Faculty Profiles - KOTANI Yasuhiro

Papers - KOTANI Yasuhiro

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Management Strategies for Truncus Arteriosus: A Comparative Analysis of Staged vs. Primary Repair

Yasuyuki Kobayashi, Shunji Sano, Yuto Narumiya, Ayari Kimura, Etsuji Suzuki, Shingo Kasahara, Yasuhiro Kotani

Pediatric Cardiology 2025.1

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

We reviewed the outcomes of truncus arteriosus repair (primary vs. staged repair incorporating bilateral pulmonary artery banding), focusing on survival, reintervention, and functional data. We analyzed 39 patients who underwent a first intervention for truncus arteriosus (staged, n = 19; primary, n = 20) between 1992 and 2022. The median follow-up period was 8.0 (2.2–13.2) years. Survival, freedom from reoperation, and freedom from catheter intervention were estimated using the Kaplan–Meier method. High-risk patients were defined as those with a weight ≤ 2.5 kg, ≥ moderate truncal valve regurgitation, interrupted aortic arch, or preoperative shock. In the staged group, patients with a median weight of 2.6 kg had a median intensive care unit stay of 5 days and no hospital mortality after bilateral pulmonary artery banding. At repair, the staged group had a larger conduit for the right ventricular outflow tract (14 vs. 12 mm; P = .008). Catheter intervention on the branch pulmonary artery was required in 67% of patients in the staged group, but right ventricular end-diastolic pressure at follow-up was comparable between the groups (P = .541). Survival rates were higher among high-risk patients in the staged group (87.5% vs. 21.4% at 15 years; P = .004) but were comparable between groups for standard-risk patients (P = 1.000). Bilateral pulmonary artery banding was a safe, effective procedure. Reintervention for branch pulmonary artery was common but did not affect functional outcomes. Staged repair may play a pivotal role regarding survival in high-risk patients, and risk stratification is vital.

DOI： 10.1007/s00246-025-03790-z

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Other Link： https://link.springer.com/article/10.1007/s00246-025-03790-z/fulltext.html

Evaluation of the effects of fenestration in Fontan circulation using a lumped parameter model

Naohiro Horio, Shuji Shimizu, Yasuhiro Kotani, Yoshinori Miyahara, Shingo Kasahara

The Journal of Physiological Sciences 74 ( 1 ) 2024.12

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Fenestration has been reported to enhance Fontan hemodynamics in several cases of Fontan circulation. However, the indication criteria for fenestration remain under discussion. To assess the effectiveness of fenestration in Fontan circulation, we conducted a theoretical analysis using a computational model of the fenestrated Fontan circulation. The cardiac chambers and vascular systems were modeled using the time-varying elastance model and the modified Windkessel model, respectively. When the pulmonary vascular resistance index was 4.01 Wood units m², fenestration significantly reduced central venous pressure from 18.0 to 16.1 mmHg and decreased stressed blood volume from 610 to 555 ml. However, in the models with reduced ventricular end-systolic elastance, increased ventricular stiffness constant, or heightened systemic vascular resistance, the advantages of fenestration were diminished. Thus, fenestration may effectively improve the hemodynamics of Fontan circulation in patients with elevated pulmonary vascular resistance.

DOI： 10.1186/s12576-024-00947-y

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Other Link： https://link.springer.com/article/10.1186/s12576-024-00947-y/fulltext.html

Evaluation of the Efficacy and Accuracy of Super-Flexible Three-Dimensional Heart Models of Congenital Heart Disease Made via Stereolithography Printing and Vacuum Casting: A Multicenter Clinical Trial Reviewed

Isao Shiraishi, Masaaki Yamagishi, Takaya Hoashi, Yoshiaki Kato, Shigemitsu Iwai, Hajime Ichikawa, Tatsuya Nishii, Hiroyuki Yamagishi, Satoshi Yasukochi, Masaaki Kawada, Takaaki Suzuki, Takeshi Shinkawa, Naoki Yoshimura, Ryo Inuzuka, Yasutaka Hirata, Keiichi Hirose, Akio Ikai, Kisaburo Sakamoto, Yasuhiro Kotani, Shingo Kasahara, Toshiaki Hisada, Kenichi Kurosaki

Journal of Cardiovascular Development and Disease 11 ( 12 ) 387 - 387 2024.12

Publishing type：Research paper (scientific journal) Publisher：MDPI AG

Three-dimensional (3D) printing is an advanced technology for accurately understanding anatomy and supporting the successful surgical management of complex congenital heart disease (CHD). We aimed to evaluate whether our super-flexible 3D heart models could facilitate preoperative decision-making and surgical simulation for complex CHD. The super-flexible heart models were fabricated by stereolithography 3D printing of the internal and external contours of the heart from cardiac computed tomography (CT) data, followed by vacuum casting with a polyurethane material similar in elasticity to a child’s heart. Nineteen pediatric patients with complex CHD were enrolled (median age, 10 months). The primary endpoint was defined as the percentage of patients rated as “essential” on the surgeons’ postoperative 5-point Likert scale. The accuracy of the models was validated by a non-destructive method using industrial CT. The super-flexible heart models allowed detailed anatomical diagnosis and simulated surgery with incisions and sutures. Thirteen patients (68.4%) were classified as “essential” by the primary surgeons after surgery, with a 95% confidence interval of 43.4–87.4%, meeting the primary endpoint. The product error within 90% of the total external and internal surfaces was 0.54 ± 0.21 mm. The super-flexible 3D heart models are accurate, reliable, and useful tools to assist surgeons in decision-making and allow for preoperative simulation in CHD.

DOI： 10.3390/jcdd11120387

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Effects of systemic ventricular assist in failing Fontan patients: a theoretical analysis using a computational model.

Eiri Kisamori, Yasuhiro Kotani, Toshiaki Shishido, Shingo Kasahara, Shuji Shimizu

The journal of physiological sciences : JPS 74 ( 1 ) 53 - 53 2024.11

Language：English Publishing type：Research paper (scientific journal)

Mechanical circulatory support is a potential treatment for failing Fontan patients. In this study, we performed a theoretical analysis using a computational model to clarify the effects of systemic ventricular assist device (VAD) in failing Fontan patients. Cardiac chambers and vascular systems were described using the time-varying elastance model and modified Windkessel model, respectively. A VAD was simulated as a nonlinear function. In systolic and diastolic ventricular dysfunction and atrioventricular valve regurgitation models, systemic VAD increased the cardiac index and decreased the central venous pressure (CVP). However, in the high pulmonary vascular resistance model, CVP became extremely high above 15 mmHg to maintain the cardiac index when the pulmonary vascular resistance index (PVRI) was above 5 Wood units m2. In Fontan patients with ventricular dysfunction or atrioventricular valve regurgitation, systemic VAD efficiently improves the hemodynamics. In Fontan patients with PVRI of > 5 Wood units m2, systemic VAD seems ineffective.

DOI： 10.1186/s12576-024-00946-z

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Expression of c-jun/c-fos mRNA Indicates Persistent Myocardial Stretch During Asphyxia-Induced Cardiac Arrest

Yutaka Yokota, Sachiko Kadowaki, Satoru Yamazaki, Yuya Nishida, Toshiaki Shishido, Shuji Shimizu, Shingo Kasahara, Yasuhiro Kotani

International Heart Journal 65 ( 5 ) 939 - 944 2024.9

Effects of dapagliflozin on myoglobin efflux from cardiomyocyte during myocardial ischemia/reperfusion in anesthetized rats. Reviewed International journal

Tomohiro Hayashida, Yosuke Kuroko, Shuji Shimizu, Tsuyoshi Akiyama, Takanori Suezawa, Yukio Kioka, Yasuhiro Kotani, Toshiaki Shishido, Shingo Kasahara

Scientific reports 14 ( 1 ) 16337 - 16337 2024.7

Language：English Publishing type：Research paper (scientific journal)

It has been suggested that sodium-glucose cotransporter 2 (SGLT2) inhibitors have cardioprotective effects during myocardial ischemia/reperfusion (I/R) independent of glucose-lowering action. However, the effects of SGLT2 inhibitors on structural damage to cardiomyocytes in the ischemic region during I/R remain unknown. We applied a microdialysis technique to the heart of anesthetized rats and investigated the effects of an SGLT2 inhibitor, dapagliflozin, on myocardial interstitial myoglobin levels in the ischemic region during coronary occlusion followed by reperfusion. Dapagliflozin was administered systemically (40 μg/body iv) or locally via a dialysis probe (100 μM and 1 mM) 30 min before coronary occlusion. In the vehicle group, coronary occlusion increased the dialysate myoglobin concentration in the ischemic region. Reperfusion further increased the dialysate myoglobin concentration. Intravenous administration of dapagliflozin reduced dialysate myoglobin concentration during ischemia and at 0-15 min after reperfusion, but local administration (100 μM and 1 mM) did not. Therefore, acute systemic administration of dapagliflozin prior to ischemia has cardioprotective effects on structural damage during I/R.

DOI： 10.1038/s41598-024-67195-3

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Long-term outcome and cardiac function after anatomic repair of congenitally corrected transposition. Reviewed International journal

Fumi Yokohama, Norihisa Toh, Yasuhiro Kotani, Yoichi Takaya, Yosuke Kuroko, Kenji Baba, Teiji Akagi, Shingo Kasahara, Hiroshi Ito

Interdisciplinary cardiovascular and thoracic surgery 38 ( 3 ) 2024.3

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: There is limited information on long-term outcomes and trajectories of ventricular and valvular functions in patients with congenitally corrected transposition of the great arteries after anatomic repair according to the operative strategy with a median follow-up period of more than 10 years. METHODS: Twenty-nine patients who underwent anatomic repair in Okayama University Hospital between January 1994 and December 2020 were reviewed. Outcomes were compared between patients who underwent a double switch operation (DS group) and patients with an atrial switch with a Rastelli operation (Rastelli-Senning/Mustard group). RESULTS: Fifteen (52%) were in the DS group and 14 (48%) were in the Rastelli-Senning/Mustard group. The median follow-up period after anatomic repair was 12.7 (interquartile range 4.2-18.8) years. There were 3 (10%) early deaths and 3 (10%) late deaths. Survival rates for the entire cohort at 10 and 20 years were 86% and 71%, respectively, and were not different between the 2 groups. Using competing risk analysis, risks of heart failure, cardiac rhythm device implantation and atrial arrhythmia showed no significant differences between the 2 groups, whereas risk of reoperation was higher in the Rastelli-Senning/Mustard group than that in the DS group. Four patients after a DS operation and 1 patient after a Rastelli technique developed more than moderate aortic regurgitation. CONCLUSIONS: During a median follow-up period of more than 10 years, mortality rate and ventricular and valvular functions after anatomic repair were acceptable, though the incidences of late complications were relatively high, especially in the Rastelli-Senning/Mustard group.

DOI： 10.1093/icvts/ivae033

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Staged repair for complete atrioventricular septal defect in patients weighing less than 4.0 kg Reviewed

Yasuyuki Kobayashi, Shingo Kasahara, Shunji Sano, Hiroyuki Suzuki, Etsuji Suzuki, Takashi Yorifuji, Yasuhiro Kotani

The Journal of Thoracic and Cardiovascular Surgery 167 ( 3 ) 1136 - 1144 2024.3

成人期における修正大血管転位症患者の臨床像

小谷恭弘, 杜徳尚, 黒子洋介, 小林純子, 川畑拓也, 馬場健児, 赤木禎治, 笠原真悟

日本成人先天性心疾患学会雑誌 13 ( 1 ) 120 - 120 2024.1

TOF術後遠隔期に大動脈基部拡大および大動脈弁逆流のためCabrol法にてBentall手術を行った1例

黒子洋介, 小林純子, 小谷恭弘, 笠原真悟

日本成人先天性心疾患学会雑誌 13 ( 1 ) 118 - 118 2024.1

Minimally Invasive Surgical Repair of Simple Congenital Heart Defects Using the Right Vertical Infra-Axillary Thoracotomy Approach. International journal

Dien Minh Tran, Vinh Quang Tran, Mai Tuan Nguyen, Duyen Dinh Mai, Anh Vuong Doan, Son Thanh Hoang, Yasuhiro Kotani, Truong Ly-Thinh Nguyen

Innovations (Philadelphia, Pa.) 19 ( 5 ) 520 - 525 2024

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: To evaluate the safety and efficacy of surgical repair for patients diagnosed with simple congenital heart defects (CHD) using the minimally invasive right vertical infra-axillary minithoracotomy (RVIAT) approach. METHODS: We retrospectively reviewed the clinical data of consecutive patients who underwent minimally invasive RVIAT for repair of CHD between August 2019 and August 2022. There were 382 patients who underwent 8 primary procedures and were included in this study. RESULTS: The median age of the patients was 16.2 (interquartile range [IQR], 7.2 to 41.9) months, and the median weight of the patients was 8.8 (IQR, 6.5 to 14) kg. The preoperative diagnoses were as follows: ventricular septal defect, atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, cor triatriatum, complete atrioventricular septal defect, and myxoma. The mean aortic cross-clamp time, bypass time, and operation time were 45.4 ± 19.3 min, 65.6 ± 23.1 min, and 154.5 ± 29.7 min, respectively. There was no in-hospital mortality or conversion to median sternotomy. Two patients (0.5%) required early reoperation; 1 due to postoperative bleeding and 1 for permanent pacemaker implantation. Other complications included trivial residual shunts (23 of 382, 6%), pleural effusion (3 of 382, 0.8%), pneumothorax (0.8%), and wound infection (4 of 382, 1%). There were 2 late noncardiac deaths. Late reoperation was performed on 1 patient with progressive aortic valve regurgitation who required aortic valvuloplasty. CONCLUSIONS: RVIAT is a minimally invasive approach that can be safely performed on patients with simple CHDs. RVIAT may be a good alternative approach for median sternotomy and cardiac intervention.

DOI： 10.1177/15569845241273650

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Video-assisted transarterial modified Konno procedure with concurrent myectomy for hypertrophic obstructive cardiomyopathy Reviewed

Hiroyuki Suzuki, Yasuhiro Kotani, Shunji Sano, Shingo Kasahara

JTCVS ( 22 ) 261 - 264 2023.12

Detection of hepatocellular carcinoma during Fontan-associated liver disease follow-up: a report of three cases

Hideki Onishi, Norihisa Toh, Teiji Akagi, Kenji Baba, Yasuhiro Kotani, Akinobu Takaki, Shingo Kasahara, Hiroshi Ito

Clinical Journal of Gastroenterology 17 ( 1 ) 148 - 154 2023.11

Intravenous infusion of cardiac progenitor cells in animal models of single ventricular physiology. Reviewed International journal

Takuya Goto, Daiki Ousaka, Kenta Hirai, Yasuhiro Kotani, Shingo Kasahara

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 64 ( 4 ) 2023.10

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: The goal of this study was to identify the practical applications of intravenous cell therapy for single-ventricle physiology (SVP) by establishing experimental SVP models. METHODS: An SVP with a three-stage palliation was constructed in an acute swine model without cardiopulmonary bypass. A modified Blalock-Taussig (MBT) shunt was created using an aortopulmonary shunt with the superior and inferior venae cavae (SVC and IVC, respectively) connected to the left atrium (n = 10). A bidirectional cavopulmonary shunt (BCPS) was constructed using a graft between the IVC and the left atrium with an SVC cavopulmonary connection (n = 10). The SVC and the IVC were connected to the pulmonary artery to establish a total cavopulmonary connection (TCPC, n = 10). The survival times of half of the animal models were studied. The other half and the biventricular sham control (n = 5) were injected intravenously with cardiosphere-derived cells (CDCs), and the cardiac retention of CDCs was assessed after 2 h. RESULTS: All SVP models died within 20 h. Perioperative mortality was higher in the BCPS group because of lower oxygen saturation (P < 0.001). Cardiac retention of intravenously delivered CDCs, as detected by magnetic resonance imaging and histologic analysis, was significantly higher in the modified Blalock-Taussig and BCPS groups than in the TCPC group (P < 0.01). CONCLUSIONS: Without the total right heart exclusion, stage-specific SVP models can be functionally constructed in pigs with stable outcomes. Intravenous CDC injections may be applicable in patients with SVP before TCPC completion, given that the initial lung trafficking is efficiently bypassed and sufficient systemic blood flow is supplied from the single ventricle.

DOI： 10.1093/ejcts/ezad304

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Doubly committed ventricular septal defect: Is it safe to perform surgical closure through the pulmonary trunk approached by right vertical axillary thoracotomy? Reviewed International journal

Uoc Huu Nguyen, Truong Ly Thinh Nguyen, Yasuhiro Kotani, Mai Tuan Nguyen, Duyen Dinh Mai, Van Anh Thi Nguyen, Nam Trung Nguyen

JTCVS open 15 368 - 373 2023.9

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: This study investigated the safety of performing surgical repair for doubly committed ventricular septal defects by right vertical infra-axillary minithoracotomy (RVIAT). METHODS: A retrospective comparative study was performed to evaluate the outcomes of patients who underwent doubly committed ventricular septal defects closure from January 2019 to May 2022. Seventy-four patients were enrolled in the study and treated with either the median sternotomy approach (MSA: n = 37) or the RVIAT approach (RVIAT: n = 37). RESULTS: The median weight and age in the MSA group were significantly lower than those in the RVIAT group (MSA: 6.0 kg [interquartile range] (IQR), 5.2 to 8.7 kg] vs RVIAT: 7.5 kg [IQR, 5.6-14 kg]; P = .034 and MSA: 4.9 months [IQR, 3.6-9.4 month] vs 9.6 months [IQR, 5.0-60.4 months]; P = .0084). No patients died, and no patients in the RVIAT group required conversion to the MSA approach. The mean prebypass surgical time was longer in the RVIAT group (36.1 ± 8.2 minutes vs 31.8 ± 5.6 minutes; P = .03). There were no significant differences between the 2 groups in cardiopulmonary bypass time, aortic crossclamp time, or operation time. Significantly shorter ventilation times were observed in the RVIAT group (11.9 ± 8.2 hours vs 15.4 ± 6.3 hours; P = .006). CONCLUSIONS: Closure of doubly committed ventricular septal defects through the pulmonary trunk by the RVIAT approach is feasible and safe, and does not increase the risk of bypass-related complications.

DOI： 10.1016/j.xjon.2023.06.012

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When to intervene the pulmonary artery: Importance of anatomical assessment in the diagnosis of pulmonary artery coarctation. Reviewed International journal

Eiri Kisamori, Yasuhiro Kotani, Hiroyuki Suzuki, Junko Kobayashi, Takuya Kawabata, Yosuke Kuroko, Shingo Kasahara

The Journal of thoracic and cardiovascular surgery 166 ( 3 ) 926 - 932 2023.9

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Pulmonary artery coarctation (PACoA) is a major problem that increases the frequency of intervention. However, there is little evidence regarding the prediction of PACoA development. METHODS: A retrospective chart review was performed on 42 patients who underwent modified Blalock-Taussig shunt and preoperative contrast-enhanced computed tomography. An uneven PA branching was defined as an abnormal ductus arteriosus connection to the left PA distal to the PA branching on contrast-enhanced computed tomography. RESULTS: Nineteen (45.2%) of 42 patients were diagnosed with PACoA. The median diameters of the ductus on the aorta and PA sides were 4.1 mm and 3.6 mm in the PACoA group and 3.6 mm and 2.9 mm in the non-PACoA group, respectively (P = .07 and .28, respectively). Tortuous ductus was recognized in 7 (36.8%) patients in the PACoA group and 14 (60.8%) patients in the non-PACoA group (P = .12). PACoA was associated with pulmonary atresia (16 patients [84.2%] in the PACoA group and 12 patients [52.1%] in the non-PACoA group) (P = .02). All 19 patients had uneven PA branching in the PACoA group, whereas 5 of 23 (21.7%) patients had uneven PA branching in the non-PACoA group (P < .001). CONCLUSIONS: Uneven PA branching rather than the ductus arteriosus size was strongly associated with PACoA development; therefore, morphologic assessment by contrast-enhanced computed tomography should be considered in patients with pulmonary atresia.

DOI： 10.1016/j.jtcvs.2023.02.021

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Surgical management of a low-birth-weight neonate with ductal-dependent pulmonary circulation. Reviewed International journal

Yoshinori Inoue, Hiroyuki Suzuki, Shingo Kasahara, Yasuhiro Kotani

The Journal of thoracic and cardiovascular surgery 2023.8

大動脈離断/心室中隔欠損症の術後遠隔期の検討

福嶋遥佑, 大月審一, 馬場健児, 近藤麻衣子, 栗田佳彦, 重光祐輔, 平井健太, 原真祐子, 岩崎達雄, 笠原真悟, 小谷恭弘

日本小児循環器学会総会・学術集会抄録集 59回 [II - 06] 2023.7

Diamond-like carbon coating to inner surface of polyurethane tube reduces Staphylococcus aureus bacterial adhesion and biofilm formation

Noriaki Kuwada, Yasuhiro Fujii, Tatsuyuki Nakatani, Daiki Ousaka, Tatsunori Tsuji, Yuichi Imai, Yasuyuki Kobayashi, Susumu Oozawa, Shingo Kasahara, Kazuo Tanemoto

Journal of Artificial Organs 27 ( 2 ) 108 - 116 2023.5

Publishing type：Research paper (scientific journal) Publisher：Springer Science and Business Media LLC

Abstract

Staphylococcus aureus is one of the main causative bacteria for polyurethane catheter and artificial graft infection. Recently, we developed a unique technique for coating diamond-like carbon (DLC) inside the luminal resin structure of polyurethane tubes. This study aimed to elucidate the infection-preventing effects of diamond-like carbon (DLC) coating on a polyurethane surface against S. aureus. We applied DLC to polyurethane tubes and rolled polyurethane sheets with our newly developed DLC coating technique for resin tubes. The DLC-coated and uncoated polyurethane surfaces were tested in smoothness, hydrophilicity, zeta-potential, and anti-bacterial properties against S. aureus (biofilm formation and bacterial attachment) by contact with bacterial fluids under static and flow conditions. The DLC-coated polyurethane surface was significantly smoother, more hydrophilic, and had a more negative zeta-potential than did the uncoated polyurethane surface. Upon exposure to bacterial fluid under both static and flow conditions, DLC-coated polyurethane exhibited significantly less biofilm formation than uncoated polyurethane, based on absorbance measurements. In addition, the adherence of S. aureus was significantly lower for DLC-coated polyurethane than for uncoated polyurethane under both conditions, based on scanning electron microscopy. These results show that applying DLC coating to the luminal resin of polyurethane tubes may impart antimicrobial effects against S. aureus to implantable medical polyurethane devices, such as vascular grafts and central venous catheters.

DOI： 10.1007/s10047-023-01403-1

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Other Link： https://link.springer.com/article/10.1007/s10047-023-01403-1/fulltext.html

Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects. Reviewed International journal

Yasuyuki Kobayashi, Shingo Kasahara, Shunji Sano, Yasuhiro Kotani

The Journal of thoracic and cardiovascular surgery 165 ( 2 ) 411 - 421 2023.2

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: We compared 2-patch repair (TP) with modified single-patch repair (MSP) for complete atrioventricular septal defects and evaluated their effect on the left atrioventricular valve (LAVV) competence. We also identified risk factors for unfavorable functional outcomes. METHODS: This retrospective study included 118 patients with complete atrioventricular septal defects who underwent intracardiac repair from 1998 to 2020 (MSP: 69; TP: 49). The median follow-up period was 10.4 years. The functional outcome of freedom from moderate or greater LAVV regurgitation (LAVVR) was estimated using the Kaplan-Meier method. RESULTS: The hospital mortality was 1.7% (2/118) and late mortality was 0.8% (1/118). Eight patients required LAVV-related reoperation (MSP: 4; TP: 4) and none required left ventricular outflow tract-related reoperation. In the MSP group without LAVV anomaly, the receiver operating characteristic curve analysis revealed that the ventricular septal defect (VSD) depth was strongly associated with moderate or greater postoperative LAVVR, with the best cutoff at 10.9 mm. When stratified according to the combination of intracardiac repair type and VSD depth, the MSP-deep VSD (VSD depth >11 mm) group showed the worst LAVV competence among the 4 groups (P = .002). According to multivariate analysis, weight <4.0 kg, LAVV anomaly, and moderate or greater preoperative LAVVR were independent risk factors for moderate or greater postoperative LAVVR, whereas MSP was not a risk factor. CONCLUSIONS: Postoperative LAVVR remains an obstacle to improved functional outcomes. MSP provides LAVV competence similar to TP unless deep VSD is present. The surgical approach should be selected on the basis of anatomical variations, specifically VSD depth.

DOI： 10.1016/j.jtcvs.2022.07.041

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