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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TETRALOGY OF FALLOT
and pulmonary artery reconstruction in patients with
tetralogy of Fallot and major aortopulmonary collateral
arteries who underwent surgery before referral
Michael Ma, MD, Yulin Zhang, PhD,
Lisa Wise-Faberowski, MD, Amy Lin, MPH, Ritu Asija, MD,
Frank L. Hanley, MD, Doff B. McElhinney, MD
diverse prereferral management strategies, patients
with TOF/MAPCAs achieved comparable rates of complete
repair with low mortality whether treated primarily or
secondarily at our center.
It is a matter of choice
E. O'Brien Jr., MD
Select patients with TOF/MAPCAs who
have initial procedures at outside institutions can
undergo unifocalization at a referral center, but
the selection criteria might be the key to that
Maybe there is just one way to skin a cat!
Eckhauser, MD, MS
Using a comprehensive and
programmatic approach, heterogeneous populations of
patients with TOF/MAPCAs can achieve similarly
excellent results despite the initial surgical
The fundamental techniques used in
revision surgery for TOF/MAPCAs are demonstrated,
emphasizing extensive distal dissection into lung
parenchyma after branch PA or MAPCA mobilization,
management of existing catheter-based stent therapy,
segmental and subsegmental vessel interrogation, and
multilevel homograft patch augmentation.
Impact of prior
diaphragm plication on subsequent stages of single
S. Ram Kumar, MD, PhD, Jassimran
Bainiwal, BS, John D. Cleveland, MD, Nancy Pike, RN,
PhD, Winfield J. Wells, MD, Vaughn A. Starnes, MD
diaphragm plication does not adversely affect surgical
outcomes at subsequent stages of palliation or
progression to Fontan completion.
The challenge of postoperative diaphragmatic paralysis
in patients with functionally univentricular
circulation: A data-driven strategy
P. Jacobs, MD, Charles D. Fraser III, MD, James S.
Tweddell, MD, Marshall L. Jacobs, MD
A recent analysis of the STS
Congenital Heart Surgery Database documented that
substantial variability exists regarding the use of
diaphragm plication in patients with postoperative
diaphragmatic paralysis. Kumar and colleagues
provide important data to help guide the management
of these challenging patients.
Brains over brawn: Do strong diaphragm muscles matter?
Diaphragm plication for diaphragm
paresis does not adversely affect pulmonary
hemodynamics or progression through staged
palliation for single-ventricle patients.
MECHANICAL CIRCULATORY SUPPORT
outcomes in biventricular assist device support in
Nathanya Baez Hernandez, MD,
Richard Kirk, MA, FRCP, David Sutcliffe, MD, Ryan
Davies, MD, Robert Jaquiss, MD, Ang Gao, MS, Song
Zhang, PhD, Ryan J. Butts, MD
in unmatched patient outcomes between biventricular
assist device versus left ventricular assist device
cohorts likely represent differences in severity of
illness rather than device strategy.
Is two ever better than one in pediatric ventricular
assist device support? The controversy continues
Riggs, MD, David L.S. Morales, MD, Farhan Zafar, MD
Although data may suggest pediatric patients
with BiVAD support can have similar survival as
patients supported with an LVAD, delayed BiVAD
placement and using BiVAD support in those who only
required LVADs obscure the true answer.
To BiVAD or not to BiVAD…that is the question?
Dykes, MD, Katsuhide Maeda, MD, PhD
Poor outcomes traditionally
associated with BiVAD use may be more related to
patient selection and timing of implant rather than
the device strategy.
Two sides of the same coin: Competing biventricular
assist device outcomes from Pediatric Interagency
Registry for Mechanical Circulatory Support data
Moon, MD, Iki Adachi, MD
The typical argument for poorer
outcome with BiVAD (vs LVAD) is a difference in the
patient’s characteristics. Hernandez et al
attempted to shed a light on this classic subject
using the Pedimacs data.
experience introducing an enhanced recovery program in
congenital cardiac surgery
Nathalie Roy, MD, M. Fernanda
Parra, MD, Morgan L. Brown, MD, PhD, Lynn A. Sleeper,
ScD, Meena Nathan, MD, MPH, Brenda A. Sefton, PA-C,
Christopher W. Baird, MD, Kshitij P. Mistry, MD, MS,
Pedro J. del Nido, MD
study represents the initial experience and early
results of developing and adopting an ERAS program in
congenital heart surgery at a large pediatric hospital.
Enhanced recovery program after congenital heart
surgery: Promising baby steps
Zhu, BS, Nicholas D. Andersen, MD, Veerajalandhar
A novel enhanced recovery program
for congenital heart surgery shows promising
results in its initial implementation.
The art of medicine versus paint by numbers
C. Romano, MD, MS
Guidelines are used in the inpatient
setting to optimize efficiency and quality of care.
Some say they restrict the “art” of medicine.
Implementing these “paint-by-number” guidelines can
be just as clinically challenging.
False start—Offense: Premature data may cost more than
Karamlou, MD, MSc, Hani K. Najm, MD, MSc, Samir
Latifi, MBBS, Ming Sing-Si, MD, MSc
Although ERAS Pathways in pediatric
cardiac surgery may have benefit, the current paper
may not provide a complete picture, given the
formative stage of the program.