Pontailler M, Bernheim S, Pavy C
… +10 more, Moreau De Bellaing A, Belhadjer Z, Milani G, Méot M, Auriau J, Garcelon N, Vouhé P, Bonnet D, Houyel L, Raisky O
OBJECTIVES: To describe the mitral valve (MV) anomalies found in patients with transposition of the great arteries (TGA), the surgical procedures performed and the fate of the abnormal MV. METHODS: From 1990 to 2020, 52...OBJECTIVES: To describe the mitral valve (MV) anomalies found in patients with transposition of the great arteries (TGA), the surgical procedures performed and the fate of the abnormal MV. METHODS: From 1990 to 2020, 52 patients out of 1590 TGA {S, D, D} patients (3.3%) undergoing biventricular repair were identified with abnormal MV. Anomalies were a mitral cleft (n = 46 (88%), ejection/outflow tract in 40 and as AVSD-type in 6) and/or anomalies of the subvalvular apparatus (60%). A ventricular septal defect was present in 88.5% and pulmonary stenosis in 17.3%. RESULTS: The main surgical procedure was an arterial switch operation (90.4%). Overall survival was 92.3% at 1 year and 88,3% at 20 years with a mean follow-up of 11.2 years. Ten patients (19.2%) had a concomitant mitral procedure at initial surgery: cleft/indentation closure alone in 4, isolated subvalvular/annuloplasty repair in 1, and combined cleft closure plus subvalvular procedures in 5; 4 had a preoperative grade ≥2 mitral regurgitation (MR). None of these patients have required subsequent MV surgery during follow-up. Another six patients required late MV surgery for MR (n = 4) and/or for left ventricular outflow tract obstruction (LVOTO) due to accessory MV material or a narrowed subaortic pathway. None had undergone a mitral procedure at initial repair. All six underwent cleft closure, with LVOTO relief in 3 (abnormal chordae attachments resection in 2 and fibromuscular stenosis without MV subvalvular apparatus' anomalies in 1). One patient required redo MV surgery for MV replacement. Freedom from late MV surgery in the overall cohort was 97,9% at 1 year, 93.7% at 5 years, and 82.8% at 20 years. CONCLUSIONS: The most frequent MV anomalies in TGA are anterior clefts and subvalvular abnormalities. Mortality and reoperation rates are much higher than in the other subtypes of TGA. Mitral repair at initial surgery should be considered only in cases of significant regurgitation or obstruction due to subvalvular apparatus' anomalies. Late MV procedure, for a limited proportion of patients, involves cleft closure and LVOTO relief.
Onodera K, Aokage K, Saji H
… +19 more, Wakabayashi M, Endo M, Tsutani Y, Nakagawa K, Shimada Y, Isaka T, Isaka M, Nakajima R, Hattori A, Maniwa T, Mimae T, Miyoshi T, Yoshioka H, Yotsukura M, Mitome N, Uozumi T, Fukuda H, Watanabe SI, Suzuki K
Eur J Cardiothorac Surg
· 2026 Jun · PMID 42341065
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OBJECTIVE: Quantify inter-operator variation in referred coronary artery bypass grafting (CABG) following angiography and evaluate associations with practice patterns and long-term outcomes. METHODS: Observational study...OBJECTIVE: Quantify inter-operator variation in referred coronary artery bypass grafting (CABG) following angiography and evaluate associations with practice patterns and long-term outcomes. METHODS: Observational study using administrative health data in British Columbia, Canada (2010-2024). Interventional cardiologist level CABG Rate was defined as the proportion of referred CABGs to total angiograms performed. Variation across Interventionalists was correlated with other practice characteristics. Among patients undergoing angiography followed by revascularization, associations between operator CABG Rate and all-cause mortality, major adverse cardiovascular events (MACE), and repeat revascularization were evaluated using hierarchical Cox regression. RESULTS: Among 252,408 angiograms by 40 Interventionalists, CABG Rate varied 13-fold (2.03%-26.4%) and was not explained by hospital-level factors alone (ICC: 0.358; 95% CI: 0.054-0.621). Higher CABG Rates were associated with lower percutaneous coronary intervention (PCI) utilization (R=-0.60;P<.001), lower PCI extensiveness (R=-0.52;P<.001), and lower procedural volume (R=-0.36;P=.022). In 73,603 first-time revascularized patients, CABG Rate was associated with reduced repeat revascularization (HR = 0.075;P<.001), without differences in mortality or MACE. CONCLUSIONS: Referred CABG varies markedly between Interventionalists and reflects operator practice style. Higher CABG utilization is associated with more durable revascularization without impact on survival or MACE. Broader implementation of multidisciplinary Heart Teams may improve consistency of care.
Govers PJ, Kawczynski MJ, Heuts S
… +13 more, Veen KM, de Kerchove L, Lansac E, Demers P, Verbrugghe P, Rudez I, Laubriet A, Vojacek J, Bidar E, Takkenberg J, Kluin J, Arabkhani B, Aortic Valve Research Network Investigators
Eur J Cardiothorac Surg
· 2026 Jun · PMID 42178209
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OBJECTIVES: Valve-sparing aortic root replacement (VSARR) is technically demanding and may vary in institutional procedural volumes, rendering the establishment of thresholds for centres of expertise challenging. This st...OBJECTIVES: Valve-sparing aortic root replacement (VSARR) is technically demanding and may vary in institutional procedural volumes, rendering the establishment of thresholds for centres of expertise challenging. This study aims to identify an annual case volume that could define a high-volume centre for VSARR using data from the Heart Valve Society Aortic Valve (HVS AV) database. METHODS: All consecutive elective patients undergoing VSARR within the HVS AV database were included. The primary early outcome was a composite of mortality, thromboembolic events, reinterventions, intraoperative conversions, and recurrent aortic regurgitation grade ≥2 within 30 days. The primary long-term outcome was freedom from AV reintervention. Volume-outcome (V-O) associations were modelled using restricted cubic splines; the high-volume threshold was derived using the elbow method. Analyses were adjusted for EuroSCORE II. RESULTS: In total, 2668 patients from 37 centres were included. Annual volume was not significantly associated with the early composite outcome (P = .8003). However, a significant non-linear V-O association was found for long-term AV reintervention-free survival (P = .0023), with improved outcomes at centres performing ≥12 cases per year (95% CI, 10-12). These results were consistent in sensitivity analyses (P < .0001). CONCLUSIONS: An annual institutional volume of ≥12 VSARRs is associated with improved long-term valve durability and survival, while early postoperative outcomes appear less sensitive to annual case load given their low event rates. This high-volume threshold may serve as a benchmark for centres already experienced in AV and/or root surgery and guide quality improvement efforts.
OBJECTIVES: Thoracoscopy is the gold standard for paediatric lung surgery. However, in patients with prior infections or inflammatory lung disease, conversion rate to open surgery remains high. Optimized technical skills...OBJECTIVES: Thoracoscopy is the gold standard for paediatric lung surgery. However, in patients with prior infections or inflammatory lung disease, conversion rate to open surgery remains high. Optimized technical skills with robotic-assisted thoracic surgery (RATS) may offer technical advantages in complex cases. METHODS: This retrospective multicentre study assessed safety and outcomes of RATS for anatomical lung resection in paediatric patients. We retrospectively collected data from all the French university hospital using robotic platform for lung surgery between 2016 and 2024. The procedures were conducted in collaboration with robotic adult thoracic surgeons. RESULTS: During the study period, 687 lung resections were performed in the 3 participating centres. Among them, 30 underwent RATS lung resection, with a median age of 10 years [8.3-13.0] and a median weight of 32.5 kilograms (kg) [27.3-48.8]. No intraoperative complications or conversions to thoracotomy occurred. The overall postoperative complication rate was 33%, consisting mostly of minor air leaks and pleural effusions that resolved spontaneously. Severe complications (Clavien-Dindo ≥ III) occurred in 10% of cases. Median hospital stay was 5 days. Despite a predominance of chronic inflammatory lung disease and previous infections (conditions typically associated with higher morbidity), the robotic approach maintained acceptable outcomes. Within those patients, 3 bronchial sleeves were successfully performed. CONCLUSIONS: Robotic-assisted thoracic surgery appears to be a feasible and safe alternative to thoracotomy for paediatric lung resection especially for complex cases. Its enhanced dexterity and 3-dimensional visualization facilitate complex dissections and suturing, particularly in inflammatory conditions. The rarity of indications and the limited operative workspace in this population remain challenges, encouraging collaboration with high-volume adult robotic thoracic surgeons.
OBJECTIVES: Arrhythmic mitral valve prolapse (AMVP) is associated with malignant ventricular arrhythmias, yet the impact of surgical repair versus transcatheter edge-to-edge repair (TEER) on arrhythmic outcomes remains u...OBJECTIVES: Arrhythmic mitral valve prolapse (AMVP) is associated with malignant ventricular arrhythmias, yet the impact of surgical repair versus transcatheter edge-to-edge repair (TEER) on arrhythmic outcomes remains unclear. We evaluated ventricular arrhythmia occurrence and premature ventricular contraction (PVC) burden following mitral repair in patients with and without AMVP. METHODS: We conducted a retrospective cohort study of 1911 patients who underwent surgical mitral valve repair or TEER between 2004 and 2024 at a single institution. AMVP was defined per EHRA/ESC criteria, requiring mitral valve prolapse with frequent (≥5% PVC burden) or complex ventricular arrhythmias and no alternative arrhythmic substrate. Outcomes included non-sustained ventricular tachycardia (NSVT), ventricular tachycardia (VT), implantable cardioverter-defibrillator (ICD) implantation, mortality, and changes in PVC burden in patients with pre- and post-procedural rhythm monitoring. RESULTS: Among 154 patients with AMVP, 109 (71%) underwent surgical repair and 45 (29%) underwent TEER. Following surgical repair, patients with AMVP had similar rates of NSVT (18% vs 13%), VT (3.7% vs 3.6%), and ICD implantation (3.7% vs 3.7%) compared with non-AMVP patients. In contrast, after TEER, patients with AMVP experienced significantly higher NSVT (33% vs 7%, P < 0.01), VT (12% vs 2.6%, P = 0.01), and ICD implantation (4.7% vs 0%, P = 0.02). PVC burden decreased after surgical repair (1.1% to 0.5%, P < 0.001) but remained unchanged after TEER. Mortality was higher in AMVP but not statistically significant. CONCLUSIONS: Surgical mitral repair is associated with reduced arrhythmic burden in AMVP, whereas TEER is associated with persistently elevated ventricular arrhythmias. These findings support phenotype-guided repair strategies and underscore the need for prospective studies comparing arrhythmic outcomes across repair modalities.