of polyglactin (Vicryl; Ethicon), and a reduction in tracheal release maneuvers. Here, we aimed to comprehensively compare these 2 techniques.</div></div><div><h3>Methods</h3><div>In this cohort study, patients who underwent type I TRA (no laryngeal involvement) for tracheal stenosis between April 2018 and October 2024 were divided into 2 groups based on anastomosis technique, including continuous TRA (cTRA) and interrupted TRA (iTRA). Postoperative outcomes such as anastomotic complications (dehiscence, granulation, and recurrence), and surgical site issues were assessed through follow-up and bronchoscopy. Propensity score matching was applied, and comparative analyses were conducted using standard statistical methods.</div></div><div><h3>Results</h3><div>Of 334 patients undergoing type I TRA, 321 were analyzed (62 cTRA, 259 iTRA). After propensity score matching, 48 pairs were compared. Baseline characteristics were similar. Anastomosis time was 20.9 ± 3.1 versus 40.4 ± 5.4 minutes, after propensity score matching (95% CI, 18.2-20.7; <em>P</em> < .001, standardized mean difference, 4.15; 95% CI, 3.18-5.13). The overall rate of anastomotic complications did not differ significantly between groups (odds ratio, 0.72; 95% CI, 0.29-1.80; <em>P</em> = .64). Recurrence rates and the need for reintervention or reoperation were also similar. No statistically significant difference was observed in the granulation tissue formation, dehiscence, recurrence, wound infections, seroma/hematoma, or vocal cord paralysis across matched groups.</div></div><div><h3>Conclusions</h3><div>Continuous polydioxanone sutures for TRA type I, offer similar outcomes as the traditional methods with significantly reduced operative time and improved procedural convenience.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages 785-791"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330817","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 : 2026-03-01Epub Date: 2025-10-27DOI: 10.1016/j.jtcvs.2025.09.041
Souichi Oka PhD , Kiyo Yoshida MSc , Yoshiyasu Takefuji PhD
{"title":"Beyond linear and parametric assumptions: A call for robust models in donor extracellular vesicles transcriptomics","authors":"Souichi Oka PhD , Kiyo Yoshida MSc , Yoshiyasu Takefuji PhD","doi":"10.1016/j.jtcvs.2025.09.041","DOIUrl":"10.1016/j.jtcvs.2025.09.041","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Pages e78-e79"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379194","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 : 2026-03-01Epub Date: 2025-07-16DOI: 10.1016/j.jtcvs.2025.06.017
Cecilia Pompili MD, PhD, FACS
{"title":"Reply: A scope for work-life integration amidst return-to-work disparity in thoracic surgery","authors":"Cecilia Pompili MD, PhD, FACS","doi":"10.1016/j.jtcvs.2025.06.017","DOIUrl":"10.1016/j.jtcvs.2025.06.017","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"171 3","pages":"Page e82"},"PeriodicalIF":4.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638522","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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