Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors The work contains all elements of scientific work.
In the introduction, he explains the topic of the work,
static methods are appropriate, and the results are clearly presented through text and tables.
The discussion explains the results through comparison with other researches.
I am of the opinion that it is necessary to supplement the work with a clear explanation
of the indication for surgery, whether it is exclusively secondary tricuspid regurgitation.
In the paper, it is necessary to change the echocardiographic terminology, to use the
classification of mild, moderately severe and severe TR.
I am also of the opinion that the term "RV function good" or LV function good
should not be used. The above must be supported by clear indicators, LV EF, TAPSE. In the paper, it is necessary to explain the patient's functional status, NYHA classification.    

Author Response

Reviewer 1

Comment 1:

The work contains all elements of scientific work.
In the introduction, he explains the topic of the work,
static methods are appropriate, and the results are clearly presented through text and tables.
The discussion explains the results through comparison with other researches.

Response 1:

Thank you for the constructive remarks and feedback. We are happy to make the following changes:
Comment 2: I am of the opinion that it is necessary to supplement the work with a clear explanation of the indication for surgery, whether it is exclusively secondary tricuspid regurgitation.

Response 2: Commented on this in the study population section.
Comment 3: In the paper, it is necessary to change the echocardiographic terminology, to use the
classification of mild, moderately severe and severe TR.

Response 3: updated according to current guidelines.
Comment 4: I am also of the opinion that the term "RV function good" or LV function good
should not be used. The above must be supported by clear indicators, LV EF, TAPSE. Response 4: updated the preoperative table with clear classifications.

Comment 5: In the paper, it is necessary to explain the patient's functional status, NYHA classification.

Response 5: added this to the preoperative table as well.

Reviewer 2 Report

Comments and Suggestions for Authors

Minor comments

1. No air lock and no 30-day mortality in 31 patients are encouraging, but is thisis safe or equivalent to conventional bicaval cannulation? For zero-event outcomes, the upper 95% confidence bound remains clinically meaningful. Please report exact confidence intervals for air lock, mortality, conversion, stroke, ECMO, bleeding re-exploration, and pacemaker implantation if possible.
2. The central endpoint is prevention of venous air lock, yet the manuscript provides little objective perfusion data. Will it be possible to report cannula flow rates, use of vacuum-assisted venous drainage, venous line pressure, suction settings, CO2 insufflation rate, intraoperative hypercarbia management, TEE evidence of residual air, and any cannula repositioning or drainage inadequacy? Without these details, the proposed mechanism remains plausible but insufficiently documented.
3. Several numbers do not reconcile. Postoperative TR grades sum to 30 rather than 31, as do MR grades; RV and LV function categories also appear incomplete. The “non-surgical complications” sentence reports five patients but lists only three events. Baseline risk is underreported: EuroSCORE II/STS risk, NYHA class, RV function, pulmonary hypertension, hepatic/renal dysfunction, and TR mechanism should be included. At minimum, the authors should present missing-data denominators, standard definitions, and 30-day follow-up beyond discharge; longer follow-up would materially strengthen the paper.

Editorial issues: The manuscript needs language editing for grammar and surgical terminology. Examples include “minimal invasive,” “charachteristics,” “smart canula,” “air block/air lock,” “TOE/TEE” inconsistency, and the typo stating 730 mm cannula use for patients ≥170 mm rather than ≥170 cm. The abstract and conclusion could be shortened and toned down as well.

Author Response

 

1. No air lock and no 30-day mortality in 31 patients are encouraging, but is thisis safe or equivalent to conventional bicaval cannulation? For zero-event outcomes, the upper 95% confidence bound remains clinically meaningful. Please report exact confidence intervals for air lock, mortality, conversion, stroke, ECMO, bleeding re-exploration, and pacemaker implantation if possible.

Comment 1: thank you for your feedback. We added 95% CI to the tables 2 and 3.

1. The central endpoint is prevention of venous air lock, yet the manuscript provides little objective perfusion data. Will it be possible to report cannula flow rates, use of vacuum-assisted venous drainage, venous line pressure, suction settings, CO2 insufflation rate, intraoperative hypercarbia management, TEE evidence of residual air, and any cannula repositioning or drainage inadequacy? Without these details, the proposed mechanism remains plausible but insufficiently documented.

Comment 2: yes, absolutely! Will add a paragrph on these details in the surgical technique section

1. Several numbers do not reconcile. Postoperative TR grades sum to 30 rather than 31, as do MR grades; RV and LV function categories also appear incomplete. The “non-surgical complications” sentence reports five patients but lists only three events. Baseline risk is underreported: EuroSCORE II/STS risk, NYHA class, RV function, pulmonary hypertension, hepatic/renal dysfunction, and TR mechanism should be included. At minimum, the authors should present missing-data denominators, standard definitions, and 30-day follow-up beyond discharge; longer follow-up would materially strengthen the paper.

Comment 3: thank you! We corrected the numerical mistakes and added more data in the preoperative table to better illustrate the demographic characteristics. We added a comment on the etiology/mechanism of TR in the study population section. We agree that a follow-up would strengthen the paper, yet, we are not able to collect this data on such short notice. We definitely will for future research.

Editorial issues: The manuscript needs language editing for grammar and surgical terminology. Examples include “minimal invasive,” “charachteristics,” “smart canula,” “air block/air lock,” “TOE/TEE” inconsistency, and the typo stating 730 mm cannula use for patients ≥170 mm rather than ≥170 cm. The abstract and conclusion could be shortened and toned down as well.

Response: corrected all the above, but havent found the TEE typo though. Also, smartcanula is a registered name, with one n. Apart from that, I refer to cannulas.