This study aimed to elucidate the long-term surgical outcomes of multiple ventricular septal defects and to determine the appropriate closure techniques according to the size, distribution, and morphology of muscular defects. A single-institutional retrospective review was performed in 127 patients with multiple ventricular septal defects who underwent biventricular repair between February 2005 and November 2020. The cohort included 52 patients with Swiss cheese ventricular septal defects (40

Background:Excess intraoperative fluid can increase postoperative complications in elective surgery, but data on esophageal cancer surgery remain limited. We examined the relationship between intraoperative fluid volume and short-term outcomes after minimally invasive esophagectomy. Methods:This study analyzed 8782 patients who underwent minimally invasive esophagectomy between 2018 and 2022 using data from the National Clinical Database in Japan. Multivariable logistic regression and smoothing spline models were used to assess associations between intraoperative fluid volume and short-term outcomes. Results:The median intraoperative fluid volume was 3700 mL (3000-4500) or 7.8 mL/kg/h (6.2-9.7). Postoperatively, pneumonia occurred in 13.6% of patients, anastomotic leakage in 13.1%, prolonged ventilation (> 48 h) in 3.5%, and surgery-related mortality in 0.8%. Patients were classified into tertiles (low, middle, high) based on fluid volume. A high intraoperative fluid volume was significantly associated with pneumonia (risk-adjusted odds ratio 1.22, 95% confidence interval 1.04-1.45, p = 0.02). However, there was no significant association with anastomotic leakage, prolonged ventilation, or surgery-related mortality. Smoothing spline model showed a positive monotonic relationship between fluid volume and the risk-adjusted odds ratio for pneumonia, prolonged ventilation, and surgery-related mortality, whereas anastomotic leakage showed a negative monotonic trend. Conclusions:Higher intraoperative fluid volume was significantly associated with an increased risk of pneumonia after minimally invasive esophagectomy.

OBJECTIVES:Although there has been rapid development in the field of three-dimensional morphological analyses of congenital heart disease, with the three-dimensional volume-rendered images providing visualization of the external vascular anatomy, the precise reproduction of 'Swiss-cheese' ventricular septum is not well established. We created three-dimensional printed models and computer graphics based on multi-slice computed tomography of patients with complex multiple ventricular septal defects for surgical decision planning of this difficult cardiac defect. METHODS:Seven patients with complex multiple ventricular septal defects were evaluated preoperatively using 3-dimensional printed models and computer graphics to plan therapeutic interventions. RESULTS:The three-dimensional printed models detected muscular VSDs in 9 out of 15 (60%) regions. On the other hand, 3-dimensional computer graphics detected 10 out of 15 (67%) regions. The 3-dimensional printed models and computer graphics allowed the evaluation of the muscular ventricular septal defects from both the left and right ventricular aspects of the septum. CONCLUSIONS:Our preliminary experiences suggest that three-dimensional printed models and computer graphics can help plan surgery in patients with complex multiple ventricular septal defects. Three-dimensional printed models allowed surgeons to understand the three-dimensional positioning of complex multiple ventricular septal defects preoperatively. High-quality three-dimensional computer graphics provided precise information about the size, shape and localization of muscular ventricular septal defects especially from the left ventricular side.

There is controversy regarding appropriate surgical ablation procedures concomitant with nonmitral valve surgery. We retrospectively investigated the impact of surgical ablation for atrial fibrillation during aortic valve replacement between 2010 and 2015 in 16 institutions registered through the Japanese Society for Arrhythmia Surgery. Clinical data of 171 patients with paroxysmal and nonparoxysmal atrial fibrillation undergoing aortic valve replacement were collected and classified into full maze operation (n = 79), pulmonary vein isolation (PVI) (n = 56), and no surgical ablation (n = 36) groups. All patients were followed up and electrocardiograms were recorded in 68% at 2 years. The myocardial ischemia time was significantly longer in the maze group than the others during isolated aortic valve replacement (p ≤ 0.01), but there were no significant differences in 30-day or 2-year mortality rates between groups. The ratios of sinus rhythm at 2 years in paroxysmal and nonparoxysmal atrial fibrillation in the maze group versus PVI group were 87% versus 97%, respectively (p = 0.24) and 53% versus 42%, respectively (p = 0.47). No patients with nonparoxysmal atrial fibrillation in the no surgical ablation group maintained sinus rhythm at 2 years. In conclusion, both maze and PVI during aortic valve replacement are valuable strategies to restore sinus rhythm at 2 years and result in favorable early and midterm survival rates.