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Journal and News Scan
A meta-analysis of nine studies involving 8,557 patients found that early chest tube removal after cardiac surgery was associated with a higher risk of pericardial effusion, although it resulted in shorter hospital stays without significant differences in mortality or postoperative infections. The findings suggest that while early removal may be safe in terms of mortality and infections, it should be approached with caution and monitored closely for potential complications.
This novel study examined tricuspid annular (TA) remodeling in conscious, awake sheep with functional tricuspid regurgitation (FTR) using tachycardia-induced cardiomyopathy. Fifteen sheep underwent thoracotomy with sonomicrometry crystal implantation around the TA and right ventricular epicardium. Eight surviving animals had baseline measurements acquired while awake, then underwent pacing (180-240 bpm for 18±2 days) until developing FTR. The model produced moderate-severe FTR, with a 48 percent increase in right ventricular (RV) volume, a 57 percent enlargement of the TA area, and a 24 percent perimeter expansion. Critically, all annular segments dilated significantly: the anterior perimeter increased by 27 percent, the posterior perimeter increased by 17 percent, and the septal perimeter by 25 percent (all p<0.01), with the TA area contraction decreasing from 16.6 percent to 4.5 percent. The authors conclude that septal annular dilation, which has traditionally been unsupported by partial rings, may explain high annuloplasty failure rates, suggesting that complete annular support could improve surgical durability in severe FTR.
In this propensity score matched analysis of 1,531 patients undergoing mitral valve surgery, women presented at an older age, with more advanced symptoms and more complex valve pathology than men. Female patients more frequently exhibited Carpentier type IIIA disease, annular calcification, and concomitant tricuspid involvement, resulting in lower rates of mitral valve repair and minimally invasive surgery. Women experienced higher mortality rates at 30 days and five years. However, after adjusting for valve morphology, calcification, and surgical strategy, sex was no longer an independent predictor of repair rates or long-term survival. These findings indicate that adverse outcomes in women are primarily driven by delayed referrals and more complex disease rather than sex itself, highlighting the need for earlier recognition and intervention.
This study from the Mini-Mitral International Registry (2015-2021) compared endo-aortic balloon occlusion (EABO) to transthoracic clamping (TTC) in minimally invasive mitral valve surgery. After propensity matching 733 pairs from 6,884 patients, EABO showed significantly lower rates of conversion to sternotomy, although it was associated with longer cardiopulmonary and intubation times. Mortality, stroke, bleeding, vascular complications, ICU stay, and hospital length were similar between the groups. The authors concluded that both techniques are excellent options, but EABO reduces sternotomy conversion rates.
This retrospective analysis of the UNOS registry investigated patients after the latest allocation revision and examined whether ex vivo heart perfusion (EVHP) mitigated ischemic penalties in adult donation-after-brain-death heart transplants with preservation times of six hours or more. Among 546 recipients who met the criteria (320 receiving EVHP and 226 undergoing static/hypothermic storage), EVHP was associated with superior one-year survival (92.5 percent vs 86.3 percent, p=0.029) and three-year survival (90.9 percent vs 79.6 percent, p<0.001). Multivariable Cox regression confirmed that EVHP reduced the risk of mortality (HR 1.90 for non-EVHP, 95 percent CI 1.08-3.35, p=0.027), with benefits concentrated at high-volume centers. Spline analyses demonstrated an increase in mortality with prolonged preservation in static storage, attenuated by EVHP. The authors conclude that EVHP offsets the survival penalty associated with ischemic times of six hours or more, potentially enabling safer long-distance procurement and broader donor utilization.
Alessandro Tamburrini, a consultant thoracic surgeon, reflects on how Professor Peter Altman saved his life as a child with an advanced pelvic rhabdomyosarcoma through innovative treatment and surgery. Inspired by Altman’s compassion and expertise, Tamburrini dedicated his career to medicine, aiming to pay forward the second chance he received.
This propensity score-matched cohort study compared long-term outcomes of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in 2,033 matched pairs of women with chronic severe coronary artery disease. The mean age was 66.5 years, with a median follow-up of 5.1 years. PCI was associated with a significantly higher risk of major adverse cardiovascular and cerebral events (MACCE) compared with CABG (hazard ratio [HR] 1.81). All-cause mortality was also higher after PCI (HR 1.34), as was cardiovascular readmission for myocardial infarction, heart failure, or stroke (HR 1.40). These real-world data show a consistent long-term survival and event-free advantage for CABG over PCI in women with severe chronic coronary artery disease (CAD), supporting CABG as the preferred revascularization strategy in this context.
In this study, the authors report the long-term outcomes of the randomized phase II NEOpredict-Lung trial, which evaluates short-course neoadjuvant nivolumab with or without the LAG-3 inhibitor relatlimab in resectable non-small cell lung cancer (NSCLC). Sixty patients with stage IB to IIIA disease received two preoperative cycles of immunotherapy followed by surgery. With a median follow-up of 37 months, the three-year overall survival approached 89 percent in both arms, with durable disease-free survival and low recurrence rates. A major pathological response was associated with improved outcomes. The combination arm showed higher nodal downstaging rates, suggesting a potential added biological effect of LAG-3 blockade. These results support chemotherapy-free neoadjuvant immunotherapy as a feasible and promising strategy, especially in patients who are sensitive to immune checkpoint inhibitors.
This case report describes a 62-year-old man with exertional dyspnea due to a massive, serpentine right coronary artery aneurysm with fistulization to the coronary sinus, causing significant left-to-right shunt and right heart dilation. Given the large size and complex anatomy, transcatheter closure was deemed unsuitable. The team performed complete aneurysm unroofing, fistula ligation, and comprehensive revascularization using a reversed saphenous vein graft to construct a neo–right coronary artery with eight sequential bypasses. Postoperative imaging confirmed patent grafts and normalized anatomy. At one-year post-surgery, the patient remained asymptomatic.
Mesfin Yana Dollar, who received life-saving heart surgery as a teenager in the United States, now collaborates with Dr. Jim Kauten, the surgeon who saved him, as a cardiac perfusionist at the Mayo Clinic. Together, they perform advanced open-heart surgeries and participate in medical missions to help patients in Ethiopia.