This study aimed to compare aortic root reimplantation planning using computed tomography (CT) with conventional methods and to assess the accuracy of automated CT measurements using a deep-learning algorithm.
Methods
Twenty patients underwent David reimplantation at our hospital with CT-based planning to determine graft sizes from virtual basal ring dimensions and predict commissural positions using electrocardiogram-gated CT. In the controls (n = 20), preoperative transesophageal echocardiography determined virtual basal ring sizing, whereas surgeons intraoperatively assessed commissural positions. We also analyzed correlations between CT measurements obtained manually by experts and automatically by our deep-learning-based algorithm using 50 cases indicated for David reimplantation.
Results
The CT group had a shorter aortic crossclamp time (P = .001). Horizontal shifting of commissures (80% vs 40%) and uneven commissural heights (95% vs 60%) were more frequently observed in the CT group than in the controls (P = .010) during David reimplantation. The CT group had fewer patients (25% vs 85%) and commissures (15% vs 63%) requiring intraoperative commissural position adjustments than the controls (P < .001). Cusp repair was required in 1 patient in the CT group and 7 patients in the control group (P = .018). Algorithm-based measurements showed excellent agreement with expert measurements for virtual basal ring diameters, intercommissural distances, and commissural heights (differences: −0.3 to 0.1 mm; intraclass correlation coefficients: 0.87-0.97).
Conclusions
For David reimplantation, CT-based planning of graft sizes and commissural positions may reduce the need for intraoperative commissural position adjustments and cusp repair. Our deep learning−based algorithm can replace expert measurements in standardized surgical planning.
目的本研究旨在比较使用计算机断层扫描（CT）和传统方法的主动脉根部再植计划，并评估使用深度学习算法的自动CT测量的准确性。方法20例患者行David再植术，采用基于CT的规划，根据虚拟基环尺寸确定移植物大小，并利用心电图门控CT预测连接位置。在对照组（n = 20）中，术前经食管超声心动图确定虚拟基环大小，而术中外科医生评估联合位置。我们还分析了专家手动获得的CT测量值与我们基于深度学习的算法自动获得的CT测量值之间的相关性，并使用了50例需要进行David再植的病例。结果CT组主动脉夹持时间短（P = 0.001）。在David再植期间，CT组比对照组更常观察到相交水平移位（80% vs 40%）和相交高度不均匀（95% vs 60%） （P = 0.010）。与对照组相比，CT组术中需要调整联合关节位置的患者（25% vs 85%）和联合关节（15% vs 63%）较少（P < .001）。CT组1例，对照组7例（P = 0.018）。基于算法的测量结果与专家测量的虚拟基环直径、关节间距离和关节高度非常吻合（差异：−0.3至0.1 mm；类内相关系数：0.87-0.97）。结论对于David再植，基于ct的移植物大小和联合位置规划可减少术中联合位置调整和尖部修复的需要。我们基于深度学习的算法可以在标准化手术计划中取代专家测量。
{"title":"Computed tomography−based prediction of commissural positions facilitates valve-sparing aortic root replacement","authors":"Haruo Yamauchi MD, PhD , Masahiko Ando MD, PhD, MPH , Kenji Ino MS , Hiroyuki Tsukihara MD, PhD , Gakuto Aoyama MS , Ichiro Sakuma PhD , Minoru Ono MD, PhD","doi":"10.1016/j.xjtc.2025.11.007","DOIUrl":"10.1016/j.xjtc.2025.11.007","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare aortic root reimplantation planning using computed tomography (CT) with conventional methods and to assess the accuracy of automated CT measurements using a deep-learning algorithm.</div></div><div><h3>Methods</h3><div>Twenty patients underwent David reimplantation at our hospital with CT-based planning to determine graft sizes from virtual basal ring dimensions and predict commissural positions using electrocardiogram-gated CT. In the controls (n = 20), preoperative transesophageal echocardiography determined virtual basal ring sizing, whereas surgeons intraoperatively assessed commissural positions. We also analyzed correlations between CT measurements obtained manually by experts and automatically by our deep-learning-based algorithm using 50 cases indicated for David reimplantation.</div></div><div><h3>Results</h3><div>The CT group had a shorter aortic crossclamp time (<em>P</em> = .001). Horizontal shifting of commissures (80% vs 40%) and uneven commissural heights (95% vs 60%) were more frequently observed in the CT group than in the controls (<em>P</em> = .010) during David reimplantation. The CT group had fewer patients (25% vs 85%) and commissures (15% vs 63%) requiring intraoperative commissural position adjustments than the controls (<em>P</em> < .001). Cusp repair was required in 1 patient in the CT group and 7 patients in the control group (<em>P</em> = .018). Algorithm-based measurements showed excellent agreement with expert measurements for virtual basal ring diameters, intercommissural distances, and commissural heights (differences: −0.3 to 0.1 mm; intraclass correlation coefficients: 0.87-0.97).</div></div><div><h3>Conclusions</h3><div>For David reimplantation, CT-based planning of graft sizes and commissural positions may reduce the need for intraoperative commissural position adjustments and cusp repair. Our deep learning−based algorithm can replace expert measurements in standardized surgical planning.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102163"},"PeriodicalIF":1.9,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071036","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}
Pub Date : 2025-11-26DOI: 10.1016/j.xjtc.2025.102164
Yueying Yang MM , Ao Li BM , Yunfei Gao MM , Kayishaer Ainiwaer BM , Jun Chen MM , Dongbo Luo PhD
{"title":"Multiarm single-port robot-assisted secondary carinal reconstruction for right main bronchial schwannoma: A case report","authors":"Yueying Yang MM , Ao Li BM , Yunfei Gao MM , Kayishaer Ainiwaer BM , Jun Chen MM , Dongbo Luo PhD","doi":"10.1016/j.xjtc.2025.102164","DOIUrl":"10.1016/j.xjtc.2025.102164","url":null,"abstract":"","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102164"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071131","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}
Pub Date : 2025-11-26DOI: 10.1016/j.xjtc.2025.102167
Mark Petrovic MS , John M. Trahanas MD , Stephen DeVries DMSc, PA-C , Joshua Lowman PA-C , Chen Chia Wang BSc , Awab Ahmad MD , Brian Lima MD, MBA , Clifton Keck BS , Chris Schwartz BS , Ashish S. Shah MD , Matthew Bacchetta MD, MBA , Swaroop Bommareddi MD , Aaron M. Williams MD
{"title":"Temperature performance of a commercially available hybrid power cooler for cardiac allograft preservation","authors":"Mark Petrovic MS , John M. Trahanas MD , Stephen DeVries DMSc, PA-C , Joshua Lowman PA-C , Chen Chia Wang BSc , Awab Ahmad MD , Brian Lima MD, MBA , Clifton Keck BS , Chris Schwartz BS , Ashish S. Shah MD , Matthew Bacchetta MD, MBA , Swaroop Bommareddi MD , Aaron M. Williams MD","doi":"10.1016/j.xjtc.2025.102167","DOIUrl":"10.1016/j.xjtc.2025.102167","url":null,"abstract":"","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102167"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071073","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}
Pub Date : 2025-11-25DOI: 10.1016/j.xjtc.2025.102165
Philipp Pfeiffer MD, Karen Wittemann, Edoardo Zancanaro MD, Vanessa Buchholz, Leon Mattern, Chris Probst MD, Franz Masseli MD, Ahmed Ghazy MD, Hendrik Treede MD, PhD, Daniel-Sebastian Dohle MD, PhD
Pub Date : 2025-11-21DOI: 10.1016/j.xjtc.2025.11.005
Huy Q. Dang PhD, MD , Huong T. Le MD , Phu D. Bui PhD, MD
{"title":"Totally endoscopic extensive resection and reconstruction of the left atrial wall for myxoma with unusual origin","authors":"Huy Q. Dang PhD, MD , Huong T. Le MD , Phu D. Bui PhD, MD","doi":"10.1016/j.xjtc.2025.11.005","DOIUrl":"10.1016/j.xjtc.2025.11.005","url":null,"abstract":"","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102161"},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146070859","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}
Pub Date : 2025-11-21DOI: 10.1016/j.xjtc.2025.10.030
Pablo Codner MD , Victor Rubchevsky MD , Ashraf Hamdan MD , Janan Awesat MD , David Belkin MD , Yaron Shapira MD , Hilla Shaked MD , Hana Bernstine MD , Mordehay Vaturi MD , Ran Kornowski MD , Dror B. Leviner MD , Katia Orvin MD , Ram Sharony MD
Objectives
Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is rare. We describe patients referred to a tertiary heart center endocarditis team, with post-TAVR IE complicated by infected ascending aorta false aneurysms.
Methods
Among 60 patients with post-TAVR IE who were referred to our center between January 2016 and October 2024, 7 (11.7%) patients were complicated by false aneurysm and aortitis. In all cases, self-expanding transcatheter heart valves (THVs), primarily Symetis ACURATE neo, were used.
Results
Infected false aneurysm formation mainly at the tip of the THV stabilization arches and aortitis were identified only on cardiac computerized tomography. Five patients underwent surgical explant of the TAVR valve with aortic valve replacement. Interposition graft replacement of the ascending aorta was performed in 4 cases whereas 1 patient underwent aorta patch repair. Mitral valve surgery and coronary artery bypass graph were performed as a concomitant procedure in 2 cases. Two patients were managed conservatively due to extreme surgical risk. One patient died perioperatively, and one patient died during follow-up.
Conclusions
Unlike prosthetic valve endocarditis after surgical aortic valve replacement, TAVR-IE may involve the ascending aorta, leading to life-threatening false aneurysm formation at the tip of the THV stabilization arches, where the device was adherent to the aortic wall. This pathology often eludes detection by echocardiography, underscoring the essential role of cardiac computed tomography in diagnosis and surgical planning. Clinicians should maintain a high index of suspicion for this rare but unique life-threatening complication and consider early use of advanced imaging.
目的经导管主动脉瓣置换术（TAVR）后并发感染性心内膜炎（IE）较为少见。我们描述了三级心脏中心心内膜炎小组的患者，tavr后IE并发感染的升主动脉假动脉瘤。方法2016年1月至2024年10月至本中心收治的60例tavr术后IE患者中，7例（11.7%）合并假性动脉瘤和主动脉炎。所有病例均使用自膨胀经导管心脏瓣膜（thv），主要是Symetis accurate neo。结果感染的假性动脉瘤主要在THV稳定弓的顶端形成，主动脉炎仅在心脏计算机断层扫描上被发现。5例患者行TAVR瓣膜置换术。4例行升主动脉间置置换术，1例行主动脉补片修复术。2例合并二尖瓣手术及冠状动脉搭桥术。2例患者因手术风险大而采取保守治疗。1例患者围手术期死亡，1例患者随访期间死亡。结论手术主动脉瓣置换术后出现假瓣膜心内膜炎，TAVR-IE可能累及升主动脉，导致附着于主动脉壁的THV稳定弓尖端形成危及生命的假动脉瘤。这种病理常常无法通过超声心动图检测到，强调了心脏计算机断层扫描在诊断和手术计划中的重要作用。临床医生应该对这种罕见但独特的危及生命的并发症保持高度的怀疑，并考虑早期使用先进的影像学检查。
{"title":"Transcatheter aortic valve replacement infective endocarditis presenting as ascending aorta false aneurysm—a new clinical entity?","authors":"Pablo Codner MD , Victor Rubchevsky MD , Ashraf Hamdan MD , Janan Awesat MD , David Belkin MD , Yaron Shapira MD , Hilla Shaked MD , Hana Bernstine MD , Mordehay Vaturi MD , Ran Kornowski MD , Dror B. Leviner MD , Katia Orvin MD , Ram Sharony MD","doi":"10.1016/j.xjtc.2025.10.030","DOIUrl":"10.1016/j.xjtc.2025.10.030","url":null,"abstract":"<div><h3>Objectives</h3><div>Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is rare. We describe patients referred to a tertiary heart center endocarditis team, with post-TAVR IE complicated by infected ascending aorta false aneurysms.</div></div><div><h3>Methods</h3><div>Among 60 patients with post-TAVR IE who were referred to our center between January 2016 and October 2024, 7 (11.7%) patients were complicated by false aneurysm and aortitis. In all cases, self-expanding transcatheter heart valves (THVs), primarily Symetis ACURATE neo, were used.</div></div><div><h3>Results</h3><div>Infected false aneurysm formation mainly at the tip of the THV stabilization arches and aortitis were identified only on cardiac computerized tomography. Five patients underwent surgical explant of the TAVR valve with aortic valve replacement. Interposition graft replacement of the ascending aorta was performed in 4 cases whereas 1 patient underwent aorta patch repair. Mitral valve surgery and coronary artery bypass graph were performed as a concomitant procedure in 2 cases. Two patients were managed conservatively due to extreme surgical risk. One patient died perioperatively, and one patient died during follow-up.</div></div><div><h3>Conclusions</h3><div>Unlike prosthetic valve endocarditis after surgical aortic valve replacement, TAVR-IE may involve the ascending aorta, leading to life-threatening false aneurysm formation at the tip of the THV stabilization arches, where the device was adherent to the aortic wall. This pathology often eludes detection by echocardiography, underscoring the essential role of cardiac computed tomography in diagnosis and surgical planning. Clinicians should maintain a high index of suspicion for this rare but unique life-threatening complication and consider early use of advanced imaging.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102160"},"PeriodicalIF":1.9,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071035","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}
Pub Date : 2025-11-19DOI: 10.1016/j.xjtc.2025.09.039
Matthew R. Schill MD, Ruth Obiarinze MD, Sophia R. Pyeatte MD, Tari-Ann Yates MD, June He MBBS, James R. Edgerton MD, Harold G. Roberts Jr. MD, Tsuyoshi Kaneko MD, Ralph J. Damiano Jr. MD
Objective
Resection of atrial myxomas and valvular papillary fibroelastomas has traditionally involved sharp excision of the tumor accompanied by a small margin of normal tissue when feasible. Cryoablation of the tumor base is a potentially effective adjunct to radical excision alone and may prevent collateral damage and/or the need for reconstruction and late recurrence. This study aimed to evaluate the safety and effectiveness of adjunctive cryoablation with cardiac tumor resection.
Methods
We performed a retrospective analysis of all patients from our institution who underwent resection of first occurrence of a myxoma or papillary fibroelastoma between January 1, 1999, and December 31, 2024. Operative reports were reviewed to determine whether cryoablation was used as an adjunct to resection. Echocardiographic images were reviewed to determine tumor recurrence.
Results
Of the 94 patients included in this study, 50 underwent resection with adjunctive cryoablation around the tumor base and 44 underwent sharp excision alone. Fifty-one patients had a myxoma (54%) and 43 patients had a fibroelastoma (46%). Tumor recurrence was detected in 3 (3%) patients overall. All recurrences were in the sharp excision group (3/44, 7%), compared with none in the cryoablation group (P = .098).
Conclusions
Cryoablation was an effective adjunct that reduced recurrence without increasing complications after benign cardiac tumor resection.
{"title":"Cryoablation as an adjunct to the excision of primary cardiac tumors","authors":"Matthew R. Schill MD, Ruth Obiarinze MD, Sophia R. Pyeatte MD, Tari-Ann Yates MD, June He MBBS, James R. Edgerton MD, Harold G. Roberts Jr. MD, Tsuyoshi Kaneko MD, Ralph J. Damiano Jr. MD","doi":"10.1016/j.xjtc.2025.09.039","DOIUrl":"10.1016/j.xjtc.2025.09.039","url":null,"abstract":"<div><h3>Objective</h3><div>Resection of atrial myxomas and valvular papillary fibroelastomas has traditionally involved sharp excision of the tumor accompanied by a small margin of normal tissue when feasible. Cryoablation of the tumor base is a potentially effective adjunct to radical excision alone and may prevent collateral damage and/or the need for reconstruction and late recurrence. This study aimed to evaluate the safety and effectiveness of adjunctive cryoablation with cardiac tumor resection.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of all patients from our institution who underwent resection of first occurrence of a myxoma or papillary fibroelastoma between January 1, 1999, and December 31, 2024. Operative reports were reviewed to determine whether cryoablation was used as an adjunct to resection. Echocardiographic images were reviewed to determine tumor recurrence.</div></div><div><h3>Results</h3><div>Of the 94 patients included in this study, 50 underwent resection with adjunctive cryoablation around the tumor base and 44 underwent sharp excision alone. Fifty-one patients had a myxoma (54%) and 43 patients had a fibroelastoma (46%). Tumor recurrence was detected in 3 (3%) patients overall. All recurrences were in the sharp excision group (3/44, 7%), compared with none in the cryoablation group (<em>P</em> = .098).</div></div><div><h3>Conclusions</h3><div>Cryoablation was an effective adjunct that reduced recurrence without increasing complications after benign cardiac tumor resection.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102158"},"PeriodicalIF":1.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071074","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}
Pub Date : 2025-11-19DOI: 10.1016/j.xjtc.2025.11.001
Ji Hyeon Park MD , Samina Park MD , Jimyung Park MD , Sooah Cho MD , Susie Yoon MD , Taeyoung Yun MD , Bubse Na MD , Kwon Joong Na MD , Hyun Joo Lee MD , In Kyu Park MD , Chang Hyun Kang MD , Young Tae Kim MD
{"title":"Assistant-independent robotic lung transplantation","authors":"Ji Hyeon Park MD , Samina Park MD , Jimyung Park MD , Sooah Cho MD , Susie Yoon MD , Taeyoung Yun MD , Bubse Na MD , Kwon Joong Na MD , Hyun Joo Lee MD , In Kyu Park MD , Chang Hyun Kang MD , Young Tae Kim MD","doi":"10.1016/j.xjtc.2025.11.001","DOIUrl":"10.1016/j.xjtc.2025.11.001","url":null,"abstract":"","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102153"},"PeriodicalIF":1.9,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146070920","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}
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