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Objectives To mitigate the shortage of homograft sources, the use of handmade trileaflet expanded polytetrafluoroethylene valves in pulmonary valve replacement has shown excellent results from multicentre studies conducted in Japan. However, world-wide data outside Japan is relative insufficient. This study presents the long-term results of a single surgeon’s use of flipped-back trileaflet method in a 10-year case series. Methods We have developed an efficient way to make a trileaflet-valved conduit utilizing flipped-back method for pulmonary valve replacement and have employed the technique since 2011. Retrospective data were studied between October 2010 and January 2020. Echocardiography, electrocardiogram, Pro-Brain Natriuretic Peptide, and Magnetic Resonance Imaging data were analyzed. Results 55 patients were reviewed and median follow-up duration was 2.9 years. The majority of diagnoses was Tetralogy of Fallot (n = 41), and these patients subsequently underwent secondary pulmonary valve replacement at a median age of 15.6 years. Survival was 92.7% with the longest follow-up period being 10 years. There was no need for reoperation, and freedom from reintervention was 98.0% at 10 years. There were 4 deaths (3 in-hospital and 1 outpatient). One patient eventually received transcatheter pulmonary valve implantation. Postoperative echocardiography showed mild or less pulmonary stenosis and pulmonary regurgitation degree in 92.2% and 92.0% of patients, respectively. Comparable magnetic resonance imaging data (n = 25) showed significant reduction in right ventricular volumes but not in ejection fractions. Conclusion Our series showed satisfactory long-term function of handmade flipped-back trileaflet valved conduit used in our patients. The simple design is efficiently reproducible without complex fabrication process.

OBJECTIVES We report our surgical experience in congenitally corrected transposition of great arteries (CCTGAs) and the long-term follow-up result. METHODS From January 1995 to February 2012, 56 patients with CCTGA received definite surgical repair; 15 patients received conventional repair (Group I), 18 patients received anatomical repair (Group II) and 23 patients received single ventricular palliation (Group III). They were followed for early and late mortality, long-term survival, postoperative morbidity and reintervention or reoperation. RESULTS The overall survival rate was 80% at 16 years in Group I, 53% at 13 years in Group II and 100% at 13 years in Group III. After excluding the early surgical mortality, the long-term survival rate was 92% at 16 years in Group I, 64% at 13 years in Group II and 100% at 13 years in Group III. Patients with significant tricuspid valve regurgitation showed the worst outcome after surgery. CONCLUSIONS Our series showed good results with single ventricular palliation (SVP) in CCTGA with complex anatomy, but the long-term result should be followed. Anatomical repair is the choice of operation only for those with favourable anatomy. The more complicated intracardiac repair may result in late left ventricular outflow tract obstruction, various degrees of atrioventricular block, systemic or pulmonary venous return obstruction and the lack of an ideal conduit (e.g. homograft) for Rastelli reconstruction. Therefore, we preferred SVP in patients with complex and unfavourable anatomy.

OBJECTIVE Malignancy is the leading cause of death among heart-transplant recipients. There is a higher incidence of post-transplant malignancy in heart-transplant recipients than in kidney-transplant recipients. This study sought to assess the incidence of malignancy in heart-transplant recipients in Taiwan. METHODS This is a retrospective chart review. RESULTS From 1987 to 2008, 291 patients who underwent heart transplantation and survived for more than 1 month were enrolled. Seventeen patients (5.8%) developed de novo malignancies including skin cancers (three), post-transplant lymphoproliferative diseases (seven) and solid-organ malignancies (seven). Solid-organ malignancies affected prostate, liver, urinary bladder, kidney, lung, larynx, pancreas and brain in seven patients. Malignancy was responsible for 7% and 13% of all death for heart-transplant recipients who lived for more than 1 year and more than 5 years. The cumulative incidence of 1.03% at 1 year, 4.2% at 5 years and 8.1% at 10 years in our patients was much lower than the incidences reported in the multicentre registry of the International Society for the Heart and Lung Transplantation and in the Western series. The incidence was especially low for skin cancers. Compared with previous reports of kidney-transplant recipients in Taiwan, the incidence of post-transplant malignancy was not significantly increased. CONCLUSIONS The incidence of post-transplant malignancy was low in Chinese heart-transplant recipients compared with heart-transplant recipients in Western countries. It resulted from a relative rarity of skin cancers in the Chinese population.

Objective: Bloodstream infection (BSI) is a well-recognized problem and it affects 10—50% of solid organ transplant recipients. The purpose of this study was to assess the incidence and prognosis of BSI in heart transplant recipients at our hospital. Methods: The study is a retrospective chart review. Results: We diagnosed 101 episodes of BSI in 73 out of 306 heart transplant patients (24%) during the 12-year study period. BSI occurred at a median of 191 days (range 1—3376) after transplant and 50% occurred within 6 months after transplant. Most BSI episodes were nosocomial (73%), especially those occurring within the first month (94%). As far as pathogen was concerned, Gram-negative bacteria predominated (57%), followed by Gram-positive bacteria (34%), fungus (5%), anaerobics (2%), and cryptococcus (2%). Overall 30-day mortality rate was 30%. Death occurred in 36% (13/36) of the patients with early-onset BSI, 14% (2/14) of the patients with BSI in months 2—6, and 29% (15/ 51) of the patients with late-onset BSI. Mortality rate was over 50% in those patients with Pseudomonal infection, fungal infection, cryptococcal infection of central nervous system, lung infection, and severe sepsis. Compared to Western series, there was a high incidence of infections caused by Enterobacter species and Acinetobacter baumannii. Conclusions: There was a high incidence of BSI after heart transplantation in Taiwan, especially infections caused by Enterobacter species and A. baumannii. Mortality was high in patients with infection caused by Pseudomonas, Candida, and Cryptococcus and in patients with severe sepsis. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

We were glad to receive the comments from Ma et al. [1], regarding our recently published article [2]. This is a retrospective study with chart review using our patients’ medical records. In our data, there was no moderate to severe tricuspid regurgitation (TR) in our patients receiving single ventricle palliation (SVP) [2]. We chose to perform SVP in this group of patients due to the presence of severe pulmonary stenosis or pulmonary atresia combined with other anatomical restrictions (e.g. remote type ventricular septal defect (VSD), chordae straddling, unusual coronary artery pattern and unbalanced ventricle) [2]. There was only 1 patient with moderate TR receiving valve repair before the SVP, and the postoperative echo showed no aggravation of valve regurgitation [3]. Why was there no patient receiving SVP with severe TR in our study? We believed severe tricuspid valve regurgitation is not an indication for SVP, and anatomical repair might be helpful, despite the suboptimal long-term result [4]. We think the progress of TR severity is slow and insidious. When TR becomes apparent, it might be due to structural defects (i.e. Ebsteinoid anomalies) or be regarded as a sign of morphological RV dysfunction. We performed SVP in the early years of the patients’ lives (mean age of 8.6 years) to prevent TR progression in the near future and preserve ventricular function [2, 4–6]. Our article presented only the shortand mid-term results; the long-term follow-up results are still unknown. Although there is no consensus for the timing of performing surgical repair in patients without severe TR or cyanosis, we preferred to perform the operation earlier, before right ventricular failure [2, 5, 6]. Our patients with congenitally corrected transposition of the great arteries typically presented with cyanosis or other heart failure symptoms. Patients without symptoms usually do not seek medical help and are diagnosed accidentally for other medical diseases. If there were no major cardiac anatomical anomalies such as large VSD, severe pulmonary stenosis or atresia, and atrioventricular valve defects with severe valve regurgitation that would lead to heart failure in the future, surgical intervention would not be beneficial for these patients [6].