Pub Date : 2025-10-13DOI: 10.1016/j.xjtc.2025.09.032
Jiaxi Huang MD , Li Jiang MM , Gong Chen MD , Chen Chao MD , Weicheng Chen MD , Ming Ye MD , Shunmin Wang MD , Gang Chen MD
Objective
Complex tracheoesophageal fistula (TEF), encompassing recurrent, large-defect, or foreign-body-induced TEF caused by congenital or acquired origin, represents a formidable surgical challenge. Although various endoscopic and surgical techniques have been developed, the optimal approach remains controversial. Slide tracheoplasty with cardiopulmonary bypass provides excellent exposure of both the trachea and esophagus, making it a potentially valuable salvage technique for the treatment of complex TEF in children. We present a series of patients who underwent successful slide tracheoplasty by a multidisciplinary team in our institution.
Methods
We retrospectively reviewed 3 consecutive patients who underwent slide tracheoplasty for complex TEF between January and April 2024. Data collected included demographic characteristics, etiology, surgical details, perioperative parameters, and outcomes.
Results
All 3 patients successfully underwent slide tracheoplasty and esophageal repair with cardiopulmonary bypass support. All patients were successfully weaned from mechanical ventilation and had an uneventful recovery. At a median follow-up of 12 months, there were no cases of postoperative infection, vocal cord paralysis, esophageal or tracheal strictures, recurrent fistula, or need for reintervention.
Conclusions
Slide tracheoplasty with cardiopulmonary bypass demonstrates excellent early outcomes for the management of complex tracheoesophageal fistula in children. This technique represents a promising salvage option when conventional repair approaches are inadequate or have failed.
{"title":"Slide tracheoplasty for repair of complex tracheoesophageal fistulas in children: A salvage technique","authors":"Jiaxi Huang MD , Li Jiang MM , Gong Chen MD , Chen Chao MD , Weicheng Chen MD , Ming Ye MD , Shunmin Wang MD , Gang Chen MD","doi":"10.1016/j.xjtc.2025.09.032","DOIUrl":"10.1016/j.xjtc.2025.09.032","url":null,"abstract":"<div><h3>Objective</h3><div>Complex tracheoesophageal fistula (TEF), encompassing recurrent, large-defect, or foreign-body-induced TEF caused by congenital or acquired origin, represents a formidable surgical challenge. Although various endoscopic and surgical techniques have been developed, the optimal approach remains controversial. Slide tracheoplasty with cardiopulmonary bypass provides excellent exposure of both the trachea and esophagus, making it a potentially valuable salvage technique for the treatment of complex TEF in children. We present a series of patients who underwent successful slide tracheoplasty by a multidisciplinary team in our institution.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 3 consecutive patients who underwent slide tracheoplasty for complex TEF between January and April 2024. Data collected included demographic characteristics, etiology, surgical details, perioperative parameters, and outcomes.</div></div><div><h3>Results</h3><div>All 3 patients successfully underwent slide tracheoplasty and esophageal repair with cardiopulmonary bypass support. All patients were successfully weaned from mechanical ventilation and had an uneventful recovery. At a median follow-up of 12 months, there were no cases of postoperative infection, vocal cord paralysis, esophageal or tracheal strictures, recurrent fistula, or need for reintervention.</div></div><div><h3>Conclusions</h3><div>Slide tracheoplasty with cardiopulmonary bypass demonstrates excellent early outcomes for the management of complex tracheoesophageal fistula in children. This technique represents a promising salvage option when conventional repair approaches are inadequate or have failed.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"34 ","pages":"Pages 195-202"},"PeriodicalIF":1.9,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580088","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 : 2025-10-10DOI: 10.1016/j.xjtc.2025.09.023
Igor E. Konstantinov MD, PhD, FRACS , Carolina Rodrigues MD , Sergei I. Konstantinov BMedSci , Tyson A. Fricke MD, PhD, FRACS
{"title":"Aortic valve repair after failed Ross operation in an adolescent","authors":"Igor E. Konstantinov MD, PhD, FRACS , Carolina Rodrigues MD , Sergei I. Konstantinov BMedSci , Tyson A. Fricke MD, PhD, FRACS","doi":"10.1016/j.xjtc.2025.09.023","DOIUrl":"10.1016/j.xjtc.2025.09.023","url":null,"abstract":"","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"34 ","pages":"Pages 141-144"},"PeriodicalIF":1.9,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579962","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}
Prosthetic valve endocarditis (PVE) complicated by complex paraannular aortic abscess remains a surgical challenge. We aimed to evaluate the mid-term outcomes of a standardized, patch-free, supra-annular aortic valve replacement strategy that avoids complete root replacement in these high-risk patients.
Methods
This retrospective, single-center study included 70 consecutive patients treated between 2015 and 2023 for complex aortic PVE using a consistent surgical protocol: radical debridement, supra-annular prosthetic valve implantation, inside the Valsalva sinuses, and external felt reinforcement—without annular or root patching. Follow-up included annual clinical and echocardiographic assessment (mean duration, 5.2 ± 1.3 years). The primary endpoint was freedom from the composite of reinfection or aortic reoperation. Secondary endpoints included survival, valve performance, and predictors of late adverse events.
Results
Hospital mortality was 5.7% (n = 4 of 70). At 5 years, overall survival was 86.0% (95% confidence interval [CI], 78.0%-93.9%), and freedom from reinfection or aortic reoperation was 89.2% (95% CI, 82.1%-96.2%). Outcomes were comparable between the original (n = 47) and expanded (n = 23) cohorts (log-rank P = .71). Two late reinfections (2.9%) were managed medically. One patient required reoperation for structural valve degeneration at 54 months. Mean transvalvular gradient remained stable at 5 years (10.4 ± 3.1 mm Hg at discharge vs 11.1 ± 3.6 mm Hg; P = .27) whereas mean left ventricular ejection fraction improved significantly (from 52 ± 10% to 58 ± 8%; P < .01). Ninety-two percent of survivors were in New York Heart Association class I-II. Independent predictors of late events included EuroSCORE II >12% and incomplete abscess excision.
Conclusions
Patch-free supra-annular valve replacement offers durable infection control and excellent hemodynamic outcomes, avoiding the need for complete root replacement in complex aortic PVE.
背景：人工瓣膜心内膜炎（PVE）合并复杂的主动脉环旁脓肿仍然是一个外科挑战。我们的目的是评估标准化、无补片、环上主动脉瓣置换术的中期结果，避免在这些高风险患者中进行完全根置换术。方法：本回顾性单中心研究纳入了2015年至2023年间连续治疗的70例复杂主动脉PVE患者，采用一致的手术方案：根治性清创、环上人工瓣膜植入、Valsalva窦内植入和外部毡强化，不进行环或根修补。随访包括年度临床和超声心动图评估（平均持续时间，5.2±1.3年）。主要终点是无再感染或主动脉再手术。次要终点包括生存、瓣膜性能和晚期不良事件的预测因子。结果住院死亡率为5.7%（70例中4例）。5年总生存率为86.0%(95%可信区间[CI]， 78.0%-93.9%)，无再感染或主动脉再手术率为89.2% （95% CI, 82.1%-96.2%）。原始队列（n = 47）和扩展队列（n = 23）的结果具有可比性（log-rank P = 0.71）。2例晚期再感染（2.9%）经药物治疗。1例患者在54个月时因结构性瓣膜退变需要再次手术。平均经瓣梯度在5年内保持稳定（出院时10.4±3.1 mm Hg vs 11.1±3.6 mm Hg; P = 0.27），而平均左室射血分数显著改善（从52±10%到58±8%；P < 0.01）。92%的幸存者属于纽约心脏协会I-II级。晚期事件的独立预测因子包括EuroSCORE II >；12%和不完全脓肿切除。结论无补片环上瓣膜置换术能持久控制感染，血流动力学结果良好，避免了复杂主动脉瓣PVE的全根置换术。
{"title":"Mid-term outcomes of a modified prosthetic aortic valve implantation technique for prosthetic valve endocarditis complicated by aortic annular abscess","authors":"Giuseppe Nasso MD, PhD , Walter Vignaroli MD , Raffaele Bonifazi MD , Flavio Fiore MD , Giacomo Schinco MD , Felice Agrò PhD , Ernesto Greco PhD , Antongiulio Valenzano MD , Giacomo Errico MD , Dritan Hila MD , Tommaso Loizzo MD , Giuseppe Santarpino MDP , Giuseppe Speziale MD, PhD","doi":"10.1016/j.xjtc.2025.09.017","DOIUrl":"10.1016/j.xjtc.2025.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Prosthetic valve endocarditis (PVE) complicated by complex paraannular aortic abscess remains a surgical challenge. We aimed to evaluate the mid-term outcomes of a standardized, patch-free, supra-annular aortic valve replacement strategy that avoids complete root replacement in these high-risk patients.</div></div><div><h3>Methods</h3><div>This retrospective, single-center study included 70 consecutive patients treated between 2015 and 2023 for complex aortic PVE using a consistent surgical protocol: radical debridement, supra-annular prosthetic valve implantation, inside the Valsalva sinuses, and external felt reinforcement—without annular or root patching. Follow-up included annual clinical and echocardiographic assessment (mean duration, 5.2 ± 1.3 years). The primary endpoint was freedom from the composite of reinfection or aortic reoperation. Secondary endpoints included survival, valve performance, and predictors of late adverse events.</div></div><div><h3>Results</h3><div>Hospital mortality was 5.7% (n = 4 of 70). At 5 years, overall survival was 86.0% (95% confidence interval [CI], 78.0%-93.9%), and freedom from reinfection or aortic reoperation was 89.2% (95% CI, 82.1%-96.2%). Outcomes were comparable between the original (n = 47) and expanded (n = 23) cohorts (log-rank <em>P</em> = .71). Two late reinfections (2.9%) were managed medically. One patient required reoperation for structural valve degeneration at 54 months. Mean transvalvular gradient remained stable at 5 years (10.4 ± 3.1 mm Hg at discharge vs 11.1 ± 3.6 mm Hg; <em>P</em> = .27) whereas mean left ventricular ejection fraction improved significantly (from 52 ± 10% to 58 ± 8%; <em>P</em> < .01). Ninety-two percent of survivors were in New York Heart Association class I-II. Independent predictors of late events included EuroSCORE II >12% and incomplete abscess excision.</div></div><div><h3>Conclusions</h3><div>Patch-free supra-annular valve replacement offers durable infection control and excellent hemodynamic outcomes, avoiding the need for complete root replacement in complex aortic PVE.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"34 ","pages":"Pages 107-115"},"PeriodicalIF":1.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580082","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 : 2025-10-09DOI: 10.1016/j.xjtc.2025.09.016
Busra Cangut MD, MS , Armita Kabirpour MD , Shinobu Itagaki MD , Sean Pinney MD , David H. Adams MD , Anelechi C. Anyanwu MD
Background
Beating heart cardiac transplantation was introduced as a complement to ex vivo heart perfusion (EVHP) to allow implantation of the allograft without a second period of ischemia. We report our single-center experience of systematic use of the beating heart technique.
Methods
We retrospectively studied 75 consecutive heart transplantations performed using the Transmedics Organ Care System (OCS) over 24 months at our center, where hearts were implanted with the beating heart technique. Of the 75 recipients, UNOS status was 1 or 2 in 37 (49%) and 3 to 6 in 38 (51%), and 44 (59%) underwent reoperations, including 32 with a durable ventricular assist device, 5 with complex congenital heart disease, and 3 retransplants.
Results
Hearts were procured from donors after circulatory death (n = 35; 46.6%) or from extended criteria brain-dead donors (n = 40; 53.4%). Donors included 8 (10.6%) age ≥50 years, 13 (17.3%) with left ventricular hypertrophy, 19 (25.3%) with an undersized heart (predicted heart mass ratio <0.9); 2 (2.6%) on hemodialysis, and 11 (14.6%) with diabetes. One-quarter lived >650 miles away. The median clamp and OCS perfusion times were 7.1 hours (interquartile range [IQR], 6.4-7.6 hours) and 5.4 hours (IQR, 4.7-5.9 hours), respectively. The median cold ischemic time was 36 minutes (IQR, 29-40 minutes). Beating heart implantation was completed successfully without technical issues or complications in all patients, with no conversions to cardioplegic arrest. The period of EVHP through the cardiopulmonary bypass machine averaged 63 minutes (IQR, 56-70 minutes). Despite the higher donor risk profile, we experienced only 1 case (1.3%) of severe primary graft dysfunction (PGD) requiring mechanical circulatory support. The median vasoactive-inotropic score was 21.4 on leaving the operating room and 10.3 at 24 hours. There were 4 (5.3%) in-hospital mortalities, none directly attributable to the beating heart technique.
Conclusions
Beating heart transplantation is a safe, feasible, and reproducible technique. Despite an unselected surgical cohort and our high use of extended criteria donors, we experienced a low incidence of PGD. The beating heart technique may facilitate the use of extended criteria donor hearts and increase the access to heart transplantation for complex surgical recipients.
{"title":"Beating heart technique for orthotopic heart transplantation after ex vivo heart perfusion: Clinical application and experience","authors":"Busra Cangut MD, MS , Armita Kabirpour MD , Shinobu Itagaki MD , Sean Pinney MD , David H. Adams MD , Anelechi C. Anyanwu MD","doi":"10.1016/j.xjtc.2025.09.016","DOIUrl":"10.1016/j.xjtc.2025.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Beating heart cardiac transplantation was introduced as a complement to ex vivo heart perfusion (EVHP) to allow implantation of the allograft without a second period of ischemia. We report our single-center experience of systematic use of the beating heart technique.</div></div><div><h3>Methods</h3><div>We retrospectively studied 75 consecutive heart transplantations performed using the Transmedics Organ Care System (OCS) over 24 months at our center, where hearts were implanted with the beating heart technique. Of the 75 recipients, UNOS status was 1 or 2 in 37 (49%) and 3 to 6 in 38 (51%), and 44 (59%) underwent reoperations, including 32 with a durable ventricular assist device, 5 with complex congenital heart disease, and 3 retransplants.</div></div><div><h3>Results</h3><div>Hearts were procured from donors after circulatory death (n = 35; 46.6%) or from extended criteria brain-dead donors (n = 40; 53.4%). Donors included 8 (10.6%) age ≥50 years, 13 (17.3%) with left ventricular hypertrophy, 19 (25.3%) with an undersized heart (predicted heart mass ratio <0.9); 2 (2.6%) on hemodialysis, and 11 (14.6%) with diabetes. One-quarter lived >650 miles away. The median clamp and OCS perfusion times were 7.1 hours (interquartile range [IQR], 6.4-7.6 hours) and 5.4 hours (IQR, 4.7-5.9 hours), respectively. The median cold ischemic time was 36 minutes (IQR, 29-40 minutes). Beating heart implantation was completed successfully without technical issues or complications in all patients, with no conversions to cardioplegic arrest. The period of EVHP through the cardiopulmonary bypass machine averaged 63 minutes (IQR, 56-70 minutes). Despite the higher donor risk profile, we experienced only 1 case (1.3%) of severe primary graft dysfunction (PGD) requiring mechanical circulatory support. The median vasoactive-inotropic score was 21.4 on leaving the operating room and 10.3 at 24 hours. There were 4 (5.3%) in-hospital mortalities, none directly attributable to the beating heart technique.</div></div><div><h3>Conclusions</h3><div>Beating heart transplantation is a safe, feasible, and reproducible technique. Despite an unselected surgical cohort and our high use of extended criteria donors, we experienced a low incidence of PGD. The beating heart technique may facilitate the use of extended criteria donor hearts and increase the access to heart transplantation for complex surgical recipients.</div></div>","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"35 ","pages":"Article 102102"},"PeriodicalIF":1.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071072","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 : 2025-10-09DOI: 10.1016/j.xjtc.2025.09.021
Yin Wang MD, PhD, Yixuan Wang MD, PhD, Fei Li MD, PhD, Nianguo Dong MD, PhD, Xingjian Hu MD, PhD
{"title":"Atrial rotation maneuver technique in heart transplantation for recipients with dextrocardia","authors":"Yin Wang MD, PhD, Yixuan Wang MD, PhD, Fei Li MD, PhD, Nianguo Dong MD, PhD, Xingjian Hu MD, PhD","doi":"10.1016/j.xjtc.2025.09.021","DOIUrl":"10.1016/j.xjtc.2025.09.021","url":null,"abstract":"","PeriodicalId":53413,"journal":{"name":"JTCVS Techniques","volume":"34 ","pages":"Pages 191-194"},"PeriodicalIF":1.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580087","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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