JTCVS open最新文献

{"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}

{"title":"The impact of race and sex on recent mortality trends after coronary artery bypass grafting","authors":"Anthony V. Norman MD, MSc ,&nbsp;Mohamad El Moheb MD ,&nbsp;Ariaz Goudarzi BS ,&nbsp;Alexander M. Wisniewski MD, MSc ,&nbsp;Matthew P. Weber MD, MS ,&nbsp;Steven Young MD ,&nbsp;Andrew M. Young MD ,&nbsp;Abdulla Damluji MD ,&nbsp;Michael C. Kontos MD ,&nbsp;Mohammed Quader MD ,&nbsp;Ourania Preventza MD ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.xjon.2025.10.029","DOIUrl":"10.1016/j.xjon.2025.10.029","url":null,"abstract":"<div><h3>Objective</h3><div>Despite declining mortality after coronary artery bypass grafting, it is unclear if Black or female patients similarly benefit. We hypothesized differences in outcomes persist and disproportionately affect Black women.</div></div><div><h3>Methods</h3><div>We examined patients undergoing isolated coronary artery bypass grafting from July 2011 to July 2023 in a multicenter regional collaborative. Patients were stratified by race and sex: White men, White women, Black men, and Black women. Hierarchical logistic regression analyses were performed to identify trends and risk factors associated with operative mortality.</div></div><div><h3>Results</h3><div>Among 27,309 patients, White men, White women, Black men, and Black women made up 66.1%, 19.2%, 9.3%, and 5.4% of the cohort, respectively. Their Society of Thoracic Surgeons Predicted Risk of Mortality was 0.83%, 1.55%, 1.11%, and 1.66%, respectively (<em>P &lt;</em> .001). Mortality (1.5% vs 2.7% vs 2.5% vs 3.2%, <em>P &lt;</em> .001) and major morbidity (8% vs 12% vs 14% vs 17%, <em>P &lt;</em> .001) were highest in Black women. There was no reduction in mortality over time (odds ratio [OR], 1.06 95% CI, 0.95-1.2, <em>P =</em> .338). Compared with White men, White women (OR, 1.53, 95% CI, 1.22-1.91, <em>P &lt;</em> .001), Black men (OR, 1.41, 95% CI, 1.04-1.9, <em>P =</em> .026), and Black women (OR, 1.8, 95% CI, 1.28-2.53, <em>P =</em> .001) had higher risk-adjusted odds of mortality. Society of Thoracic Surgeons Predicted Risk of Mortality (OR, 1.13, 95% CI, 1.11-1.14, <em>P &lt;</em> .001), distress score (OR, 1.01 95% CI, 1.01-1.01, <em>P =</em> .007), log anastomosis ratio (OR, 0.775, 95% CI, 0.625-0.962, <em>P =</em> .021), and bypass time (OR, 1.01, 95% CI, 1.01-1.01, <em>P &lt;</em> .001) were associated with mortality.</div></div><div><h3>Conclusions</h3><div>Differences persist with Black women having the highest risk-adjusted odds of mortality after coronary artery bypass grafting. Reinvigorated efforts are needed in an era of plateauing mortality rates.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101510"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412579","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":"Long-term cardiac surgery outcomes in patients receiving dialysis and with previous kidney transplantation: A national registries analysis","authors":"Dominic Keuskamp PhD ,&nbsp;Christopher E. Davies PhD ,&nbsp;Robert A. Baker PhD ,&nbsp;Kevan R. Polkinghorne MBChB, PhD ,&nbsp;Christopher M. Reid PhD ,&nbsp;Julian A. Smith MBBS, MS ,&nbsp;Lavinia Tran PhD ,&nbsp;Jenni Williams-Spence PhD ,&nbsp;Rory Wolfe PhD ,&nbsp;Stephen P. McDonald MBBS(Hons), PhD","doi":"10.1016/j.xjon.2025.11.019","DOIUrl":"10.1016/j.xjon.2025.11.019","url":null,"abstract":"<div><h3>Objectives</h3><div>Whether patients with kidney failure who undergo cardiac surgery have a survival advantage with previous kidney transplantation is unclear. This study evaluated long-term outcomes after cardiac surgery for kidney transplant recipients and patients dependent on dialysis using national registries.</div></div><div><h3>Methods</h3><div>Probabilistic data linkage was undertaken between registries for the period 2010-2019. Time-to-event analyses were used to estimate the risk after cardiac surgery of (1) survival for kidney-replacement therapy recipients (n = 1250), and (2) graft survival for kidney transplant recipients (n = 225). Using cardiac surgery as a time-varying covariate, kidney graft survival was compared among the national contemporary kidney transplant population (n = 7934).</div></div><div><h3>Results</h3><div>Five-year survival probabilities after cardiac surgery for patients with kidney transplants and receiving dialysis were 70% (95% confidence interval [CI], 61%-76%) and 49% (95% CI, 45%-53%), respectively. The benefit for kidney transplantation persisted in a multivariable Cox regression model (reference: facility hemodialysis; adjusted hazard ratio [HR], 0.53; 95% CI, 0.37-0.74; <em>P</em> &lt; .001). Five-year kidney graft survival probability after cardiac surgery was 60% (95% CI, 52%-68%) and was lower with stage 3 acute kidney injury (reference: none; adjusted HR, 2.61; 95% CI, 1.32-5.16; <em>P</em> = .006). Among the national contemporary kidney transplant recipient population, cardiac surgery was associated with an increased risk of graft loss (adjusted HR, 1.70; 95% CI, 1.07-2.74; <em>P</em> = .026).</div></div><div><h3>Conclusions</h3><div>Among adults with kidney failure undergoing cardiac surgery, kidney transplant recipients experienced a long-term survival advantage compared with patients dependent on dialysis. Transplant recipients undergoing cardiac surgery had greater risk of graft loss than the national contemporary kidney transplant population.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101535"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412583","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":"When wedge resection is good enough: Survival outcomes and nodal involvement of ground-glass–dominant stage IA non–small cell lung cancer","authors":"Naoyuki Oka MD ,&nbsp;Masaya Yotsukura MD ,&nbsp;Yukihiro Yoshida MD ,&nbsp;Yasushi Yatabe MD ,&nbsp;Shun-ichi Watanabe MD","doi":"10.1016/j.xjon.2025.101549","DOIUrl":"10.1016/j.xjon.2025.101549","url":null,"abstract":"<div><h3>Objective</h3><div>Whether the indications for wedge resection can be extended to early-stage non–small cell lung cancer (NSCLC) remains unclear. We investigated the survival outcomes and nodal involvement of ground-glass-opacity–dominant stage IA NSCLC undergoing wedge resection, segmentectomy, or lobectomy.</div></div><div><h3>Methods</h3><div>We retrospectively investigated the prognostic and clinicopathological outcomes of patients who underwent lung resection for ground-glass-opacity–dominant clinical stage IA (diameter ≤3 cm; consolidation-to-tumor ratio ≤0.5) NSCLC between 2017 and 2022. Patients with tumors ≤2 cm and consolidation-to-tumor ratio ≤0.25 were excluded. Propensity score matching was performed to equalize the preoperative characteristics of patients undergoing wedge resection and segmentectomy. Overall and relapse-free survival rates were estimated, and differences were compared.</div></div><div><h3>Results</h3><div>Of the 398 patients who met the inclusion criteria, 77, 258, and 63 underwent lobectomy, segmentectomy, and wedge resection, respectively. Two (0.5%) patients experienced disease recurrence, and 6 (1.5%) patients died; however, no lung cancer-related deaths were observed. Two patients developed locoregional recurrence, all of which were nodal. No patients had pN1/2 disease. The 5-year overall and relapse-free survival rates were 97.6% and 96.4%, respectively. Relapse-free survival did not differ significantly according to the extent of lung resection (91.7%, 97.7%, and 100%; <em>P</em> = .146). Even after propensity score matching, overall and relapse-free survival did not differ significantly between wedge resection and segmentectomy.</div></div><div><h3>Conclusions</h3><div>Patients with ground-glass-opacity–dominant clinical stage IA NSCLC showed an excellent prognosis, with no survival differences between procedures. In those patients, wedge resection without nodal dissection may be oncologically equivalent to anatomic resection.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101549"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411913","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":"Cryoablation for ground-glass nodules: Indications and short-term outcomes","authors":"Ji Yun Han MD ,&nbsp;Woohyun Jung MD ,&nbsp;Kun Yung Kim MD ,&nbsp;Yeon Wook Kim MD, PhD ,&nbsp;Jae Hyun Jeon MD ,&nbsp;Sukki Cho MD, PhD ,&nbsp;Chang Jin Yoon MD, PhD ,&nbsp;Kwhanmien Kim MD, PhD","doi":"10.1016/j.xjon.2025.101548","DOIUrl":"10.1016/j.xjon.2025.101548","url":null,"abstract":"<div><h3>Objective</h3><div>We prospectively applied cryoablation to nonsubpleural small ground-glass nodules (GGNs) with risk factors for growth (high-risk GGNs). Herein, we present our inclusion criteria and short-term outcomes.</div></div><div><h3>Methods</h3><div>This is an interim report from a prospective, single-arm observational cohort study of cryoablation for high-risk GGNs. Inclusion criteria were GGN size between 8 and 20 mm; nonsubpleural GGNs; presence of risk factor for growth; clinically predicted as minimally invasive based on standardized uptake value and consolidation-to-tumor ratio; patients aged 20 to 65 years, those with a history of prior lung cancer surgery, or those with impaired pulmonary function test results; and provision of informed consent after thorough explanation. Exclusion criteria were GGNs located within 1 cm of a major vessel or main bronchus, evidence of nodal or distant metastasis, and severe coagulopathy.</div></div><div><h3>Results</h3><div>A total of 14 patients underwent cryoablation for GGNs. The mean age was 68.1 ± 10.5 years. All patients had multiple GGNs, and 11 patients (78.6%) had a history of lung cancer surgery. Mean GGN size was 12 ± 5 mm with standardized uptake value 0.5 ± 0.6 and consolidation-to-tumor ratio 0.6 ± 0.3. All lesions were successfully encompassed within the target −40 °C isotherm zone with 10-mm safety margins. Only Common Terminology Criteria for Adverse Events grade 1 complications occurred. The median hospital stay was 2 days.</div></div><div><h3>Conclusions</h3><div>We have presented the indications of cryoablation for GGNs. This study demonstrates that cryoablation can be safely performed in carefully selected patients, achieving favorable short-term safety outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101548"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147411915","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":"Risk model for mortality in Japanese patients requiring dialysis undergoing transcatheter aortic valve implantation: A report from a Japanese nationwide study","authors":"Kizuku Yamashita MD, PhD ,&nbsp;Koichi Maeda MD, PhD ,&nbsp;Hiraku Kumamaru MD, ScD ,&nbsp;Shun Kohsaka MD, PhD ,&nbsp;Kazuo Shimamura MD, PhD ,&nbsp;Ai Kawamura MD, PhD ,&nbsp;Isamu Mizote MD, PhD ,&nbsp;Daisuke Yoshioka MD, PhD ,&nbsp;Shigeru Miyagawa MD, PhD","doi":"10.1016/j.xjon.2025.101570","DOIUrl":"10.1016/j.xjon.2025.101570","url":null,"abstract":"<div><h3>Objectives</h3><div>Transcatheter aortic valve implantation (TAVI) is widely performed. However, the prognosis of patients requiring dialysis undergoing TAVI remains guarded; therefore, we aimed to establish a risk model to predict their prognosis.</div></div><div><h3>Methods</h3><div>A total of 888 patients requiring dialysis underwent TAVI for severe aortic stenosis between February 2021 and March 2022 at 54 facilities in Japan. Patients from 44 randomly selected facilities were included in the development cohort, and the rest were included in the validation cohort. Based on clinical perspective and prior research, 15 preoperative background factors, including the grade of clinical frailty scale (1-3, 4-6, or 7-9) and serum albumin level, were selected and a prognostic model was constructed using Cox proportional hazards regression.</div></div><div><h3>Results</h3><div>The median age of the patients was 80 years (interquartile range, 75-85 years). Three hundred nineteen men (35.9%) and 587 high-risk (Society of Thoracic Surgeons predicted risk of mortality ≥8%) patients (66.1%) were enrolled. The cumulative overall survival rates at 30 days and 1 year after TAVI were 95.9% and 78.3%, respectively. The exacerbated clinical frailty scale was strongly associated with 1-year mortality in the development cohort (hazard ratio, 2.06; 95% CI, 1.47-2.87). Uno's concordance index in the validation cohort was 0.686 (95% CI, 0.588-0.783). Observed survival rates were 91.7% (95% CI, 53.9%-98.8%) in the group with ≥90% predicted survival, 84.8% (95% CI, 70.7%-92.5%) in the group with 80% to &lt;90% predicted survival, and 64.4% (95% CI, 51.9%-74.5%) in the group with &lt;80% predicted survival.</div></div><div><h3>Conclusions</h3><div>The model developed in this study predicts 1-year survival probability, which is useful in considering indications for TAVI in patients requiring dialysis with a poor prognosis.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101570"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412064","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":"Aortic valve neocuspidization in children: A systematic review and meta-analysis","authors":"Andrey Semyashkin MD ,&nbsp;Julia Nesteruk MD ,&nbsp;Lotfi Ben Mime MD","doi":"10.1016/j.xjon.2025.101547","DOIUrl":"10.1016/j.xjon.2025.101547","url":null,"abstract":"<div><h3>Background</h3><div>Aortic valve neocuspidization (AVNeo) has emerged as a reconstructive alternative for children with aortic valve disease who are poor candidates for prosthetic replacement or the Ross procedure. Although early clinical results appear favorable, concerns persist regarding mid-term durability and material-related valve degeneration. To clarify these uncertainties, we systematically evaluated global pediatric AVNeo outcomes, focusing on early performance, mid-term reintervention rates, and the influence of pericardial material on valve longevity.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and preprint servers (January 2000-October 2025) identified studies reporting neocuspidization in patients age ≤18 years. Two reviewers independently screened and extracted data. Pooled proportions were calculated with a random-effects model; heterogeneity was assessed with the <em>I</em>² statistic. Risk ratios compared reoperation rates between autologous and xenopericardial reconstructions, and comparative cohorts versus the Ross operation were summarized narratively.</div></div><div><h3>Results</h3><div>Twelve studies including 336 children met the inclusion criteria. Early mortality was 1.2%, and late mortality was 1.1%. The pooled reoperation rate was 15.4% (95% confidence interval [CI], 5.4%-29.2%; <em>I</em>² = 86%). Reoperation was 7-fold more frequent after xenopericardial reconstruction (risk ratio, 7.09; 95% CI, 2.95-17.06). Comparative series consistently favored the Ross operation for mid-term durability.</div></div><div><h3>Conclusions</h3><div>AVNeo provides excellent early outcomes but limited mid-term durability, particularly with xenopericardium. Autologous pericardium markedly reduces reoperation risk and should remain the preferred material.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101547"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412066","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":"Minimally invasive mitral valve repair: Ten-year outcomes of the “Re-Lock technique” for complex bileaflet mitral valve disease","authors":"Giuseppe Speziale MD, PhD ,&nbsp;Raffaele Bonifazi MD ,&nbsp;Tommaso Loizzo MD ,&nbsp;Ernesto Greco MD, PhD ,&nbsp;Giuseppe Nasso MD, PhD","doi":"10.1016/j.xjon.2025.101543","DOIUrl":"10.1016/j.xjon.2025.101543","url":null,"abstract":"<div><h3>Objective</h3><div>The objective was to evaluate the 10-year clinical and echocardiographic outcomes of minimally invasive Re-Lock mitral valve repair for Barlow-type or complex bileaflet degenerative disease, evaluating overall survival, freedom from mitral regurgitation 2+ or greater, need for reoperation, and New York Heart Associaton class.</div></div><div><h3>Methods</h3><div>From 2008 to 2016, 140 consecutive patients with Barlow-type degenerative bileaflet mitral valve disease underwent video-assisted minimally invasive right anterolateral thoracotomy repair at a single institution. In all cases, the repair was based on the Re-Lock maneuver. Patients were classified according to the need for anterior intervention. Group 1 included patients receiving Re-Lock only (n = 33), in whom anterior billowing or mild prolapse became competent after posterior correction and required no additional repair. Group 2 included patients receiving Re-Lock + anterior expanded polytetrafluoroethylene neochordae (n = 107), in whom true anterior prolapse or flail warranted targeted neochordal implantation. Follow-up was completed through scheduled clinical and echocardiographic evaluations, with a median duration of 10.2 years.</div></div><div><h3>Results</h3><div>Technical success with freedom of mitral regurgitation (mild or less on intraoperative transesophageal echocardiography) was 99.3%, with no 30-day mortality. At 10 years, overall survival was 95.7%. Freedom from mitral regurgitation 2+ or greater was 91.2%, and freedom from reoperation was 96.4%. Postoperative New York Heart Association class improved in 130 of 140 patients (92.9%) and maintained class I at last follow-up in 122 of 130 survivors (93.8%). No statistically significant difference was observed in outcomes by technique group (log-rank <em>P =</em> .74). A learning curve was evident, with crossclamp time decreasing from 69.7 ± 11.9 to 45.3 ± 10.4 minutes over time.</div></div><div><h3>Conclusions</h3><div>The minimally invasive Re-Lock technique provides safe, reproducible, and effective long-term results for complex bileaflet mitral valve disease, including Barlow's pathology.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"29 ","pages":"Article 101543"},"PeriodicalIF":1.9,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147412070","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}