Congenital heart disease (CHD) is a common birth defect in children, and surgical intervention is the primary treatment. The traditional standard median sternotomy (MS) has drawbacks such as significant trauma and obvious scarring. The right axillary incision (RAI) has gradually become a conventional approach due to its advantages of preserving thoracic cage integrity, small incision size, rapid recovery, and hidden scarring. However, there is currently a lack of relevant guidelines and consensus for its application. This consensus adopts the international Delphi process, systematically searching domestic and foreign literature on CHD from 1982 to 2024. It uses the GRADE system for evidence grading and, through multidisciplinary expert discussions, clarifies the applicable CHD types, surgical techniques, establishment of extracorporeal circulation, organ protection strategies, management of special disease types, and approaches to common complications of RAI. Results show that RAI is strongly recommended for most simple congenital heart diseases (CHDs) (e.g., simple ventricular septal defect, atrial septal defect), weakly recommended for some complex CHDs (e.g., mild tetralogy of Fallot), and not recommended for complex CHDs such as transposition of the great arteries or in children with severe right thoracic deformity. Additionally, it standardizes key operational parameters: weight (5-30 kg as optimal), age (6 months-6 years as preferred), incision location, extracorporeal circulation cannulation, and organ protection measures. This consensus provides an evidence-based basis for standardizing the clinical application of RAI in open-heart surgery for CHD, ensuring surgical safety and efficacy.

Objectives To evaluate the mid-term outcomes of mechanical valve replacement of the common atrioventricular valve (CAVV) in single-ventricle pediatric patients and compare this with valvuloplasty.Methods We conducted a retrospective study of 91 single-ventricle pediatric patients who underwent CAVV surgery between 2014 and 2025. Patients were divided into two groups according to the initial surgery: valvuloplasty and mechanical valve replacement groups. Baseline and perioperative characteristics were compared between groups. Overall survival and freedom from reintervention were analyzed using Kaplan-Meier curves. Receiver operating characteristic (ROC) curve analysis and maximally selected rank statistics were used to determine the optimal cut-off values for cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) time in predicting in-hospital and late mortality.Results There were 78 cases in valvuloplasty and 13 cases in the mechanical valve replacement group. The replacement group had significantly longer CPB and ACC time (p<0.001). In-hospital mortality was 2 out of 13 (15.4%) in the replacement group and 8 out of 78 (10.3%) in the valvuloplasty group (p>0.050). The median follow-up was 39 months. Kaplan-Meier analysis showed no significant difference in overall survival (p=0.280) and freedom from reintervention (p=0.270). Reintervention for recurrent regurgitation was required in eight patients after ventriculoplasty, whereas no reintervention was observed following valve replacement. ROC analysis identified a CPB time of 173.5 min as the optimal cut-off for predicting in-hospital mortality,with an area under the curve (AUC) of 0.751. Patients with CPB duration exceeding 180 min had significantly poorer survival (p=0.003).Conclusions Mechanical valve replacement of the CAVV in single-ventricle pediatric patients provides satisfactory mid-term survival comparable to valvuloplasty, but with superior valve durability. Prolonged CPB time is associated with poorer survival and should be minimized whenever possible.

Objective: This study compares perspectives between interventional cardiologists and cardiac surgeons on congenital heart disease management via a national survey. Methods: An online questionnaire was distributed to senior surgeons or interventional cardiologists capable of comprehensive congenital heart disease care at 118 hospitals (236 total invitations). Results: Of 162 valid responses, 90 were surgeons and 72 were cardiologists. There were no differences between surgeons and cardiologists in demographic factors. Survey results showed no statistical differences in (1) the overall relationship between interventional and surgical approaches (complementary and sequential); (2) interventional treatment for complex congenital heart disease (using the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery, simple and complex congenital heart disease were defined as lesions with category I and categories II-V); and (3) multidisciplinary team management (long-term follow-up by a consistent core team). Differences were found in the following areas: 1. In decision-making, surgeons placed emphasis on age and developmental potential (adjusted P = .016), whereas cardiologists focused on physiological status and complications (adjusted P = .008). 2. For secundum atrial septal defect (P < .001), patent ductus arteriosus (P < .001), muscular/perimembranous ventricular septal defect (P = .001), pulmonary valve stenosis (P = .010), and coarctation of the aorta (P < .001), each specialty considered their own approach as the preferred option. 3. Surgeons expressed greater demand for interdisciplinary cross-training (adjusted P = .020). Conclusions: Despite broad consensus, cardiologists and surgeons differ in decision-making priorities and training needs. These findings support structured communication, optimized management, specialty-tailored training, and hybrid care models to improve patient outcomes.

The comparative clinical outcomes of the modified Konno procedure (MKP) and transaortic septal myectomy (TSM) for severe left ventricular outflow tract (LVOT) obstruction in children remain unclear. A total of 177 consecutive patients (age <14 years old) underwent surgical treatments, categorized by MKP or TSM technique (MKP n = 45, TSM n = 132). After propensity-score matching, 45 MKP patients were matched 1:1 with TSM patients. At discharge, the MKP group demonstrated a significantly lower LVOT peak gradient compared to the TSM group (median, 3.2 vs 11.6 mmHg, P = 0.011), which persisted at follow-up (median, 4.8 vs 11.6 mmHg, P = 0.01) in matched data. Although postoperative atrioventricular block was more frequent in the MKP group, no significant difference was observed in permanent pacemaker implantation rate between groups (P = 0.108). During follow-up (median, 1.08 years, 0.25-2.5), the incidence of recurrent LVOT obstruction was higher in the TSM group (17.8% vs 0%). Recurrent LVOT obstruction was associated with aortic annulus size (hazard ratio [HR] = 0.811; 95% confidence interval [CI], 0.675-0.974; P = 0.025) and preoperative LVOT peak gradient (HR = 1.030, 95% CI: 1.010-1.050, P = 0.003). The smaller aortic annulus size (<12.5 mm) or severe LVOT obstruction (>82.5 mmHg) significantly decreased the risk of survival free from recurrent LVOT obstruction (P = 0.01, P < 0.001). The MKP can provide better relief of LVOT obstruction than TSM in young children, particularly with a small aortic annulus or severe obstruction. MKP may not increase the risk of permanent pacemaker implantation and mortality.

Objective To evaluate the midterm outcomes of the aortic valve neocuspidalization (AVNeo) procedure for aortic valve reconstruction in 83 pediatric patients with complex aortic valve disease and to identify risk factors associated with the outcomes. Methods A retrospective analysis was conducted on pediatric patients who underwent the AVNeo procedure between January 2017 and June 2025. The composite primary end point included all-cause mortality, reoperation, or moderate-to-severe aortic valve dysfunction (regurgitation or stenosis). Univariate and multivariate Cox proportional hazards models were used to identify risk factors. Results Among the 83 patients (mean age 7.0 ± 3.7 years; 67.5% male) included in the analysis, the predominant preoperative pathology was moderate-to-severe aortic regurgitation (88.0%). Single-leaflet reconstruction (65.1%) using autologous pericardium (94.0%) was the most common surgical approach. Over a mean follow-up of 28.4 ± 23.9 months, 27 patients (32.5%) met the composite end point, including 2 late deaths, 18 cases of moderate-to-severe regurgitation, and 9 cases of moderate-to-severe stenosis; 10 patients underwent reoperation. The probability of freedom from the primary end point was 83.6%, 64.5%, and 54.4% at 1, 3, and 6 years, respectively. Multivariable analysis identified tricuspid aortic valve morphology as an independent protective factor against the primary end point (hazard ratio, 0.408; 95% CI, 0.178-0.935, P = .034), whereas the use of autologous pericardium showed a strong protective trend (hazard ratio, 0.284; 95% CI, 0.078-1.037, P = .057). Conclusions AVNeo provides midterm outcomes that support its use as an alternative strategy. Tricuspid aortic valve morphology is a strong predictor of favorable outcomes, and the use of autologous pericardium demonstrates significant potential as a protective factor.

Objectives: Humanitarian program has emerged as a critical support mechanism for the management of congenital heart disease (CHD), yet its cost-effectiveness at the hospital level receives little investigation. Methods: We reviewed 2759 patients underwent CHD surgery at Fuwai Hospital, National Center for Cardiovascular Diseases from 2012 to 2022, and received financial aid from nongovernmental organizations. Analyzed data included baseline characteristics, surgical complexity, hospitalization costs, nongovernmental organization funding proportions, and disability-adjusted life years (DALYs) averted. Cost-effectiveness was calculated as funding expenditure per DALY averted, with adjustments for natural disease history and surgical outcomes. Results: Charitable fundings covered a median of 31% of hospitalization costs (¥36,564.34/USD $5424.98 per patient), averting 50.82 DALYs per patient at a cost of ¥952.19 ($141.27) per DALY. Neonates and complex CHD cases showed higher number of DALYs averted (59.44 and 54.42, respectively) but lower charitable funding proportions (24% and 32%, respectively). Patients with single-ventricle physiology and patients with previous surgeries exhibited relatively lower cost-effectiveness (¥1627.30 and ¥1349.08 per DALY). Unexpected reinterventions correlated with higher in-hospital mortality (9.6% vs 1%) and lower funding support (19% vs 33%). Conclusions: Charitable funding reduces financial barriers for surgical CHD treatment in China, demonstrating high cost-effectiveness. Funding models should evolve to incorporate surgical complexity and patient age, ensuring more reasonable support in the future. More importantly, the demonstrated cost-effectiveness should encourage more organizations to join the effort of funding CHD surgery, which is the most pivotal action at present.

Background:The Ozaki technique demonstrated promising results in adults, but few studies reported on pediatric patients with limited follow-up time. This study aimed to evaluate the mid-term results of Ozaki technique compared with Ross operation for complex aortic valve diseases in children.Materials and methods:One hundred and seventeen children underwent either Ozaki (n=64) or Ross (n=53) operation from January 2017 to December 2023. The primary endpoint was incidence of moderate or severe regurgitation/stenosis (AR/AS) post procedure.Results:No significant difference was observed in age (6.5 +/- 3.4 vs. 7.9 +/- 4.3 years) and weight (25.9 +/- 15.5 vs. 31.0 +/- 25.9 kgs) at surgery. The Ozaki group had significantly more patients in heart failure (20.3 vs. 1.9%, P = 0.003) before surgery and more patients needed ECMO installation (6.3% vs. 0, P=0.125) after surgery. The Ozaki group were in worse status with more patients occurred heart failure (20.3 vs. 1.9%, P = 0.003) before surgery and needed ECMO installation (6.3 vs. 0, P = 0.125) after surgery. During follow-up (20.4 +/- 17.3 vs. 22.7 +/- 22.8 months, P=0.526), five patients (7.8%) in Ozaki group but no patients in Ross group required reoperations. The incidence of moderate or severe AR (28.1 vs. 3.1%) and AS (31.3 vs. 5.7%) were significantly higher than Ross group. Multivariate analysis identified lower age [HR: 1.282 (95% CI: 1.075-1.529), P=0.006] and ECMO installation [HR: 0.126 (0.018-0.887), P=0.037] to be risk factors for moderate or severe AR, and higher aortic transvalvular gradient before discharge was confirmed as the only risk factor for moderate or severe AS (>= 36 mmHg) at follow-up in Ozaki group.Conclusion:Ozaki technique may be used as a palliative procedure for complex aortic valve diseases in children, but its' mid-term results were not durable as Ross surgery, especially younger patients.

OBJECTIVES:We aimed to summarize the clinical implications and outcomes of the Ross II procedure for infants and young children. METHODS:This study retrospectively reviewed consecutive paediatric patients who underwent Ross II procedure from 2011 to 2022 at Fuwai Hospital. Baseline, operative, postoperative characteristics, and outcomes were summarized. Postoperative all-cause mortality was defined as the primary outcome, and reoperation as the secondary outcome. RESULTS:Ten patients who underwent the Ross II procedure were included in the final analysis, with 2 cases of late mortality and 3 cases of reoperation during a median follow-up of 36 months (range: 3.5 months to 9 years). The median age at surgery was 1.8 years (interquartile range [IQR]: 0.65 to 3.5), and the median mitral annulus diameter was 16 mm (IQR: 15 to 18). Patients who underwent the Ross II procedure experienced a prolonged postoperative course, with a median intensive care unit stay of 11.5 days (IQR: 8.5 to 19.75) and postoperative hospital stay of 24 days (IQR: 20.25 to 34.75). Mitral stenosis emerged as the predominant late complication following the Ross II procedure, affecting 80% patients, as evidenced by the increase in mean gradient 3 years postoperatively compared with discharge. CONCLUSIONS:The Ross II procedure may represent a safe option for infants and young children when prosthetic valves are unavailable, despite the limited growth potential of the pulmonary autograft.

BACKGROUND:The comparative clinical outcomes of homograft (HG) and handmade polytetrafluoroethylene (PTFE) tri-leaflet valved conduit for right ventricular outflow tract reconstruction (RVOTR) in children with cyanotic congenital heart diseases remain unclear. METHODS:We reviewed 265 consecutive patients (aged <14 years old) with cyanotic congenital heart diseases who underwent surgical intervention from 2015 to 2025 in our center (HG n = 141, PTFE n = 124). Competing risk analysis was performed for perioperative mortality, early reintervention, and re-operative conduit replacement during follow-up. RESULTS:There were five early deaths (1.9 %). Multivariate analysis revealed a significant relationship between early mortality and preoperative left ventricular ejection fraction [hazard ratio (HR), 0.879; 95 % confidence interval (CI), 0.777-0.993; p = 0.039]. During a median follow-up of 45 months (range, 1-96), six patients (2.3 %) had reintervention on pulmonary artery by percutaneous balloon pulmonary dilation in the early postoperative period (average 7.8 months). Compared with HG conduit, patients in the PTFE group demonstrated longer conduit durability (p = 0.013) and lower reoperation rate (p = 0.049) during follow-up. Overall, freedom from reoperation for conduit dysfunction was no different for both conduits (p = 0.037). Freedom from re-operative conduit replacement at 3 and 5 years in the PTFE group was 95.2 % and 91.8 %; 90.3 % and 81.2 % in the HG group, respectively without significant difference (p = 0.37). Multivariate analysis revealed a significant relationship between reoperation and cardiopulmonary bypass time (HR, 0.989; 95 % CI, 0.979-0.999; p = 0.036), conduit size/body surface area > 25.77 mm/m2 (HR, 0.152; 95 % CI, 0.038-0.614; p = 0.008) and PTFE conduit (HR, 0.350; 95 % CI, 0.127-0.964; p = 0.042). Patients aged >34 months were associated with longer freedom from reoperation (p = 0.013). CONCLUSION:We demonstrate excellent outcomes for RVOTR in pediatric patients with cyanotic congenital heart diseases. The handmade PTFE tri-leaflet valved conduit showed better results for reoperation and conduit durability. Younger age showed worse survival without reoperation for both conduits.

AbstractAimsHeritable dilated cardiomyopathy (DCM) or DCM associated with congenital or acquired left ventricular diseases carries a significant mortality risk. Pulmonary artery banding (PAB) has been proposed as an alternative to heart transplantation. This study aimed to delineate the clinical development, ventricular reverse remodelling, and functional regeneration of the dilated left ventricle, presenting as a pioneering approach in China.Methods and resultsThis prospective study was initiated in November 2021, involving paediatric patients with a significant dilated left ventricle and preserved right ventricle who underwent surgical PAB. The baseline characteristics and clinical information during follow‐up were collected. Seven patients (five boys) with a median age of 240 (148, 1028) days have been included thus far. No procedural or follow‐up mortality was observed. The modified Ross functional class improved from treatment to follow‐up of 348 (200, 629) days, and the median left ventricular ejection fraction increased from 27.0 (15.0, 34.0) % before surgery to 61.0 (52.0, 68.0) % (P < 0.05); the median left ventricular end‐diastolic diameter and corresponding Z‐scores decreased from 43.0 (40.0, 55.0) mm [+9.4 (+7.7, +11.7)] to 33.0 (29.0, 39.0) mm [+1.8 (+1.3, +3.8)] (P < 0.05). Functional regeneration of the left ventricle was observed in five patients. Three of them underwent balloon dilation of the PAB to relieve excessively elevated right ventricular pressures.ConclusionsThe application of PAB should adhere to strict criteria. Initial results are promising for infants and even toddlers with a dilated left ventricle and limited probability of spontaneous recovery. PAB can be an alternative when there is a shortage of donor transplants and assist devices, especially for low‐ and middle‐income countries.

OBJECTIVES: Risk factors associated with adverse cardiac events (cardiac AEs) after pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot are incompletely understood. In this study, we aimed to determine the relationship between histological myocardial fibrosis and cardiac AEs after PVR in patients with rTOF.METHODS: We consecutively collected clinical, cardiac magnetic resonance, echocardiography and electrocardiogram data of 51 patients with rTOF who underwent surgical PVR. The right ventricular outflow tract tissue was collected during the PVR and the degree of histological myocardial fibrosis was determined by a tailor-made automated image analysis method of picrosirius red staining.RESULTS: The median follow-up time was 4.9 years, and 14 patients had cardiac AEs (a composite of heart failure admission and arrhythmia) during follow-up. The total analysis area of myocardial samples was 5782.18 mm(2), and the median percentage of myocardial fibrosis was 20.6% (interquartile range 16.7-27.0%), which were significantly elevated in patients with cardiac AEs compared with patients without cardiac AEs (24.1% vs 19.7%, P = 0.007). Right ventricular ejection fraction and left ventricular end-systolic volume index were significantly associated with myocardial fibrosis in multivariable stepwise linear regression analysis (R-2 = 0.238). Cox proportional hazards regression identified degree of myocardial fibrosis [hazard ratio 1.127; 95% confidence interval (CI) 1.047-1.213; P = 0.001] and age at PVR (hazard ratio 1.062; 95% CI 1.010-1.116; P = 0.019) were associated with increased risk of cardiac AEs. The incidence of adverse cardiac events was significantly increased when myocardial fibrosis >20.1% and age at PVR >18.2 years.CONCLUSIONS: Histological myocardial fibrosis was associated with biventricular systolic functions in rTOF. Higher myocardial fibrosis and older age at PVR are independent risk factors for the adverse cardiac events after PVR in patients with rTOF.

Objective We retrospectively analyzed the clinical results and complications of applying flow study in patients with pulmonary atresia and ventricular septal defect and major aortopulmonary collateral arteries（PA/VSD/MAPCAs） during cardiopulmonary bypass（CPB）. Methods Patients with PA/VSD/MAPCAs enrolled in flow study during CPB were collected from January 2016 to December 2020. The mean pulmonary artery pressures（mPAP） in flow study and the complications were analyzed. Results A total of twenty-nine patients underwent flow study during operations including 11 males and 18 females, with a median age of 33 months and an average body mass of 11.42±3.41 kg. Twenty patients achieved VSD closure（mPAP 15.95±4.67 mmHg） and nine patients’ VSD were closed with salvage VSD fenestration（mPAP 31.11±4.51 mmHg）. One patient died of pulmonary hypertensive crisis. Five patients underwent re-intubation in ICU. Conclusion The flow study was an effective procedure in patients with PA/VSD/MAPCAs. We shoud be more cautious for patients with VSD fenestration. It is challenging for perfusionists to improve preoperative preparation, be familiar with surgical procedures, and conduct good management during surgery, so as to ensure the surgical safety of patients.

The normal anatomical course of right upper lobe pulmonary vein involves drainage anteriorly to the pulmonary artery, ultimately reaching the left atrium. However, anomalies can occur with the most common variation involving the convergence of the right upper lobe pulmonary vein with the superior vena cava. In a rare pulmonary vascular malformation, the anomalous right upper lobe pulmonary vein takes a path between the right pulmonary artery and right main bronchus [1]. During a clinical consultation, a patient presented in our hospital with this specific anomalous right upper lobe pulmonary vein, along with an atrial septal defect and a patent ductus arteriosus. As a consequence of this aberrant positioning, the right upper lobe pulmonary vein was compressed between the pulmonary artery and trachea, leading to pulmonary vein obstruction. Thus, a successful pulmonary vein replantation was performed to correct the congenital malformation.

This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene (ePTFE) conduits in the absence of a suitable homograft. Patients who underwent right ventricular outflow tract reconstruction with tri-leaflet ePTFE conduits or homografts between December 2016 and August 2020 were included. The primary endpoint was the incidence of moderate or severe conduit stenosis (≥ 36 mmHg) and/or moderate or severe insufficiency. The secondary endpoint was the incidence of severe conduit stenosis (≥ 64 mmHg) and/or severe insufficiency. There were 102 patients in the ePTFE group and 52 patients in the homograft group. The median age was younger [34.5 (interquartile range: 20.8–62.8) vs. 60.0 (interquartile range: 39.3–81.0) months, P = 0.001] and the median weight was lower [13.5 (10.0–19.0) vs. 17.8 (13.6–25.8) kg, P = 0.003] in the ePTFE group. The conduit size was smaller (17.9 ± 2.2 vs. 20.5 ± 3.0 mm, P < 0.001) and the conduit Z score was lower (1.48 ± 1.04 vs. 1.83 ± 1.05, P = 0.048) in the ePTFE group. There was no significant difference in the primary endpoints (log rank, P = 0.33) and secondary endpoints (log rank, P = 0.35). Multivariate analysis identified lower weight at surgery [P = 0.01; hazard ratio: 0.75; 95% confidence interval (CI) 0.59–0.94] and homograft conduit use (P = 0.04; hazard ratio: 8.43; 95% CI 1.14–62.29) to be risk factors for moderate or severe conduit insufficiency. No risk factors were found for moderate or severe conduit stenosis or conduit dysfunction on multivariate analysis. Handmade tri-leaflet ePTFE conduits showed acceptable early and midterm outcomes in the absence of a suitable homograft, but a longer follow-up is needed.

ObjectivesThis study was to assess the mid-term results of the one-and-a-half ventricular repair (hemi-Mustard and bidirectional Glenn procedures combined with the Rastelli procedure) and Fontan pathway for correcting congenitally corrected transposition of great artery (ccTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malposition.MethodsIn this retrospective study, 74 consecutive ccTGA with LVOTO and cardiac malposition underwent the one-and-a-half ventricular repair (group A; 33 cases) and Fontan operation (group B; 41 cases) between October 2011 and March 2018. The Median follow-up time was 49 (20–84) and 42 (7–85) months in groups A and B, respectively. To estimate excise tolerance the 6-min walk test (MWT) was performed.ResultsNo in-hospital death. Compared with group A, group B have significantly less CPB, mechanical ventilation time, and intensive care unit stay, but prolonged pleural effusions developed more frequently in Group B. The survival probability was 90.2% (95% CI, 80.2–100%) and 97.2% (95% CI, 92–100%) at 7 years (p = 0.300) in group A and B. The probability of freedom from re-intervention were 80.6% (95% CI, 66.5–97.6%) and 97.2% (95% CI, 92–100%) at 7 years (p = 0.110). Longitudinal repeated measured echo data at every follow-up time shows that group A has more systemic ventricular EF% (p < 0.001) and less moderate systemic ventricular valve regurgitation (p < 0.001) compared with group B. Estimated by 6 MWT, group A has better outcomes for 6-min walk distance.ConclusionsFor correction of ccTGA with LVOTO and cardiac malposition, the one-and-a-half ventricular repair had superior midterm heart function and excise tolerance.

BACKGROUND Surgical outcomes for primary pulmonary vein stenosis (PPVS) remain unfavorable, and risk factors are still poorly understood. This study evaluated outcomes and risk factors after PPVS repair. METHODS This retrospective study included 40 patients with PPVS who underwent surgical repair in Fuwai Hospital from 2010 to 2020. Adverse outcomes included overall death, pulmonary vein (PV) restenosis, and reintervention. A univariate and multivariate risk analysis was performed to determine risk factors. RESULTS The mean follow-up duration was 37.5 +/- 31.5 months. Sutureless technique was performed in 7 patients (17.5%), endovenectomy in 9 (22.5%), and patch venoplasty in 24 (60%). Bilateral PV involvement was documented in 12 patients (30%). Overall death, PV reintervention, and restenosis occurred in 15%, 12.5%, and 25% of patients, respectively. Freedom from overall death, PV reintervention, and restenosis at 5 years was 85% +/- 6.3%, 88.9% +/- 5.2%, and 65.1% +/- 13.2%, respectively. Multivariate analysis revealed that bilateral PV involvement was an independent risk factor for death or PV reintervention (hazard ratio, 10.4; 95% confidence interval, 1.9-56; P = .006) and that involvement of the left inferior PV was an independent risk factor for postoperative restenosis of the left inferior PV (hazard ratio, 13.1; 95% confidence interval, 2.2-76.8; P = .004). CONCLUSIONS Surgical treatment for PPVS remains a challenging issue with imperfect prognosis. Therefore, it is right and appropriate to take close surveillance on mild or moderate stenosis on a single PV. Bilateral and left inferior PV involvement are independent risk factors for adverse outcomes. (c) 2022 by The Society of Thoracic Surgeons

OBJECTIVES:The optimal timing for atrioventricular valve (AVV) repair in patients with a Fontan circulation remains controversial. Few studies have reported the long-term outcomes of AVV repair concomitant with a Fontan operation.METHODS:From January 2006 to December 2018, a total of 89 patients who developed moderate or severe AVV regurgitation before a Fontan operation were divided into 2 groups: group 1, including 37 patients who did not undergo concomitant AVV repair; and group 2, including 52 patients who received AVV repair concomitant with a Fontan operation.RESULTS:The mean age at the time of the Fontan operation was 6.74 years for group 1 and 8.96 years for group 2, respectively. Early death occurred in 3 patients [2 patients (5.4%) in group 2, patient 1 (1.9%) in group 1]. Freedom from long-term death, cardiac function reduction and protein-losing enteropathy were similar among the 2 groups. Common AVV function was apparently poorer than mitral valve function after repair [hazard ratio (HR) 3.83, 95% confidence interval (CI) 1.31-11.17; P = 0.014]. The occurrence of AVV valve failure in group 1 was lower than that in group 2 (HR 0.44, 95% CI 0.22-0.91; P = 0.026). AVV function became worse during the follow-up period than that at discharge in both groups (P = 0.03 in group 1 and P = 0.001 in group 2).CONCLUSIONS:The long-term results of AVV repair concomitant with a Fontan operation are favourable.

目的 总结阜外医院标准化二尖瓣修复策略治疗完全房室间隔缺损(CAVSD)术后严重左侧房室瓣反流(LAVVR)的应用经验.方法 回顾性分析2016-2019年于我院通过标准化二尖瓣修复策略治疗CAVSD术后LAVVR的11例患者临床资料,其中男5例、女6例,中位年龄56(22～ 152)个月.总结二尖瓣大量反流病理特征、术中操作要点及近中期术后随访结果.结果 与初次手术时间间隔48(8～ 149)个月,主动脉阻断时间(54.6士21.5)min,体外循环时间(107.4士38.1)min,呼吸机使用时间(16.4士16.3)h.术后恢复顺利,无死亡病例.随访(29.0±-12.8)个月,超声心动图提示二尖瓣微少量反流5例,少量反流5例,中量反流1例.心功能分级(NYHA)均为Ⅰ级.结论 标准化二尖瓣修复策略治疗CAVSD术后大量LAVVR安全有效,近中期随访结果良好.

OBJECTIVES:In patients with anatomically repaired congenitally corrected transposition of the great arteries, the impact of electrophysiological features on postoperative ventricular dysfunction remains less well known. Our goal was to investigate the role of fragmented QRS and QRS duration in mortality and systemic ventricular dysfunction after anatomical repair of corrected transposed great arteries.METHODS:Consecutive patients who underwent anatomical repair in our institution from January 2005 to December 2017 were enrolled in this retrospective analysis. Fragmented QRS was defined as ≥1 discontinuous deflections in narrow QRS complexes, and ≥2 in wide QRS complexes, in 2 contiguous electrocardiogram leads. The primary end point was a composite of all-cause mortality and systemic ventricular dysfunction.RESULTS:A total of 74 patients were included. Among them, 30, 15 and 29 underwent the Senning arterial switch, the Senning Rastelli and the hemi-Mustard/bidirectional Glenn/Rastelli procedures, respectively. The primary end point occurred in 9 (12.2%) patients and included 7 late deaths and 2 cases of late-onset systemic ventricular dysfunction. Fragmented QRS and QRS prolongation were noted in 19 (25.7%) and 21 (28.4%) patients, respectively. In patients with the primary end point, QRS fragmentation (6/9 vs 10/65; P < 0.001) and QRS prolongation (6/9 vs 15/65; P = 0.013) were noted more frequently than in patients without the primary end point. No statistical differences in these electrocardiogram findings were found among patients treated with 3 surgical strategies.CONCLUSIONS:Appearance of QRS fragmentation or QRS prolongation is associated with death or ventricular dysfunction in anatomically repaired corrected transposition of the great arteries. Although there is a trend that QRS fragmentation and QRS prolongation appear more frequently in patients who had the Senning-arterial switch operation, there is no statistically significant difference associated with these electrocardiogram features among varied procedures.

目的 总结超过手术建议年龄的完全房室间隔缺损(complete atrioventricular septal defect,CAVSD)患儿外科治疗的效果及经验.方法 回顾性分析2002～ 2013年163例7周岁以下单纯CAVSD患儿的临床资料,根据是否＞1周岁分为适龄组[n=84,其中男37例、女46例,平均年龄(7.6±2.7)个月]与超龄组[n=79,其中男30例、女49例,平均年龄(34.6±19.6)个月].结果 两组患者在平均主动脉阻断时间[(88.3±24.4)min vs.(106.1±35.4)min,P＜0.001]、平均体外循环时间[(123.6±31.1)min vs.(142.6±47.1)min,P=0.003]方面差异有统计学意义.术后随访过程中[适龄组(53.3±43.9)个月,超龄组(57.2±48.2)个月],两组在全因死亡率(10.7％ vs.8.9％,P=0.691)、中重度左侧房室瓣反流发生率(16.7％ vs.21.5％,P=0.430)及再干预率(3.6％ vs.0.0％,P=0.266)方面差异无统计学意义.两组均无左室流出道梗阻及房室传导阻滞发生.结论 经过合理的外科治疗,超过建议矫治年龄的患儿也可取得令人满意的结果.