Month: June 2026

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