ObjectiveTo evaluate the mid-term outcomes between tricuspid valve detachment (TVD) and non-detachment (NTVD) for ventricular septal defect (VSD).Methods The patients who underwent perimembranous VSD repair in the Department of Cardiovascular Surgery, West China Hospital from 2015 to 2020 were included. According to the surgical method, the patients were divided into a TVD group and a NTVD group. The clinical data of the two groups were compared.Results Totally 538 patients were included in the study. There were 240 patients in the TVD group, including 121 males and 119 females, with an average age of 3.85±8.42 years and an average weight of 14.12±12.97 kg. There were 298 patients in the NTVD group, including 149 males and 149 females, with an average age of 4.42±9.36 years and an average weight of 14.87±12.51 kg. There was no statistical difference in the age, weight, sex, preoperative New York Heart Association (NYHA) classification or tricuspid regurgitation (TR) degree between the two groups (P＞0.05). Median follow-up was 30 (23, 40) months in the TVD group, and 29 (23, 41) months in the NTVD group (P=0.600). After operation, one patient in each group developed third-degree atrioventricular block and recovered to sinus rhythm before discharge (P=0.848). No pacemaker was needed. There was no statistical difference in the length of stay (P=0.054), mortality (P=1.000), in-hospital reoperation (P=0.199), or follow-up reoperation (P=0.505). More than 98% of patients in both groups had postoperative TR less than moderate (P=0.926). At the last follow-up, only 7 (2.9%) patients in the TVD group were detected trivial residual shunting, and 14 (4.7%) in the NTVD group (P=0.289). No one needed to have reoperation because of residual VSD. The TVD group showed less TR during the follow-up (P=0.019).Conclusion TVD is an alternative technique which can be safely used in the closure of VSD, especially in technologically mature medical center. Appropriate tricuspid valve detachment for those hard-to-expose VSDs does not result in poorer tricuspid valve function or higher risk of atrioventricular block, and might reduce the incidence of residual shunting.
Objective To compare the short- to mid-term outcomes of aortic valve plasty (AVP) and Ross surgery in children with severe aortic valve disease. Methods The patients (aged<18 years) with severe aortic valve disease who underwent AVP (an AVP group) or Ross surgery (a Ross group) at the Department of Cardiovascular Surgery, West China Hospital from January 2019 to September 2023 were retrospective included. We compared perioperative and follow-up data between the groups. Results A total of 48 pediatric patients were included, including 28 males and 20 females, with an average age of (9.3±4.5) years. There were 25 patients in the AVP group, and 23 in the Ross group. Leaflet thinning (15/25, 60.0%) and leaflet extension (10/25, 40.0%) were the most common strategies used in the AVP group, while root replacement technique (12/23, 52.2%) and subcoronary technique (10/23, 43.5%) were the most frequently used strategies in the Ross group. There was no in-hospital death. The median follow-up time was 16.0 (7.0, 30.0) months. Peak flow velocity of the aortic valve was higher in the AVP group [2.0 (1.4, 2.9) m/s vs. 1.2 (1.0, 1.5) m/s, P<0.001], while there was no difference in the postoperative aortic valve regurgitation severity between the two groups (P=0.127). During follow-up, the overall reoperation rate and aortic valve reoperation rate were similar between the AVP group and the Ross group (8.0% vs. 13.0%, P=0.922; 8.0% vs. 0.0%, P=0.266). The rate of recurrent aortic valve disease was higher in the AVP group (52.0% vs. 4.3%, P<0.001), while further analysis failed to recognize any risk factors. Conclusion AVP and Ross procedure show similar perioperative safety, survival and reoperation rate. The rate of recurrent aortic valve disease is higher in the AVP group, but further investigations are needed to confirm the causes.