Category: General

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

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):25-0728. doi: 10.70352/scrj.cr.25-0728. Epub 2026 Apr 1.

ABSTRACT

INTRODUCTION: Posterobasal ventricular septal rupture (P-VSR) developed after acute myocardial infarction (AMI) is often associated with right ventricular infarction and carries a high surgical mortality. The coexistence of tricuspid regurgitation (TR) further aggravates right ventricular dysfunction and right heart failure. Therefore, surgical repair of P-VSR complicated by right ventricular infarction and severe TR is particularly challenging.

CASE PRESENTATION: A 75-year-old woman developed acute inferior myocardial infarction complicated by right ventricular infarction. A coronary stent was deployed for right coronary artery occlusion. On day 16 after the onset of AMI, transthoracic echocardiography revealed a P-VSR and severe TR, and she was transferred to our institution for surgical management. Through a right atrial approach, excellent visualization of the P-VSR was obtained. The septal defect was closed securely using two bovine pericardial patches placed on both the right and left ventricular sides of the ventricular septum. Tricuspid valve replacement (TVR) was also performed. Postoperative echocardiography confirmed complete closure of the defect without residual shunt.

CONCLUSIONS: In the surgical treatment of P-VSR complicated by severe TR, a right atrial approach may provide adequate exposure of the septal defect while potentially minimizing additional ventricular injury. In selected patients with severe TR in a similar anatomical and clinical context, concomitant TVR may represent a feasible surgical option.

PMID:41940043 | PMC:PMC13044581 | DOI:10.70352/scrj.cr.25-0728

Ann Surg Oncol. 2026 Apr 3. doi: 10.1245/s10434-026-19618-w. Online ahead of print.

ABSTRACT

BACKGROUND: Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent.

METHODS: We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC.

RESULTS: Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0).

CONCLUSIONS: To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.

PMID:41933245 | DOI:10.1245/s10434-026-19618-w

Ann Surg Oncol. 2026 Apr 3. doi: 10.1245/s10434-026-19618-w. Online ahead of print.

ABSTRACT

BACKGROUND: Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent.

METHODS: We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC.

RESULTS: Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0).

CONCLUSIONS: To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.

PMID:41933245 | DOI:10.1245/s10434-026-19618-w

Int J Biol Macromol. 2026 May 14;367:152551. doi: 10.1016/j.ijbiomac.2026.152551. Online ahead of print.

ABSTRACT

The longevity and applicability of glutaraldehyde cross-linked commercial bioprosthetic heart valves (BHVs) that are the first choice for the transcatheter heart valve replacement (THVR) remain limited due to thrombus accumulation, calcification, inflammatory reactions and poor endothelialization. In this study, we first performed the prefunctionalization treatment of dual crosslinking by carboxymethylated λ-carrageenan and 4-pentenoic acid on decellularized bovine pericardium; subsequently, we conducted a post-functionalization treatment by dual modification of immobilizing the cyclodextrin (CD)/rutin and organic selenium onto above-mentioned doubly cross-linked (DC) bovine pericardium through the amidation reaction; finally, we obtained the anticipated bioprosthetic heart valve with multiple functions (DC + CD/Rutin+Se-BP). Uniaxial tensile tests demonstrated that this doubly cross-linked BHV exhibited superior mechanical properties compared with glutaraldehyde-treated bovine pericardium, which is expected to increase its structural stability and service life. By introducing the CD/Rutin complex and organic selenium, DC + CD/Rutin+Se-BP not only exhibited the ability to inhibit the adsorption of plasma proteins, platelet aggregation and thrombosis but also presented the excellent anti-inflammatory and anti-calcification characteristics both in vitro and in vivo. Furthermore, DC + CD/Rutin+Se-BP also exhibited stable in situ nitric oxide (NO) catalytic release ability due to the immobilization of organic selenium, which endowed bioprosthetic heart valve with excellent compatibility with human umbilical vein endothelial cells (HUVECs) and facilitated the long-term promotion of its endothelialization process. In summary, this approach combining dual cross-linking and dual modification provides a promising strategy for future design of BHVs, and DC + CD/Rutin+Se-BP exhibits a bright prospect in the clinical applications of BHVs.

PMID:42140293 | DOI:10.1016/j.ijbiomac.2026.152551

Ann Surg Oncol. 2026 Apr 3. doi: 10.1245/s10434-026-19618-w. Online ahead of print.

ABSTRACT

BACKGROUND: Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent.

METHODS: We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC.

RESULTS: Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0).

CONCLUSIONS: To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.

PMID:41933245 | DOI:10.1245/s10434-026-19618-w

Int J Biol Macromol. 2026 May 14:152551. doi: 10.1016/j.ijbiomac.2026.152551. Online ahead of print.

ABSTRACT

The longevity and applicability of glutaraldehyde cross-linked commercial bioprosthetic heart valves (BHVs) that are the first choice for the transcatheter heart valve replacement (THVR) remain limited due to thrombus accumulation, calcification, inflammatory reactions and poor endothelialization. In this study, we first performed the prefunctionalization treatment of dual crosslinking by carboxymethylated λ-carrageenan and 4-pentenoic acid on decellularized bovine pericardium; subsequently, we conducted a post-functionalization treatment by dual modification of immobilizing the cyclodextrin (CD)/rutin and organic selenium onto above-mentioned doubly cross-linked (DC) bovine pericardium through the amidation reaction; finally, we obtained the anticipated bioprosthetic heart valve with multiple functions (DC + CD/Rutin+Se-BP). Uniaxial tensile tests demonstrated that this doubly cross-linked BHV exhibited superior mechanical properties compared with glutaraldehyde-treated bovine pericardium, which is expected to increase its structural stability and service life. By introducing the CD/Rutin complex and organic selenium, DC + CD/Rutin+Se-BP not only exhibited the ability to inhibit the adsorption of plasma proteins, platelet aggregation and thrombosis but also presented the excellent anti-inflammatory and anti-calcification characteristics both in vitro and in vivo. Furthermore, DC + CD/Rutin+Se-BP also exhibited stable in situ nitric oxide (NO) catalytic release ability due to the immobilization of organic selenium, which endowed bioprosthetic heart valve with excellent compatibility with human umbilical vein endothelial cells (HUVECs) and facilitated the long-term promotion of its endothelialization process. In summary, this approach combining dual cross-linking and dual modification provides a promising strategy for future design of BHVs, and DC + CD/Rutin+Se-BP exhibits a bright prospect in the clinical applications of BHVs.

PMID:42140293 | DOI:10.1016/j.ijbiomac.2026.152551

Ann Surg Oncol. 2026 Apr 3. doi: 10.1245/s10434-026-19618-w. Online ahead of print.

ABSTRACT

BACKGROUND: Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent.

METHODS: We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC.

RESULTS: Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0).

CONCLUSIONS: To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.

PMID:41933245 | DOI:10.1245/s10434-026-19618-w

Interdiscip Cardiovasc Thorac Surg. 2026 Apr 1;41(4):ivag084. doi: 10.1093/icvts/ivag084.

ABSTRACT

Cardiac hemangiomas are rare benign tumours that may cause significant haemodynamic compromise when reaching large dimensions. We report a case of a giant right atrial cavernous hemangioma occupying almost the entire atrial cavity and involving multiple adjacent structures. A 55-year-old woman presented with progressive symptoms and was found to have a large right atrial mass on echocardiography and computed tomography. Urgent surgical resection was performed under mild hypothermic cardiopulmonary bypass. The tumour involved the right atrial free wall, interatrial septum, inferior vena cava, coronary sinus, and posterior wall of the left atrium, requiring radical excision and atrial reconstruction using bovine pericardial patches. Tricuspid annuloplasty was performed due to annular dilatation and moderate regurgitation. Postoperative recovery was uneventful, with preserved venous drainage and no new rhythm disturbances. Histopathology confirmed cavernous hemangioma. This case demonstrates that even extremely large benign atrial tumours can be successfully managed with radical resection and tailored reconstruction.

PMID:41863326 | PMC:PMC13070375 | DOI:10.1093/icvts/ivag084