Month: December 2024

J Cardiothorac Surg. 2024 Dec 30;19(1):690. doi: 10.1186/s13019-024-03248-y.

ABSTRACT

OBJECTIVE: Berry syndrome is a group of rare congenital cardiac malformations including aortopulmonary window (APW), aortic origin of the right pulmonary artery (AORPA), interruption of the aortic arch (IAA), patent ductus arteriosus (PDA) (supplying the descending aorta) and intact ventricular septum. This paper will analyze the clinical data of 7 patients with Berry syndrome who underwent surgical treatment in our institution and discuss the one-stage surgical correction of Berry syndrome in combination with the literature.

METHODS: From January 2013 to July 2024, a total of 7 children with Berry syndrome were admitted to the Cardiac Surgery Department of Beijing Children’s Hospital. The median age was 3 months (range, 1-36 months). All patients’ IAA morphology were type A. The APW morphology was type IIA in 2, type IIB in 4, and type III in 1 patient. Three different surgical correction techniques were used to repair the APW and AORPA, including intra-aortic patch in 2, RPA angioplasty with aortic cuff in 2, RPA detachment and reimplant in 3 patients.

RESULTS: Among the 7 patients, one died in the early postoperative period, (1/7, 14.3%). The remaining 6 surviving patients, mechanical ventilation was lasted for 51 to 166 h postoperatively, with an average of (113.3 ± 50.8) hours; the CCU stay was 6 to 23 days, with an average of (11.8 ± 6.5) days. Two cases (2/7, 28.6%) of patients adopted the strategy of delayed sternal closure. The 6 surviving children were followed up for a period ranging from 3 to 132 months, with a median follow-up duration of 36 months. During the follow-up, 2 patients underwent a second operations (2/6, 33.3%). The remaining 4 patients showed no obvious RPA stenosis, descending aorta (DAO) stenosis, aortic valve stenosis or aortic valve regurgitation (AR) during the follow-up period. In the latest follow-up, the average velocity of the RPA of the 4 patients was 1.68 ± 0.36 m/s, and the average pressure gradient was 11.9 ± 4.8 mmHg; the average velocity of the DAO was 2.1 ± 1.7 m/s, and the average pressure gradient was 17.9 ± 2.6 mmHg. All the AR were less than mild.

CONCLUSION: Most children can achieve one-stage surgical correction. For children with APW type IIA, the intra-aortic patch method can be attempted, but its therapeutic effect still requires medium to long-term follow-up. The surgical approach of RPA detachment and reimplant can be applied to all types of patients with Berry syndrome, and the medium to long-term follow-up result is favorable. For the treatment of IAA, it is recommended that end-to-side anastomosis be performed between the DAO and the aortic arch, and the anterior wall be augmented by using bovine pericardial tissue patches. For the residual obstruction at the postoperative anastomosis site, balloon dilation angioplasty can be considered. Compression of the left main bronchus can be supported by intratracheal stents.

PERSPECTIVE STATEMENT: In the English literature accessed thus far, there are less than 50 cases associated with the surgical treatment of Berry syndrome. In this work, we analyzed the clinical data of 7 patients from January 2013 to July 2024 with Berry syndrome who underwent surgical treatment in our institution and showed one-stage surgical correction can achieved acceptable outcomes.

PMID:39736764 | PMC:PMC11684305 | DOI:10.1186/s13019-024-03248-y

Ann Vasc Surg. 2025 Jan;110(Pt A):498-504. doi: 10.1016/j.avsg.2024.08.032. Epub 2024 Oct 17.

ABSTRACT

BACKGROUND: The treatment outcomes of vein and bovine pericardial patches in thromboendarterectomy (TEA) for common femoral artery (CFA) lesions in patients with peripheral arterial disease (PAD) remain unclear. The purpose of this study was to evaluate the efficacy and safety of the bovine pericardial patch by comparing it with vein patch angioplasty.

METHODS: This was a multicenter retrospective study. We reviewed the data of patients who underwent TEA with patch angioplasty (vein versus bovine pericardial patch angioplasty) for PAD between January 2018 and December 2022. Indication for revascularization is patients with PAD with claudication symptoms to rest pain and foot ulcers that interfere with daily life, with lesions in the CFA region. The primary end point was 2-year patency. The secondary end points were postoperative wound complications, including patch rupture, and safety of remote-phase puncture of the patch area after patch angioplasty.

RESULTS: Within the observation period, TEA was performed on 157 limbs in 136 patients using vein patches and on 86 limbs in 79 patients using bovine pericardial patches. The number of claudication/rest pain/tissue loss was 110/13/34 cases in the vein patch group and 57/14/15 cases in the bovine pericardial patch group, respectively. No significant differences were observed in patient characteristics. No significant between group differences were observed in operative time, blood loss, or percentage of patients who underwent concomitant revascularization during the procedure. The 2-year primary patency rates of the vein and bovine pericardial patch were 95.6% and 92.8%, respectively (P = 0.49). The rate of surgical site infection in this study was 2.5% in the vein patch group and 5.8% in the bovine pericardial patch group, respectively (P = 0.29). Rupture of the patch occurred in 4 (2.5%) and 4 (4.7%) patients in the vein and bovine pericardial patch groups, respectively (P = 0.46), and the percentage of cases requiring revision of the patch site was 7 (4.5%) and 5 (5.8%) in the vein and bovine pericardial patch groups, respectively (P = 0.76). Postoperatively, 23 patients in the vein and 13 patients in the bovine pericardial patch groups underwent patch puncture during the remote period. The median follow-up duration from the date of the surgery to the date of the puncture was 544 days and 374 days in the vein and bovine pericardial patch groups, respectively. No patch-related complications were observed during remote stage puncture.

CONCLUSIONS: Compared with vein patches, TEA with bovine pericardial patches had acceptable outcomes in terms of patency and postoperative complications.

PMID:39424177 | DOI:10.1016/j.avsg.2024.08.032

Indian J Thorac Cardiovasc Surg. 2025 Jan;41(1):35-40. doi: 10.1007/s12055-024-01769-8. Epub 2024 Jul 1.

ABSTRACT

AIM: To evaluate the short-term outcomes of Tissue Engineered Decellularized Bovine pericardium (Synkroscaff®) in congenital heart surgery as a prosthetic material.

METHODOLOGY: This is a prospective observational cohort study. SynkroScaff® was used as prosthetic material in cohort of successive patients under 18 years of age requiring cardiac surgery for congenital heart diseases. Patients were evaluated for residual shunt, infective endocarditis, stenosis, calcification and aneurysmal dilatation at discharge, after 1 month, 3 months, 6 months and 1 year post-operatively.

RESULTS: Ninety-two patients were included, and the patch was used in ventricular septal defect (VSD), closure, aortic arch reconstructions and pulmonary arterioplasty (tetralogy of Fallot repair). Four (4.3%) had transient heart block, one had complete heart block needing a permanent pacemaker. A residual shunt was present in less than 5% of the VSD patients which spontaneously closed within 12 months. One patient of VSD repair had a significant residual shunt requiring redo surgery. The intra-operative ease of handling was rated as 9/9 in 92.3% of patients. None of the patients were noticed to develop patch leaks, aneurysmal dilatation or calcification on 12-month follow-up.

CONCLUSIONS: This tissue engineered bovine pericardium is a safe and reliable prosthetic material for corrective congenital heart surgery in short-term period.

PMID:39679085 | PMC:PMC11638438 | DOI:10.1007/s12055-024-01769-8