The following is a collection of featured congenital articles from the Journal of Thoracic and Cardiovascular Surgery (JTCVS). To read the latest issue, or browse the feature video library and other journal highlights, please visit www.jtcvs.org.
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TRANSPOSITION
The influence of coronary artery anatomy on mortality after the arterial switch operation
Tyson A. Fricke, MBBS, BMedSci, Douglas Bell, MBBS, Michael Daley, MBBS, Yves d'Udekem, MD, PhD, FRACS, Christian P. Brizard, MD, Nelson Alphonso, MBBS, FRACS, Igor E. Konstantinov, MD, PhD, FRACS
Patients with anomalous coronary anatomy had higher rates of early mortality after the ASO but this was not statistically significant and coronary reoperation was rare.
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Commentary: The (un)usual suspects
Jonathan M. Chen, MD
Embracing the concept that all coronary arteries in transposition—usual or unusual—are themselves not “normal” may help to reframe our future focus on potentially important long-term coronary risk.
Commentary: The arterial switch operation: Is it still all about the coronaries?
Lok Sinha, MD, Carlos M. Mery, MD, MPH
Despite improvements in outcomes with the arterial switch operation, patients with coronary abnormalities continue to be a challenge. The long-term effects of coronary translocation are still unclear.
FONTAN
Role of surgeon intuition and computer-aided design in Fontan optimization: A computational fluid dynamics simulation study
Yue-Hin Loke, MD, Byeol Kim, BSc, Paige Mass, BSc, Justin D. Opfermann, MS, Narutoshi Hibino, MD, PhD, Axel Krieger, PhD, Laura Olivieri, MD
New manufacturing methods for Fontan grafts necessitate new design tools and collaborative approaches. In addition to computer-aided design, surgeons can also directly craft patient-specific Fontan designs with low power loss.
Commentary: Yet another Fontan computational study—but this one has clay
Ronald K. Woods, MD, PhD, Salil Ginde, MD, MPH
Surgeon-fashioned clay models may improve the efficiency of computational flow dynamics and optimization of the personalized Fontan. Optimal models require verification in reality.
Commentary: A 3-minute foray into the future
William M. DeCampli, MD, PhD
Another advance in Fontan surgical planning may be just another step toward a future with fully automated planning and autonomous robotic surgery, as depicted in this science-fiction commentary.
Commentary: Man versus machine: Whose side are you on?
Tain-Yen Hsia, MD
In the quest for the optimal and personalized Fontan procedure, the gap between surgeon intuition and computer-aided design is closing fast.
FONTAN FEATURED VIDEO
Surgeon unconstrained modeling in collaboration with computer aided design to produce a patient specific Fontan design with low power loss.
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CONGENITAL HEART SURGERY
The Pediatric Heart Network Residual Lesion Score Study: Design and Objectives
Meena Nathan, MD, MPH, Felicia L. Trachtenberg, PhD, Maria I. Van Rompay, PhD, William Gaynor, MD, Kirk Kanter, MD, Richard Ohye, MD, Emile A. Bacha, MD, James Tweddell, MD, Steven M. Schwartz, MD, L. LuAnn Minich, MD, Carlos M. Mery, MD, MPH, Steven D. Colan, MD, Jami Levine, MD, Linda M. Lambert, MSN, FNP, Jane W. Newburger, MD, MPH for the Pediatric Heart Network Residual Lesion Score Writing Committee
The Residual Lesion Score can serve as a tool to guide perioperative strategies to improve outcomes of congenital heart surgery.
Commentary: No blame! Let us look at our work without pointing fingers
Yves d’Udekem, MD, PhD, Federica Caldaroni, MD
Improvement of care in pediatric cardiac surgery goes through a careful and honest analysis of outcomes and performances, with no space for blame.
Commentary: Technical excellence is necessary but not sufficient
David P. Bichell, MD
A Residual Lesion Score that uses a discharge echocardiogram of the repaired heart to predict ultimate outcome may be strengthened by the addition of measures beyond just heart architecture.
Commentary: Relational coordination… a mechanism to improve data interoperability
Aaron J. Weiss, MD, Tara Karamlou, MD, MSc
The field of health care suffers from a lack of data interoperability, resulting in untold amounts of lost information, EMR fatigue, financial waste, and caregiver burnout.
EDUCATION
Development and validation of a procedure-specific assessment tool for hands-on surgical training in congenital heart surgery
Nabil Hussein, MBChB (Hons), Andrew Lim, BASc, MHSc, Osami Honjo, MD, Christoph Haller, MD, John G. Coles, MD, Glen Van Arsdell, MD, Shi-Joon Yoo, MD
Objective assessments within hands-on surgical simulation in congenital heart surgery is possible. As patient outcomes are scrutinized, such tools will be vital for surgeon development/progression.
Commentary: The time has come to measure and examine technical skills
James S. Tweddell, MD
Technical performance is essential for successful congenital heart surgery, and it is time to start measuring and examining surgical skills.
Commentary: Surgical skill assessment: Time to examine?
Elizabeth H. Stephens, MD, PhD, Joseph A. Dearani, MD
Evaluation of technical performance should be included in the certifying process for congenital cardiothoracic surgery.
EDUCATION FEATURED VIDEO
Clip from the gold standard video of the arterial switch procedure (medial trap door, closed technique) performed by an experienced staff surgeon. This video was used for training evaluators.