Month: June 2026

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

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 19;29:101566. doi: 10.1016/j.xjon.2025.101566. eCollection 2026 Feb.

ABSTRACT

OBJECTIVE: We sought to investigate the midterm outcomes of combined aortic and mitral valve replacement with aortomitral curtain patch reconstruction (the Commando operation).

METHODS: A single-center, retrospective review of all patients who underwent the Commando operation from January 2007 to July 2024 was performed. Outcomes included operative death or major postoperative morbidity, postdischarge (late) death, and late reintervention. Explanatory variables included primary indication for the Commando approach and patch material, among others. Associations were evaluated using logistic, Cox, or competing risk regression, adjusting for baseline patient risk and operative complexity.

RESULTS: Of 71 patients meeting entry criteria, 41 (57.8%) received glutaraldehyde-preserved bovine pericardium (GPBP) or autologous pericardium (AP); the remainder received decellularized bovine pericardium (DBP). There were 4 (5.6%) operative deaths and 15 (21.1%) cases of operative death or major postoperative morbidity. Of the 67 operative survivors, there were 18 (26.9%) deaths and 14 (20.9%) reinterventions at a median follow-up of 2.2 years (range, 0.1-12.7 years). Patch material was not associated with late death. On multivariable analysis, DBP conferred an increased risk of reintervention (subdistribution hazard ratio, 9.5; 95% confidence interval, 1.2-75.8, P = .03) versus GPBP/AP. Of the 14 reinterventions, 12 (85.7%) were performed for aorto-left atrial fistula (aortomitral curtain re-repair in 3 [25.0%] patients, redo-Commando operation in 4 [33.3%] patients, and transcatheter fistula occlusion in 5 [41.7%] patients). Use of DBP was independently associated with a greater risk of reintervention for aorto-left atrial fistula (subdistribution hazard ratio, 11.8; 95% confidence interval, 1.6-87.7, P = .02), compared to use of GPBP/AP.

CONCLUSIONS: Patch material influences reintervention risk following the Commando operation.

PMID:41960090 | PMC:PMC13059984 | DOI:10.1016/j.xjon.2025.101566

Surg Case Rep. 2026;12(1):26-0056. doi: 10.70352/scrj.cr.26-0056. Epub 2026 Apr 16.

ABSTRACT

INTRODUCTION: Cardiac paragangliomas are exceptionally rare and often functional tumors that frequently arise near the aortic root and proximal coronary arteries. Complete excision is the only potentially curative treatment, but lesions adjacent to the left main coronary trunk (LMT) pose a major surgical dilemma: achieving oncologic radicality while preserving coronary perfusion and controlling massive bleeding.

CASE PRESENTATION: A 33-year-old man presented with episodic postprandial chest/abdominal pain, paroxysmal hypertension, and cold sweating. Imaging revealed a hypervascular cardiac mass located between the ascending aorta and main pulmonary artery, extending to the left atrial roof; coronary angiography demonstrated tumor-feeding branches from the left anterior descending artery (LAD) and right coronary artery. After preoperative α-adrenergic blockade with doxazosin, surgery was performed via median sternotomy with cardiopulmonary bypass (CPB). Given the tumor’s proximity to the LMT and the anticipated risk of compromised coronary perfusion to achieve macroscopic complete resection, planned coronary artery bypass grafting was performed before tumor excision. Under cardioplegic arrest, both the ascending aorta and main pulmonary artery were transected for exposure. The LMT and LAD were preserved, whereas the left circumflex artery coursed through the tumor and was sacrificed. En bloc resection including part of the left atrial roof was required, followed by bovine pericardial patch reconstruction. Diffuse massive bleeding from the left atrial patch suture line and the dissection surface required a second CPB run for hemostasis, and recurrent ventricular tachycardia/fibrillation after weaning from CPB necessitated temporary rescue peripheral veno-arterial extracorporeal membrane oxygenation, which was weaned off on POD3. Postoperative catecholamine levels normalized, and ¹²³I-metaiodobenzylguanidine scintigraphy demonstrated no abnormal uptake at the cardiac operative site, consistent with complete resection.

CONCLUSIONS: For functional cardiac paragangliomas adjacent to the LMT, integrating planned revascularization before tumor manipulation can provide a myocardial “safety net” that enables oncologically oriented en bloc resection when coronary sacrifice becomes unavoidable. This operation carries an exceptionally high risk of massive bleeding; therefore, meticulous hemostatic planning and preparedness-including a low threshold for prompt re-institution of CPB-may be crucial for the safe completion of radical resection.

PMID:42016547 | PMC:PMC13092383 | DOI:10.70352/scrj.cr.26-0056