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Journal and News Scan
May 15, 2025
Submitted by: Jade Qu
This systematic review evaluated bar displacement following pectus excavatum repair focusing on studies assessing risk factors, stabilization methods, and reoperation strategies. Thirteen studies spanning 23 years were included, revealing bar displacement rates ranging from 0.9 percent to 33.3 percent.
Key patient-related risk factors included age and chest wall rigidity. Advanced surgical techniques—particularly bridge fixation, multipoint fixation, and adjunct stabilizers—demonstrated significant reductions in displacement rates. Specific studies highlighted the ZipFix system as a notably superior stabilization method.
The analysis underscores the necessity of personalized approaches in minimally invasive pectus excavatum repair (MIRPE) to address bar displacement. However, the lack of standardized protocols has resulted in insufficient data and consensus on optimal practices, such as the number of bars required or the most effective fixation methods to counteract Nuss bar rotational torque.
May 15, 2025
Submitted by: Mujtaba Mubashir
Type A aortic dissection is a highly morbid condition, where the patient's effective circulating blood volume (ECBV) is one of many predictors of outcomes. The authors propose a new parameter titled “effective circulating volume fraction" that serves to be a more precise measurement of ECBV. This was achieved by measuring the cross-sectional areas of the true lumens and the aorta at each level of computed tomography angiography, multiplying by the slice thickness, and then summing the results to calculate the overall volumes of the true lumens and the aorta, respectively.
May 15, 2025
Submitted by: Mateo Marin-Cuartas
The aim of this study was to compare the outcomes of mitral valve (MV) repair vs replacement after failed mitral transcatheter edge-to-edge repair (M-TEER). A total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER from 2009 to 2020. Outcomes were compared between MV repair and replacement. Primary outcomes included 30-day mortality and one-year survival after MV surgery.
Among enrolled patients (mean age 73.8 plus or minus 10.1 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 3.9 percent [Q1-Q3: 2.2 percent to 6.8 percent]), 25 (7.5 percent) underwent repair and 307 (92.5 percent) underwent replacement. The replacement group had a significantly higher rate of comorbidities, including atrial fibrillation, prior cardiac surgery, more secondary mitral regurgitation, and more devices implanted at index M-TEER (P < 0.05 for all). Replacement patients showed a trend toward higher 30-day mortality (17.7 percent [52 of 294] vs 4.0 percent [1 of 25]; P = 0.094). The observed-to-expected ratio of 30-day mortality was 3.6 (95 percent CI: 1.9-5.3) overall, 3.8 (95 percent CI: 2.1-5.5) in the replacement group, and 1.7 (95 percent CI: 0.7-3.3) in the repair group. Replacement patients had higher one-year mortality (33.3 percent [65 of 195] vs 10.5 percent [2 of 19]; P = 0.041). Significantly lower survival rates were observed after replacement at two years (P = 0.033) and persisted in the risk-adjusted Cox regression analysis (HR for replacement: 4.24; 95 percent CI: 1.04-17.31; P = 0.044).
The authors concluded that MV surgery after failed M-TEER is a high-risk procedure associated with higher than expected 30-day mortality, with higher mortality associated with MV replacement. Compared with repair, replacement is associated with higher one-year mortality and lower two-year survival.
May 15, 2025
Submitted by: Mateo Marin-Cuartas
Transcatheter aortic valve implantation (TAVI) has emerged as the treatment of choice for symptomatic severe aortic stenosis (AS) across the whole surgical risk spectrum. Current European guidelines recommend surgical aortic valve replacement (SAVR) for patients less than 75 years of age at low surgical risk, whereas US guidelines advocate for shared decision-making between SAVR and TAVI in patients aged 65 to 80 years, considering life expectancy and valve durability. Although SAVR with mechanical valves offers excellent durability, it is partially offset by significant challenges, including a higher thrombotic risk and the lifelong need for anticoagulation.
In addition, recent TAVI trials have shown potential benefits for younger, lower-risk populations, generating a growing interest in expanding its indications. Based on these considerations, whether the age threshold for TAVI should be lowered below 65 years of age remains a topic of debate. In this debate, the authors discuss the pros and cons of lowering the age threshold for TAVI.
May 7, 2025
Submitted by: Mujtaba Mubashir
Living allogeneic heart valve transplant (HVT) first emerged in 2022, featuring the unique advantage of being a valve capable of growth and self-repair over time, thus reducing the number of reoperations required in children undergoing valve intervention. This article summarizes the historical precedent for the use of growth-capable HVT, strategies for success, including the importance of preserving and implanting donor papillary musculature, and the reasons for long-term failure. Future research will focus on investigating the relationship between HVTs and donor-recipient size matching; acceptable warm and cold ischemic times, especially when papillary musculature is preserved; immunosuppression requirements; and the validation of current implantation protocols.
May 7, 2025
Submitted by: Jade Qu
This retrospective cohort study evaluated the impact of preoperative ischemic heart failure with reduced ejection fraction on long-term outcomes following coronary revascularization using either single or multiple arterial grafting techniques. Data from 59,641 patients (mean age 65.8 years; 81 percent male) across 59 cardiac centers (2001–2020) were analyzed, with patients stratified by perioperative left ventricular ejection fraction (EF). Over a median follow-up of five years, multiarterial grafting was associated with a 19 percent reduction in all-cause mortality for those with normal EF (hazard ratio [HR]=0.81, P<0.001), and similar benefits were observed in patients with mild (HR=0.83), moderate (HR=0.82), and severe left ventricular (LV) impairment (HR=0.82, P=0.01). Cox regression analysis showed no significant interaction between survival benefit and EF (P=0.75). Total arterial revascularization provided additional survival benefits except in cases with EF less than 30 percent (HR=0.87, P=0.30). These findings support the consistent survival advantage of multiarterial grafting across LV function levels and advocate for the broader use of these strategies.
May 7, 2025
Submitted by: Mujtaba Mubashir
This article highlights the growing utility of artificial intelligence (AI) and machine learning (ML) in the field of cardiothoracic surgery and discusses the current and potential future ethical and legal implications, as well as concerns regarding impact on data privacy and the trust between patients and physicians. The article also emphasizes the opportunities and utility of AI in the preoperative and postoperative periods, including the use of segmentation algorithms to accurately measure aortic dimensions for the planning of transcatheter aortic valve implantation, as well as algorithms to model and predict the development of right heart failure after left ventricular assist device implantation.
May 7, 2025
Submitted by: Jade Qu
This retrospective analysis compared three-port and four-port robotic-assisted thoracoscopic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC)(n=121, 2020–2021). Demographics, tumor characteristics, complications, and lymph node yields were similar between groups. While the three-port group showed trends toward shorter operative time (117.32 vs. 136.83 minutes), console time (90 vs. 103 minutes), less blood loss (94.34 vs. 102.73 mL), shorter chest tube duration (2.43 vs. 2.79 days), and shorter hospital stay (4.55 vs. 5.14 days), these differences were not statistically significant (p>0.05). However, three-port patients reported significantly less postoperative pain. In line with the trend toward uniportal video-assisted thoracoscopic surgery (VATS), the authors propose that fewer ports in RATS may offer benefits, warranting further investigation.
May 1, 2025
Submitted by: Jade Qu
Extended sleeve lobectomy (ESL) is considered a lung-sparing alternative to pneumonectomy (PN) for centrally located non-small cell lung cancer (NSCLC) when standard sleeve lobectomy (SSL) is not feasible. This retrospective study analyzed 94 patients who received neoadjuvant immunochemotherapy followed by either PN, ESL, or SSL. Patients undergoing ESL demonstrated lower predicted postoperative lung function compared to those who underwent PN. R0 resection rates were high across all groups, ranging from 94 to 98 percent, and postoperative complications were most frequent after PN (32.4 percent). Survival analysis showed no significant difference between ESL and SSL, but ESL offered longer event-free survival compared to PN. These findings indicate that ESL after neoadjuvant immunochemotherapy is a safe and effective option for selected patients, allowing for lung preservation without compromising oncologic outcomes, especially when SSL is insufficient for complete tumor removal.
May 1, 2025
Submitted by: Mateo Marin-Cuartas
Women with severe symptomatic aortic stenosis are underrepresented in clinical trials. The Randomized Research in Women All Comers with Aortic Stenosis (RHEIA) trial investigates the balance of benefits and risks of transcatheter aortic valve implantation (TAVI) compared to surgery in women. Women were randomized 1:1 to received either transfemoral TAVI with a balloon-expandable valve or surgical intervention. The primary composite endpoint was defined as death, stroke, or rehospitalization related to the valve, procedure, or heart failure within one year. Non-inferiority testing was conducted using a prespecified margin of 6 percent, alongside superiority testing in the as-treated population.
At 48 European centers, 443 women were randomized, with 420 receiving treatment as randomized. The mean age of participants was 73 years, and the mean estimated surgical risk of death was 2.1 percent, as determined by the Society of Thoracic Surgeons risk score. Kaplan–Meier estimates of the primary endpoint event rates at one year were 8.9 percent in the TAVI group and 15.6 percent in the surgery group. This difference of −6.8 percent, with an upper 95 percent confidence limit of −1.5 percent, demonstrated the non-inferiority of TAVI (P < 0.001). The two-sided 95 percent confidence interval of −13.0 percent to −0.5 percent further resulted in superiority (P = 0.034). The one-year incidence of the primary endpoint components was as follows: 0.9 percent for TAVI vs. 2.0 percent for surgery for death from any cause; 3.3 percent vs. 3.0 percent for stroke; and 5.8 percent vs. 11.4 percent for rehospitalization.
The authors concluded that among women with severe aortic stenosis, the incidence of the composite of death, stroke, or rehospitalization at one year was lower in the TAVI group compared to the surgery group.