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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SINGLE VENTRICLE
Low preoperative superior vena cava blood flow predicts bidirectional cavopulmonary shunt failure
Shuhua Luo, MD, PhD, Maruti Haranal, M Ch, Mimi Xiaoming Deng, BScH, Jaymie Varenbut, BScH, Kyle Runeckles, MSc, Chun-Po Steve Fan, PhD, Mike Seed, MD, Glen S. Van Arsdell, MD, Osami Honjo, MD, PhD
Preoperative SVC blood flow predicted post BCPS physiology and clinical outcome better than other anatomic and physiologic markers. Lower SVC blood flow was associated with worse BCPS takedown-free survival.
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Commentary: Vis a tergo—a push from behind—is of paramount importance for the optimal function of a bidirectional cavopulmonary shunt
Thierry Carrel, MD
Vis a tergo is a prerequisite for the optimal function of a bidirectional cavopulmonary shunt.
Commentary: When is a bidirectional cavopulmonary shunt a bad idea?
John J. Lamberti, MD
Proceed with caution when cardiac magnetic resonance imaging–derived pre–bidirectional cavopulmonary shunt superior vena cava blood flow is low. The “conventional” staging sequence of palliation for a functional single ventricle may be inappropriate in this setting.
EBSTEIN'S ANOMALY
Cone versus conventional repair for Ebstein's anomaly
Melchior Burri, MD, Karim Mrad Agua, MD, Julie Cleuziou, MD, PhD, Elisabeth Beran, MD, Nicole Nagdyman, MD, PhD, Andreas Kühn, MD, PhD, Johannes Amadeus Ziegelmueller, MD, Peter Ewert, MD, PhD, Jose Pedro Da Silva, MD, Rüdiger Lange, MD, PhD
Cone repair provided a higher rate of successful repair and a lower incidence of moderate or greater recurrent insufficiency compared with former repair procedures.
Commentary: Is the cone a superior form?
Emile Bacha, MD, FACS
The cone procedure has been confirmed to be superior to other repairs for Ebstein's anomaly. It is a difficult operation that is rarely done. Effect on right ventricle function and long-term survival remains unknown.
Commentary: Aristotle, the truth, and cone reconstruction
David M. Overman, MD
Emergence of the cone repair is a milestone in the surgical treatment of Ebstein anomaly. Yet fulfillment of its promise requires more accumulated experience and long-term outcome data.
Commentary: Should the cone repair be the only option to consider for all patients with Ebstein's anomaly? Definitely not
David Kalfa, MD, PhD
The cone repair dramatically improved the short-term and mid-term outcomes for patients with Ebstein's anomaly but a lot still needs to be learned on long-term outcomes and patient selection.
FEATURE VIDEO
Cone repair performed in a 53-year-old woman who presented with severe TR.
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PERIOPERATIVE MANAGEMENT
Transdiaphragmatic tunneled Broviac catheters: Cost-effective perioperative central venous access in infants undergoing cardiac surgery
Muhammad Owais Abdul Ghani, MBBS, Muhammad Aanish Raees, MBBS, Alan Ruigang Tang, BA, Dhivyaa Anandan, BA, Chevis N. Shannon, MBA, MPH, DrPh, David P. Bichell, MD
Patients with TBCs have fewer peripheral lines and imaging procedures, and incur lower costs when compared with traditional transthoracic or peripherally inserted catheters.
Commentary: Central venous access in congenital heart surgery: Is it time for surgeons to toe (and place) the line?
Jennifer I. Sherwin, MD, Veerajalandhar Allareddy, MD, Nicholas D. Andersen, MD
The surgeon-placed transdiaphragmatic tunneled Broviac catheter is an innovative and less expensive alternative to peripherally inserted central catheters in infants undergoing cardiac surgery.
Commentary: Transdiaphragmatic tunneled Broviac catheters: How small ripples can make big waves
Minoo N. Kavarana, MD, FACS
Transdiaphragmatic tunneled Broviac catheters provide a cost-effective, reliable, and durable method for perioperative central venous access during pediatric cardiac surgery.
HEALTH POLICY
Association between race/ethnicity, illness severity, and mortality in children undergoing cardiac surgery
Yuen Lie Tjoeng, MD, MS, Kathy Jenkins, MD, MPH, Jason F. Deen, MD, Titus Chan, MD, MS, MPP
African American race is associated with higher odds of death after congenital heart surgery, mediated by severity of illness. Improving pre- and intraoperative factors may improve this disparity.
Commentary: Ode to the editorial process: Health care disparities unmasked
Natalie Jayaram, MD, MSB, Brett R. Anderson, MD, MBA, MS, Tara Karamlou, MD, MSc
Iterative evolution of truth: Highlighting the importance of associations between illness severity and socioeconomic/race factors is a critical step forward.
Commentary: Focusing the lens on racial disparities in congenital heart surgery
Nicholas D. Andersen, MD, Joseph W. Turek, MD, PhD
Racial disparities in congenital heart surgery persist and appear to be driven largely by preoperative illness severity.