Month: June 2026

Case Rep Med. 2026 Apr 20;2026:4459572. doi: 10.1155/carm/4459572. eCollection 2026.

ABSTRACT

Extracranial carotid artery aneurysms (ECAAs) are an increase of 50% or more in the diameter of the carotid artery and classified by location. They are rare and most are located in the internal carotid artery or carotid bifurcation. Diagnosis is incidental or by the presentation of a pulsatile neck mass or neurological symptoms. There are no universal recommendations regarding its treatment. Male, 72 years old, with a pulsatile cervical mass on the left. No history of previous trauma. Angioresonance and angiography identified a saccular aneurysm in the carotid bulb, measuring 1 × 0.7 cm. Referred for open surgical treatment, which was performed under general anesthesia and by longitudinal anterior cervicotomy, endoaneurysmorrhaphy, and bovine pericardium patch. There was an uneventful postoperative recovery and hospital discharge on the 3rd postoperative day. ECAAs represent between 0.4% and 1.9% of all peripheral aneurysms. They are more prevalent in men, with an average age at diagnosis of 53 ± 17 years. They can be divided into fusiform or saccular. The most common etiology of ECAA is atherosclerosis (50% of cases). ECAAs can be classified according to Attigah into Types I to V, based on the segment involved. Half of the patients with ECAAs have symptoms at diagnosis. Presentation may include a pulsatile neck mass, cervical discomfort, headache, stroke, or neurological deficits. Although rare, rupture can occur. The indication for correction of ECAAs is based on the risk of cerebral ischemia. Duplex ultrasound is the first option for diagnosis. Angiotomography, angioresonance, and angiography are options as confirmatory examinations. The techniques for repairing ECAAs are endovascular, hybrid or open: stents, embolization, or correction by arterial resection and reconstruction or patch. ECAAs are rare and have potential complications due to cerebral thromboembolism. ECAA repair is possible through open or endovascular techniques.

PMID:42023414 | PMC:PMC13095481 | DOI:10.1155/carm/4459572

Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2026;29:24-31. doi: 10.1053/j.pcsu.2026.02.004. Epub 2026 Mar 2.

ABSTRACT

The criss-cross heart with double outlet right ventricle (DORV) and combined atrioventricular (AV) and ventriculoarterial (VA) discordance presents one of the most formidable challenges in congenital cardiac surgery. The unique ventricular topology and complex inflow-outflow relationships often preclude standard approaches to biventricular repair, and single-ventricle palliation is frequently selected. However, in appropriately selected patients, anatomical repair through a double switch procedure may offer superior long-term outcomes by preserving systemic ventricular function. This report describes a surgical strategy for addressing a criss-cross heart with DORV and AV/VA discordance using a modified Senning procedure as part of a double switch operation. Preoperative imaging-including transthoracic echocardiography, computed tomography angiography, and cardiac catheterization-is critical for assessing operability. Particular attention must be paid to pulmonary vascular resistance, Qp/Qs, morphologic left ventricular end-diastolic pressure, and coronary anatomy. The surgical technique involves ventricular septal defect baffle closure to direct left ventricular output to the pulmonary artery, an arterial switch operation, and a modified Senning atrial switch. The Senning component is performed using a pedicled autologous pericardial baffle augmented with a large bovine pericardial patch to prevent pulmonary venous pathway narrowing, a frequent concern in patients with criss-cross anatomy. This approach allows for biventricular repair even in cases with severe atrial and ventricular malalignment. The technique aims to achieve unobstructed systemic and pulmonary venous pathways, minimize arrhythmia risk, and establish long-term left ventricular systemic circulation. Careful patient selection and meticulous surgical execution are essential for optimizing outcomes in this complex subgroup of congenital heart disease.

PMID:42091300 | DOI:10.1053/j.pcsu.2026.02.004

J Biomater Sci Polym Ed. 2026 Apr 22:1-32. doi: 10.1080/09205063.2026.2659100. Online ahead of print.

ABSTRACT

Decellularized bovine and porcine pericardia are the most extensively used biological substitutes in clinical settings as self-regenerating replacements for treating cardiovascular anomalies. Despite advancements, these substitutes undergo early deterioration and degeneration if not crosslinked. The chemical crosslinking of these scaffolds, aimed at addressing their weak mechanical strength, hinders their long-term performance and regenerative efficacy. The present method describes the systematic evaluation of an alkaline-catalyzed, low-temperature mediated citric acid crosslinking strategy to incorporate silk fibroin (SF) for enhancing the biomechanical properties and stability of decellularized porcine pericardia (DPP) . Decellularization was performed using the tridecyl alcohol (ATE) method. Silk fibroin reinforced porcine pericardium (SFDPP) was systematically analyzed for successful incorporation of SF using histology, Confocal Raman microscopy, and SEM. Thermal analysis, biomechanical properties, suturability, and resistance to collagenase degradation has demonstrated increased strength and durability. In vitro cytocompatibility and toxicological studies further confirmed that SFDPP is biocompatible and non-toxic, making it suitable for cardiovascular applications. Rat subcutaneous implantation has proven SFDPP to be associated with significantly reduced inflammation and mineralization compared to the commercially available SJM Biocor pericardial patch. Results from rat abdominal wall defect and pig aortic vascular defect models demonstrated that SFDPP patch promoted structural restoration by site-appropriate constructive remodelling in both the defects. All these evidences confirmed its efficacy as a potential patch for treating cardiovascular defects.

PMID:42017470 | DOI:10.1080/09205063.2026.2659100

Acta Ophthalmol. 2026 Apr 16. doi: 10.1111/aos.70140. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the efficacy of tendon elongation using bovine pericardium (Tutopatch®) in complex strabismus surgeries, with a specific focus on longer follow-up of postoperative outcomes and patient satisfaction.

METHODS: In this pre-post cohort study, the records of all patients who underwent tendon elongation strabismus surgery with Tutopatch® at Radboudumc and Amsterdam UMC were retrospectively reviewed. Eligible patients were invited for a single prospective follow-up visit to assess long-term outcomes. Strabismus angle (success defined as ≤5.71° of orthotropia) and duction limitations (converted to a pseudo-quantitative scale ranging from 0 to 5) were evaluated preoperatively, 1 week postoperatively, 3 months postoperatively and at longer intervals where possible. Patient satisfaction was measured on a Visual Analogue Scale at the prospective follow-up.

RESULTS: Sixty-nine participants (mean age 41.3 ± 18.4 years) were included. Fifty-one patients had childhood onset and eighteen patients had acquired onset of strabismus. Tutopatch® was predominantly used to correct the horizontal deviation. Long-term follow-up data (>17.4 weeks) were available for 49 patients (71%), with a median follow-up of 124 weeks (range 19.9-431 weeks) and surgical success was achieved in 73% (near) and 60% (distance). Duction limitations significantly increased postoperatively, especially in exodeviations, but improved over time and seemed to have minimal impact on ocular alignment in primary position. Patient satisfaction was very high (median VAS 9.0), with only weak-to-moderate correlation with ocular alignment.

CONCLUSION: Tutopatch® is a viable surgical option for tendon elongation in complex strabismus cases with favorable long-term ocular alignment, mild duction limitation and high patient satisfaction.

PMID:41989268 | DOI:10.1111/aos.70140

Acta Ophthalmol. 2026 Apr 16. doi: 10.1111/aos.70140. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the efficacy of tendon elongation using bovine pericardium (Tutopatch®) in complex strabismus surgeries, with a specific focus on longer follow-up of postoperative outcomes and patient satisfaction.

METHODS: In this pre-post cohort study, the records of all patients who underwent tendon elongation strabismus surgery with Tutopatch® at Radboudumc and Amsterdam UMC were retrospectively reviewed. Eligible patients were invited for a single prospective follow-up visit to assess long-term outcomes. Strabismus angle (success defined as ≤5.71° of orthotropia) and duction limitations (converted to a pseudo-quantitative scale ranging from 0 to 5) were evaluated preoperatively, 1 week postoperatively, 3 months postoperatively and at longer intervals where possible. Patient satisfaction was measured on a Visual Analogue Scale at the prospective follow-up.

RESULTS: Sixty-nine participants (mean age 41.3 ± 18.4 years) were included. Fifty-one patients had childhood onset and eighteen patients had acquired onset of strabismus. Tutopatch® was predominantly used to correct the horizontal deviation. Long-term follow-up data (>17.4 weeks) were available for 49 patients (71%), with a median follow-up of 124 weeks (range 19.9-431 weeks) and surgical success was achieved in 73% (near) and 60% (distance). Duction limitations significantly increased postoperatively, especially in exodeviations, but improved over time and seemed to have minimal impact on ocular alignment in primary position. Patient satisfaction was very high (median VAS 9.0), with only weak-to-moderate correlation with ocular alignment.

CONCLUSION: Tutopatch® is a viable surgical option for tendon elongation in complex strabismus cases with favorable long-term ocular alignment, mild duction limitation and high patient satisfaction.

PMID:41989268 | DOI:10.1111/aos.70140

Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2026;29:24-31. doi: 10.1053/j.pcsu.2026.02.004. Epub 2026 Mar 2.

ABSTRACT

The criss-cross heart with double outlet right ventricle (DORV) and combined atrioventricular (AV) and ventriculoarterial (VA) discordance presents one of the most formidable challenges in congenital cardiac surgery. The unique ventricular topology and complex inflow-outflow relationships often preclude standard approaches to biventricular repair, and single-ventricle palliation is frequently selected. However, in appropriately selected patients, anatomical repair through a double switch procedure may offer superior long-term outcomes by preserving systemic ventricular function. This report describes a surgical strategy for addressing a criss-cross heart with DORV and AV/VA discordance using a modified Senning procedure as part of a double switch operation. Preoperative imaging-including transthoracic echocardiography, computed tomography angiography, and cardiac catheterization-is critical for assessing operability. Particular attention must be paid to pulmonary vascular resistance, Qp/Qs, morphologic left ventricular end-diastolic pressure, and coronary anatomy. The surgical technique involves ventricular septal defect baffle closure to direct left ventricular output to the pulmonary artery, an arterial switch operation, and a modified Senning atrial switch. The Senning component is performed using a pedicled autologous pericardial baffle augmented with a large bovine pericardial patch to prevent pulmonary venous pathway narrowing, a frequent concern in patients with criss-cross anatomy. This approach allows for biventricular repair even in cases with severe atrial and ventricular malalignment. The technique aims to achieve unobstructed systemic and pulmonary venous pathways, minimize arrhythmia risk, and establish long-term left ventricular systemic circulation. Careful patient selection and meticulous surgical execution are essential for optimizing outcomes in this complex subgroup of congenital heart disease.

PMID:42091300 | DOI:10.1053/j.pcsu.2026.02.004

Surg Endosc. 2026 Jun;40(6):5437-5446. doi: 10.1007/s00464-026-12830-5. Epub 2026 May 4.

ABSTRACT

BACKGROUND: In pancreatic cancer surgery, portomesenteric vein involvement can limit resectability and local tumor control, adversely affecting prognosis. While vascular reconstruction with bovine pericardium is established in open procedures, its feasibility in robot-assisted surgery remains underreported. This study evaluates the technical feasibility of portomesenteric venous reconstruction using bovine pericardium in robotic pancreatic resections.

METHODS: We retrospectively analyzed patients who underwent portomesenteric vein reconstruction with bovine pericardial patches or self-fashioned tube grafts during robotic pancreatic resections at a certified pancreatic center between July 2024 and December 2025. Feasibility and technical success were assessed based on intraoperative outcomes, postoperative complications, and graft patency. Patency was evaluated on contrast-enhanced computed tomography (CT) performed during routine oncological follow-up or when clinically indicated.

RESULTS: Ten patients underwent robotic pancreatic resection (4 pancreaticoduodenectomies, 6 total pancreatectomies with splenectomy), with portal vein reconstruction in all (10/10) and superior mesenteric vein reconstruction in 5/10. Four patches (4/10) and 6 (6/10) tube grafts, including one T-shaped graft with splenic vein implantation were used. Two patients also underwent arterial reconstruction or transposition. All grafts were patent on latest follow-up CT (19-364 days, median 52). Four patients experienced serious complications (Clavien-Dindo II:1, IIIb:3, V:1). Delayed gastric emptying (DGE) occurred in 4/10 and postoperative pancreatic fistula (POPF) in 1/10; all resolved without intervention.

CONCLUSION: Robotic portomesenteric vein reconstruction using bovine pericardial grafts is technically feasible and appears safe in the short term during pancreatectomy. The Da Vinci system enabled precise vascular control and suturing in a confined operative field. Bovine pericardium proved to be a viable graft material with no intraoperative complications or early graft failure. These preliminary results support the use of robotic techniques in complex vascular pancreatic surgery, but long-term outcomes require further evaluation in larger studies.

PMID:42257970 | DOI:10.1007/s00464-026-12830-5

Front Oncol. 2026 Mar 30;16:1790677. doi: 10.3389/fonc.2026.1790677. eCollection 2026.

ABSTRACT

BACKGROUND: Thoracoscopic wedge resection has become a standard procedure for pulmonary nodule management, yet postoperative air leak (PAL) remains a prevalent complication. While bovine pericardial patches are established in cardiovascular surgery, their utility in pulmonary resection merits further investigation. This study aimed to assess the efficacy of bovine pericardial patches in reducing PAL after thoracoscopic wedge resection and develop a predictive model for clinical utility.

METHODS: In this single-center retrospective study (2015-2020), we analyzed 2006 thoracoscopic wedge resections at Fujian Medical University Union Hospital, comparing 319 patch-treated cases with 1,687 controls. Primary outcomes included PAL incidence; while secondary outcomes encompassed drainage duration. Univariate and multivariate logistic regression analyses identified risk factors for PAL, and a nomogram was constructed to predict PAL risk.

RESULTS: Baseline characteristics were well-balanced between groups. The bovine pericardial patch group showed a significantly lower PAL incidence (2.8% vs. 13.2%, P < 0.001) and shorter chest tube drainage duration (2.85 ± 1.27 days vs. 3.06 ± 1.67 days, P = 0.033). Multivariate analysis confirmed the bovine pericardium patch as an independent protective factor against PAL (OR: 0.170; 95% CI: 0.079-0.322; P < 0.001). The nomogram incorporating these factors showed good discriminative ability (AUC = 0.739) and clinical utility in decision curve analysis.

CONCLUSION: Bovine pericardial patch application significantly reduces PAL incidence and shortens chest tube drainage duration after thoracoscopic wedge resection. The predictive nomogram helps identify high-risk patients who would benefit most from this intervention, supporting its use as a cost-effective adjunct in pulmonary surgery.

PMID:41982237 | PMC:PMC13070817 | DOI:10.3389/fonc.2026.1790677

JTCVS Open. 2025 Dec 15;29:101558. doi: 10.1016/j.xjon.2025.101558. eCollection 2026 Feb.

ABSTRACT

OBJECTIVE: This study aimed to analyze how varying glutaraldehyde fixation of porcine pericardium impacts the biomechanics of aortic valve neocuspidization (ie, Ozaki procedure).

METHODS: Four bovine aortic roots were mounted in a 3-dimensional printed left heart simulator. Leaflets were tanned for 2, 6, and 10 minutes in 0.625% glutaraldehyde and used to create the Ozaki models in the same aortic root. Three models were biomechanically compared with a native aortic control valve. Hemodynamics, high-speed videography, and echocardiography data were collected. The flexibility and strength of each pericardium were tested using tensile strength.

RESULTS: Tensile stress and strain were best at 10-minute tanning. As neo-leaflet tanning duration increased from 2 to 10 minutes, the transvalvular pressure gradient decreased by 38.0% (13.7 ± 4.0 mm Hg vs 8.5 ± 4.8 mm Hg, P < .0001). Ozaki models had smaller orifices than native valves (2.0 ± 0.6 cm² vs 1.3 ± 0.2 cm², 1.4 ± 0.3 cm², and 1.5 ± 0.1 cm² for 2, 6, and 10 minutes: P = .0003, P < .002 for 2 and 10 minutes). When tanning time extended from 2 to 10 minutes, valve regurgitation decreased by 31.1% (18.0% vs 12.4%, P < .001). The average valve opening and closing leaflet velocities increased by 38.6% and 22.5% from 2 to 10 minutes of tanning (298.7 vs 486.1 mm/s, P = .048; 188.1 vs 242.7 mm/s, P = .14), respectively.

CONCLUSIONS: Porcine pericardium tanned in glutaraldehyde for 10 minutes resulted in the lowest valve regurgitation, lowest pressure gradient, and highest leaflet velocities in ex vivo simulation. These observations can be used to optimize valve function and enhance aortic valve reconstruction techniques.

PMID:41960121 | PMC:PMC13059995 | DOI:10.1016/j.xjon.2025.101558

JTCVS Open. 2025 Dec 15;29:101558. doi: 10.1016/j.xjon.2025.101558. eCollection 2026 Feb.

ABSTRACT

OBJECTIVE: This study aimed to analyze how varying glutaraldehyde fixation of porcine pericardium impacts the biomechanics of aortic valve neocuspidization (ie, Ozaki procedure).

METHODS: Four bovine aortic roots were mounted in a 3-dimensional printed left heart simulator. Leaflets were tanned for 2, 6, and 10 minutes in 0.625% glutaraldehyde and used to create the Ozaki models in the same aortic root. Three models were biomechanically compared with a native aortic control valve. Hemodynamics, high-speed videography, and echocardiography data were collected. The flexibility and strength of each pericardium were tested using tensile strength.

RESULTS: Tensile stress and strain were best at 10-minute tanning. As neo-leaflet tanning duration increased from 2 to 10 minutes, the transvalvular pressure gradient decreased by 38.0% (13.7 ± 4.0 mm Hg vs 8.5 ± 4.8 mm Hg, P < .0001). Ozaki models had smaller orifices than native valves (2.0 ± 0.6 cm² vs 1.3 ± 0.2 cm², 1.4 ± 0.3 cm², and 1.5 ± 0.1 cm² for 2, 6, and 10 minutes: P = .0003, P < .002 for 2 and 10 minutes). When tanning time extended from 2 to 10 minutes, valve regurgitation decreased by 31.1% (18.0% vs 12.4%, P < .001). The average valve opening and closing leaflet velocities increased by 38.6% and 22.5% from 2 to 10 minutes of tanning (298.7 vs 486.1 mm/s, P = .048; 188.1 vs 242.7 mm/s, P = .14), respectively.

CONCLUSIONS: Porcine pericardium tanned in glutaraldehyde for 10 minutes resulted in the lowest valve regurgitation, lowest pressure gradient, and highest leaflet velocities in ex vivo simulation. These observations can be used to optimize valve function and enhance aortic valve reconstruction techniques.

PMID:41960121 | PMC:PMC13059995 | DOI:10.1016/j.xjon.2025.101558