JTCVS open最新文献

{"title":"Influence of patient engagement technology on reported perioperative experiences of patients undergoing lung resection","authors":"Frank Gleason MD, MSPH ,&nbsp;Benjamin Wei MD ,&nbsp;James Donahue MD","doi":"10.1016/j.xjon.2025.09.044","DOIUrl":"10.1016/j.xjon.2025.09.044","url":null,"abstract":"<div><h3>Objectives</h3><div>Patient engagement technologies (PETs) are web-based platforms that provide a means to collect patient-reported outcomes (PROs) as well as guide patients through their surgical journey. The optimal method for collecting PROs is unknown. PROs are an important measure of health care quality We sought to describe the experience of patients undergoing lung resection at our institution using an app-based PET platform.</div></div><div><h3>Methods</h3><div>Patients undergoing elective lung resection surgery from 2019 to 2023 who enrolled with a PET were identified. Patients received educational content; health checks; and surveys, including the Patient-Reported Outcomes Measurement Information System Global-10 and EuroQOL 5 Dimension surveys. Descriptive statistics were employed to determine utilization and initial observations.</div></div><div><h3>Results</h3><div>We enrolled 952 patients who underwent lung resection, of whom 88% (838 out of 952) activated the PET and completed the setup survey. More than half (436 out of 838) of patients were women and 68% (229 out of 335) had adequate health literacy. Preoperative Patient-Reported Outcomes Measurement Information System Global-10 and EuroQOL 5 Dimension surveys were completed by 73% (613 out of 838), whereas 37% (309 out of 838) completed an inpatient health check and 39% (325 out of 838) completed a 1-month follow-up survey. Overall, 91% (179 out of 196) reported the PET improved their confidence in postoperative self-care and as a result 86% (169 out of 196) reported feeling less worried about their surgical journey. Use of the PET allowed 39% (77 out of 196) to avoid telephone calls to the hospital care team and 7.6% (15 out of 196) avoided emergency room visits.</div></div><div><h3>Conclusions</h3><div>Patient engagement technologies provide a way to collect PROs. Among patients who utilize PETs in their perioperative care, there is a reported reduction in telephone calls to providers and emergency room visits, promotion of empowerment in self-care, and reduction of anxiety.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 690-703"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697866","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":"Achieving and maintaining superior postoperative outcomes with an optimized recovery after thoracic surgery protocol","authors":"Dao Minh Nguyen MD, MSc, FRCSC, FACS,&nbsp;Ahmed Alnajar MD, MSc, MPH,&nbsp;Mehmed Akcin PhD,&nbsp;Nestor Villamizar MD","doi":"10.1016/j.xjon.2025.08.018","DOIUrl":"10.1016/j.xjon.2025.08.018","url":null,"abstract":"<div><h3>Objective</h3><div>Protocol optimization to improve postoperative outcomes is a key component of enhanced recovery after surgery program. The aim of this study is to determine the long-term impact of protocol optimization on postoperative outcomes of robotic pulmonary anatomic resections.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospectively maintained database was performed. All elective robotic anatomic pulmonary resections between February 1, 2018, and December 31, 2023, were included and stratified into original Enhanced Recovery After Thoracic Surgery (ERATS) - group A (February 1, 2018, to December 31, 2019, n = 184) and optimized ERATS - group B (January 1, 2020, to December 31, 2023, n = 557). Propensity-score matching yielded highly comparable cohorts for outcome analysis. Data included demographics, operative details, postoperative outcomes (hospital length of stay [LOS], postoperative opioid use, 30-day complications), patient-reported subjective pain, and cost-savings resulting from reducing observed LOS versus expected LOS on the basis of Medicare Severity Diagnosis-Related Group classification and estimated institution per-diem cost of $1100.00.</div></div><div><h3>Results</h3><div>Of the 732 eligible patients, 499 were matched with 173 to group A and 326 group B. Protocol optimization was associated with significant improvement of postoperative outcomes: shorter LOS, greater percentages of postoperative day 1 discharge, substantial less opioid requirements with increasing number of opioid-free postdischarges, and greater cost-savings either collectively or per individual DRGs attributable to the reduction of LOS. Annual auditing of the optimized ERATS cohort demonstrated consistent improvements in key metrics over time.</div></div><div><h3>Conclusions</h3><div>Successful ERATS protocol optimization and maintenance was associated with durable and significantly superior postoperative outcomes along with greater cost-savings attributable to a reduction of LOS in patients undergoing elective robotic pulmonary anatomic resections.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 704-714"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697867","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":"Role of aortic distensibility and stiffness in ascending thoracic aneurysm outcomes","authors":"Axel Gomez MD,&nbsp;William Carroway MD,&nbsp;Nipam Raval BA,&nbsp;Liang Ge PhD,&nbsp;Marko Boskovski MD, MHS, MPH,&nbsp;Elaine E. Tseng MD","doi":"10.1016/j.xjon.2025.10.013","DOIUrl":"10.1016/j.xjon.2025.10.013","url":null,"abstract":"<div><h3>Objective</h3><div>Ascending thoracic aortic aneurysms pose a risk of acute dissection. Although diameter guides elective repair, complications often occur below surgical thresholds. Aortic distensibility and stiffness have been proposed as alternative risk markers. We aimed to evaluate the association of deformation indices with all-cause mortality in patients with dilated aortas and ascending thoracic aortic aneurysms.</div></div><div><h3>Methods</h3><div>Retrospective study of patients with ascending aortic diameter ≥4.0 cm who had a multiphasic electrocardiogram-gated computed tomography angiogram within 3 years of death or between 2021 and 2024. Diameter- and area-based distensibility and stiffness indices were calculated 3 cm above the annulus using dynamic aortic measurements across the cardiac cycle. Differences by mortality status and aortic valve phenotype were assessed using the Wilcoxon rank-sum test.</div></div><div><h3>Results</h3><div>We included 319 veterans with median age of 75 years (interquartile range, 7.0 years), of whom 35 (11.0%) died within 3 years. Aortic diameter was larger in the mortality group (4.50 vs 4.40 cm; <em>P</em> = .005). Bicuspid aortic valve was present in 12 patients (3.8%). No differences in diameter-based distensibility (0.56 vs 0.64 × 10⁻⁶ cm²/dyne; <em>P</em> = .38) or stiffness index (23.5 vs 23.5; <em>P</em> = .34) were observed by mortality status. Patients with bicuspid aortic valve had higher unadjusted distensibility (1.23 vs 0.63 × 10⁻⁶ cm²/dyne; <em>P</em> = .046) and lower stiffness index (12.5 vs 24.4; <em>P</em> = .05) compared with tricuspid valves. Area-based metrics were similar.</div></div><div><h3>Conclusions</h3><div>Aortic distensibility and stiffness index were not associated with all-cause mortality. Deformation indices varied by valve morphology in unadjusted analyses but were attenuated after adjustment. Further studies are needed to evaluate aortic deformation indices with regard to ascending thoracic aortic aneurysm risk stratification.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 13-23"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145697922","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":"Septal myectomy for obstructive hypertrophic cardiomyopathy: Comparison of outcomes of the transapical beating-heart and transaortic on-pump approaches","authors":"Younus Qamar MBBS ,&nbsp;Rui Li MD, PhD ,&nbsp;Jeffrey B. Geske MD ,&nbsp;Jing Fang MD, PhD ,&nbsp;Brian D. Lahr MS ,&nbsp;Alexander T. Lee BS ,&nbsp;Steve R. Ommen MD ,&nbsp;Song Wan MD, PhD ,&nbsp;Hartzell V. Schaff MD ,&nbsp;Xiang Wei MD, PhD","doi":"10.1016/j.xjon.2025.09.041","DOIUrl":"10.1016/j.xjon.2025.09.041","url":null,"abstract":"<div><h3>Background</h3><div>Transaortic on-pump septal myectomy (SM) is the established standard for surgical septal reduction, but transapical beating-heart SM recently has emerged as a less invasive alternative. This study compares the early outcomes of these 2 approaches to performing SM in patients with obstructive hypertrophic cardiomyopathy (oHCM).</div></div><div><h3>Methods</h3><div>We analyzed the outcomes of 200 consecutive patients undergoing transapical beating-heart myectomy and 200 patients receiving transaortic on-pump myectomy. The primary outcome was procedural success, defined as a peak left ventricular outflow tract (LVOT) gradient &lt;30 mm Hg on predismissal echocardiography. Secondary outcomes included transfusion and postoperative atrial fibrillation rates and intensive care unit (ICU) length of stay.</div></div><div><h3>Results</h3><div>Both techniques significantly reduced LVOT gradient (median reduction: transapical, 102 mm Hg to 15 mm Hg; transaortic, 88 mm Hg to 12 mm Hg; <em>P</em> &lt; .001 for both). Transapical beating-heart myectomy was associated with a shorter ICU stay (median, 24.0 hours vs 26.0 hours; <em>P</em> &lt; .001), a lower atrial fibrillation rate (9.5% vs 30.0%; <em>P</em> &lt; .001), and fewer transfusions (8.0% vs 22.0%; <em>P</em> &lt; .001) but resulted in a higher incidence of new-onset left bundle branch block (63.8% vs 37.0%; <em>P</em> &lt; .001) and longer postoperative hospital stay (median, 11 days vs 5 days; <em>P</em> &lt; .001), owing mainly to institutional protocols. Overall 30-day mortality was 0.5% (n = 1) in the transapical beating-heart myectomy group and 1.0% (n = 2) in the transaortic on-pump myectomy group (<em>P</em> = .562).</div></div><div><h3>Conclusions</h3><div>Transapical beating-heart SM provides comparable hemodynamic outcomes to transaortic on-pump myectomy with advantages in ICU recovery time, transfusion rates, and postoperative atrial fibrillation. It may be a viable, less invasive alternative for selected oHCM patients. Further studies, including randomized trials, are needed to assess long-term outcomes.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 138-145"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698076","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":"Flow benefits of pediatric arterial cannulae versus introducer sheaths as distal perfusion catheters in venoarterial extracorporeal membrane oxygenation","authors":"Joshua G. Crane MD ,&nbsp;Mark S. Slaughter MD ,&nbsp;Steven C. Koenig PhD ,&nbsp;Gretel Monreal PhD","doi":"10.1016/j.xjon.2025.09.023","DOIUrl":"10.1016/j.xjon.2025.09.023","url":null,"abstract":"<div><h3>Objective</h3><div>We test the hypothesis that pediatric arterial (“peds art”) cannulae as distal perfusion catheters (DPCs) for venoarterial extracorporeal membrane oxygenation provide more favorable distal limb hemodynamics than introducer sheaths.</div></div><div><h3>Methods</h3><div>Introducer sheaths (Teleflex 5, 6, 8 Fr) and peds art cannulae (Medtronic 6, 8, 10 Fr) were tested as DPCs in static and dynamic mock loops. Flow through each and flow loss caused by their intravascular obstructiveness was measured to calculate pressure gradient versus flow, intravascular obstruction flow, and resistances.</div></div><div><h3>Results</h3><div>All 3 peds art cannulae tested delivered greater flows than the 3 introducer sheaths. The 10-Fr peds art cannula provided the most flow (0.97 L/min, 1500 rpm), whereas all 3 introducer sheaths provided much lower and nearly identical flows (only 0.18-0.20 L/min, 1500 rpm) despite their different diameters. The 10-Fr peds art cannula provided the most flow at equivalent head pressures despite being the most obstructive (least amount of flow around it, 2.0 L/min) relative to no DPC (2.5 L/min), resulting in the highest cumulative flow distally.</div></div><div><h3>Conclusions</h3><div>The 10-Fr peds art cannula was the most beneficial DPC tested. All peds art cannulae tested possessed a better tradeoff of flow delivery versus intravascular obstructiveness compared to introducer sheaths, resulting in more favorable distal limb hemodynamics. The integrated stopcock with small holes (0.061′′ = 4.65 Fr) on the introducer sheath's sidearm and at the 90° sidearm's attachment to the sheath's hub increase resistance. These chokepoints of introducer sheaths prevent sufficient flow to support distal limb perfusion as DPC.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 304-311"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698154","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":"Administration of a novel reprogramming formula improves cardiac function and decreases cardiac fibrosis in a myocardial infarction model","authors":"Megumi Mathison MD, PhD,&nbsp;Saliha S. Pathan MS,&nbsp;Aliya Lackan BS,&nbsp;Jianchang Yang MD, PhD,&nbsp;Tamer M.A. Mohamed PhD,&nbsp;Todd K. Rosengart MD, MBA","doi":"10.1016/j.xjon.2025.09.019","DOIUrl":"10.1016/j.xjon.2025.09.019","url":null,"abstract":"<div><h3>Background</h3><div>The reprogramming of fibroblasts into (induced) cardiomyocytes offers a direct myocardial regeneration strategy for improving postinfarction myocardial function. Compared to lower-order species, human cells are relatively resistant to such reprogramming. We previously found that p63-transactivation inhibitory domain (TID; the portion of p63 that physical interacts and interferes with its activation of the epigenetic repressor HDAC1) combined with the cardio-differentiation factors Hand2 and Myocardin (HM) enhanced rat and human cell transdifferentiation. The present study sought to determine the in vivo effects of this reprogramming strategy in a rat myocardial infarction model.</div></div><div><h3>Methods</h3><div>Adult male and female rats underwent left anterior descending coronary artery ligation, followed 3 weeks later by direct myocardial injection of adenovectors encoding vascular endothelial growth factor (VEGF)+TID/HM, VEGF+GATA4+MEF2C+TBX5 (GMT), or green fluorescent protein (GFP) (n = 12/group). After serial echocardiography over a 4-week period, the animals were euthanized, and histologic analysis was performed.</div></div><div><h3>Results</h3><div>Animals treated with VEGF+GMT or VEGF+TID/HM demonstrated an increase in ejection fraction (EF) of 8% ± 17% and 7% ± 15%, respectively, at 4 weeks after vector administration, while EF decreased by 3% ± 7% in GFP-treated animals (<em>P</em> &lt; .05). Systolic left ventricular posterior wall thickness also was increased in the treated groups but decreased in the control group (<em>P</em> &lt; .05). Fibrosis likewise was reduced in treated animals compared with those receiving GFP (<em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>Adenoviral mediated administration of VEGF+TID/HM to the rat heart induced improvements in cardiac function and decreased fibrosis after myocardial infarction equivalent to that observed with VEGF+GMT administration. Given the efficacy of VEGF+TID/HM versus VEGF+GMT in cardio-differentiating human cells, these findings suggest the use of VEGF+TID/HM as a potential human myocardial regeneration strategy.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 250-261"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698239","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":"DPP-4 inhibitor linagliptin modulates myocardial metabolism in a model of coronary artery disease","authors":"Kelsey C. Muir MD ,&nbsp;Dwight D. Harris MD ,&nbsp;Christopher Stone MD ,&nbsp;Meghamsh Kanuparthy MD ,&nbsp;Jad Hamze BS ,&nbsp;Frank W. Sellke MD","doi":"10.1016/j.xjon.2025.09.007","DOIUrl":"10.1016/j.xjon.2025.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>Coronary artery disease (CAD) remains a leading public health concern in the United States. Dipeptidyl peptidase-4 inhibitors, such as linagliptin, have demonstrated cardioprotective effects in preclinical studies; however, their influence on myocardial metabolic changes remains incompletely characterized. Our study aimed to evaluate the effects of linagliptin, as it influences incretin hormones, on myocardial metabolism and substrate utilization in a clinically relevant model of CAD.</div></div><div><h3>Methods</h3><div>Eleven-week-old Yorkshire swine underwent placement of an ameroid constrictor to the proximal left circumflex coronary artery to induce chronic myocardial ischemia. After 2 weeks to ensure ameroid closure, swine were divided into a group that received daily oral linagliptin treatment for 5 weeks (n = 8) and a group that received no drug treatment (n = 8) for 5 weeks. After 5 weeks, the swine underwent a terminal harvest procedure and subsequent immunoblotting and proteomic analysis.</div></div><div><h3>Results</h3><div>Linagliptin was associated with reduced fatty acid oxidation on proteomic pathway analysis and decreased expression of carnitine palmitoyltransferase 1 beta (CPT1β) (<em>P</em> = .0014) and CPT1α (<em>P</em> = .02) on immunoblotting. Treatment resulted in strict regulation of glycolysis and increased expression of proteins involved in ketone metabolism and the glycerophosphate shuttle. Additionally, linagliptin enhanced protein expression of several citric acid enzymes and significantly regulated protein expression relating to oxidative stress within the ischemic myocardium.</div></div><div><h3>Conclusions</h3><div>Linagliptin shifted myocardial metabolism pointing to enhanced ketone utilization, upregulation of the TCA cycle, and reductions in free fatty acid oxidation, glycolysis, and lactate production. These findings suggest a potential cardioprotective role for linagliptin via metabolic manipulation under ischemic conditions, warranting further investigation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 262-275"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698240","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":"Thirty years of experience with full-root Ross procedure in the pediatric population—Timing matters!","authors":"Viktoria H.M. Weixler MD, PhD ,&nbsp;Alison J. Howell MD ,&nbsp;Bana Samman MSc ,&nbsp;Makaela Milton ,&nbsp;Gloria Ho MSc ,&nbsp;Kyle Runeckles MSc ,&nbsp;Mimi X. Deng MD ,&nbsp;Christoph Haller MD ,&nbsp;Rachel D. Vanderlaan MD, PhD ,&nbsp;David J. Barron MD ,&nbsp;Osami Honjo MD, PhD","doi":"10.1016/j.xjon.2025.09.043","DOIUrl":"10.1016/j.xjon.2025.09.043","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal timing of Ross procedure in pediatric patients remains unclear. We aimed to analyze how age, diagnosis, autograft support, and Konno-incision impact outcome.</div></div><div><h3>Methods</h3><div>Patients (0-18 years) undergoing primary/secondary Ross/Ross-Konno from August 1993 to November 2023 were included. Mortality, autograft replacement rate, and greater than mild autograft regurgitation were analyzed in the full cohort and subgroups (age, diagnosis, primary/secondary Ross, Ross/Ross-Konno, autograft support) using time-to-event methods. Propensity-score matching was performed to adjust for differences in baseline characteristics of patients undergoing supported/nonsupported Ross procedures.</div></div><div><h3>Results</h3><div>In total, 196 patients underwent Ross/Ross-Konno procedures (N = 117/79; 60/40%) with median age/weight of 9.4 years [interquartile range, 3.4-14.1 years]/31.7 kg [12.9-57 kg] and median follow-up of 8.8 years [1.6-14.8 years]. Twenty-year freedom from death, autograft replacement rate, and rate of greater than mild autograft regurgitation was 88.7% (95% confidence interval, 79.8%-93.8%), 13.2% (7.1%-24.7%), and 17.7% (11.3%-27.8%), respectively. Lowest 20-year freedom from death was observed among neonates/infants 47.6% (7.5%-80.8%)/58.9% (34.5%-76.8%) compared with older patients (97.6%; 90.6%-99.4%, <em>P</em> &lt; .001). In total, 83.3% of all deceased neonates/infants had associated mitral valve disease. Patients with isolated aortic valve stenosis and/or Konno-incision were at greater mortality risk (<em>P</em> = .02). 20-year autograft replacement rate was highest among adolescents (12-18 years): 30.7% (15.5-60.9), without statistical significance (<em>P</em> = .08), and greater in secondary Ross: 23.8% (11.4-49.7, <em>P</em> = .03). Matched pairs (supported vs nonsupported Ross, n = 30 each) did not show differences in primary outcomes.</div></div><div><h3>Conclusions</h3><div>The Ross procedure in pediatric patients demonstrated good long-term outcomes. Mortality risk is greater in neonates/infants and patients with isolated aortic stenosis. Adolescent patients/patients undergoing secondary Ross procedures were associated with greater autograft replacement rates.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 415-427"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698241","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 factors for early right ventricular-to-pulmonary artery conduit failure in congenital heart disease","authors":"Fawaz Naeem BA ,&nbsp;Travus J. White MD, MBA ,&nbsp;J. William Gaynor MD ,&nbsp;Xuemei Zhang MS ,&nbsp;Steve Ampah PhD ,&nbsp;Andrew C. Glatz MD, MSCE ,&nbsp;Laura Mercer-Rosa MD ,&nbsp;Meryl S. Cohen MD","doi":"10.1016/j.xjon.2025.09.051","DOIUrl":"10.1016/j.xjon.2025.09.051","url":null,"abstract":"<div><h3>Objectives</h3><div>Right ventricle-to-pulmonary artery conduits are a mainstay of treatment for patients with congenital heart defects. We investigated the association of underlying genetic abnormalities with conduit failure and hypothesized that 22q11.2 deletion syndrome was associated with shorter time to failure.</div></div><div><h3>Methods</h3><div>We conducted a single-center retrospective cohort study at the Children's Hospital of Philadelphia. Patients who underwent right ventricle-to-pulmonary artery conduit placement as part of a biventricular repair at 0 to 24 months of age between January 2010 and June 2020 were included. The primary exposure of interest was diagnosis of 22q11.2 deletion syndrome, and the outcome was time to conduit failure. The statistical analysis used cumulative incidence function with the Gray test and cause-specific Cox regression to account for competing risk.</div></div><div><h3>Results</h3><div>In total, 143 patients met inclusion criteria, of whom 65 experienced conduit failure in the study period. The median time to failure was 89 months (7.4 years). Use of pulmonary homograft was independently associated with lower risk of conduit failure (hazard ratio, 0.29; confidence interval, 0.11-0.77, <em>P</em> = .01) and small conduit size was associated with greater risk of conduit failure (hazard ratio, 3.99, confidence interval, 1.69-9.41, <em>P</em> = .002) during the first 24 months. Presence of 22q11.2 deletion syndrome, age at initial surgery, and diagnosis of truncus arteriosus were not associated with conduit failure.</div></div><div><h3>Conclusions</h3><div>Although 22q11.2 deletion syndrome and other genetic syndromes were not associated with conduit failure, conduit size and type were the most important factors associated with conduit longevity and should be taken into account when planning surgical repair.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 450-458"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698242","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":"Right ventricular adaptation in congenital heart disease: Does the type of right ventricular overload matter?","authors":"Renée S. Joosen MSc ,&nbsp;Gregor J. Krings MD, PhD ,&nbsp;Heleen B. van der Zwaan MD, PhD ,&nbsp;Nefise Karaman BSc ,&nbsp;Marco Guglielmo MD ,&nbsp;Lucas R. Celant MD ,&nbsp;Marco J.W. Götte MD, PhD ,&nbsp;Michael G. Dickinson MD, PhD ,&nbsp;Michiel Voskuil MD, PhD ,&nbsp;Marielle C. van de Veerdonk MD, PhD ,&nbsp;Johannes M.P.J. Breur MD, PhD","doi":"10.1016/j.xjon.2025.08.013","DOIUrl":"10.1016/j.xjon.2025.08.013","url":null,"abstract":"<div><h3>Background</h3><div>Right ventricular (RV) function is an independent predictor of prognosis in congenital heart disease (CHD), but RV adaptation to chronic pressure and/or volume overload is understudied. This study aimed to assess adaptation to chronic RV pressure and/or volume overload in CHD patients using pressure–volume (PV) loop analysis.</div></div><div><h3>Methods</h3><div>This retrospective study included CHD patients with a subpulmonary morphologic right ventricle and biventricular circulation who underwent right heart catheterization (RHC) and cardiac magnetic resonance (CMR) imaging within 12 months prior to RHC at the University Medical Center Utrecht between August 2013 and November 2024. RV volumes, function, pressures and wall tension were obtained. RV afterload (arterial elastance [Ea]), contractility (end-systolic elastance [Ees]), RV–pulmonary artery (PA) coupling (Ees/Ea), and diastolic stiffness (end-diastolic elastance [Eed]) were evaluated using PV loop analysis.</div></div><div><h3>Results</h3><div>Forty-five patients (67% male; median age, 14 [interquartile range, 9-17] years; 18 with pressure overload, 7 with volume overload, 20 with combined overload) were included. Pressure and combined overload led to a twofold increase in Ea, increased Ees, and increased Eed compared to volume overload (all <em>P</em> &lt; .05), while volume and combined overload increased end-diastolic volumes (<em>P</em> = .010). RV-PA coupling, wall tension, and CMR-derived mass, function, and strain were similar across groups.</div></div><div><h3>Conclusions</h3><div>Despite similar RV function on conventional imaging, PV analysis revealed distinct RV adaptation patterns for RV pressure and/or volume overload in CHD, suggesting potential for RV overload-specific treatments.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"28 ","pages":"Pages 459-468"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145698243","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}