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Journal and News Scan
March 6, 2025
Submitted by: Mateo Marin-Cuartas
The debate continues over long-term outcomes of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and multivessel disease. This study, based on the SWEDEHEART registry, analyzed 57,097 revascularized patients with NSTEMI and multivessel disease in Sweden from January 2005 to June 2022. The primary endpoint was all-cause mortality, encompassing both in-hospital and long-term mortality.
Percutaneous coronary intervention was the primary therapy in 42,190 patients (73.9 percent), while 14,907 (26.1 percent) received CABG. During a median follow-up of 7.1 years, PCI was associated with higher risks of death (adjusted odds ratio [aOR] 1.67; 95 percent confidence interval [CI] 1.54-1.81) and MI (aOR 1.51; 95 percent CI 1.41-1.62), but there was no significant difference in stroke. Repeat revascularization was three times more likely to PCI (aOR 3.01; 95 percent CI 2.57-3.51), while heart failure risk was 15 percent higher (aOR 1.15; 95% CI 1.07-1.25). CABG provided longer survival within 15 years, especially in patients under 70 years of age, with left main disease or left ventricular dysfunction, though, this benefit diminished over shorter time horizons.
The authors concluded that CABG is associated with lower risks of mortality, MI, repeat revascularization, and heart failure in patients with NSTEMI, particularly in high-risk subgroups. However, its survival benefit lessens with shorter life expectancy.
March 6, 2025
Submitted by: Erica Curcio
Lung cancer remains the leading cause of cancer-related deaths, and low-dose computed tomography screening can reduce mortality for high-risk individuals. In 2021, the US Preventive Services Task Force (USPSTF) expanded lung cancer screening (LCS) guidelines to include adults aged 50 to 79 with a history of 20 or more years of smoking, who are current or recent (within 15 years) smokers. This study analyzed data from the 2022 Behavioral Risk Factor Surveillance System to investigate the prevalence of LCS based on eligibility according to USPSTF criteria. This study found that nearly half of LCS was outside USPSTF recommendations, and ineligible individuals often sought screening despite not meeting the criteria. This raises concerns about the reasons for seeking screening among those not considered high risk. Further research is needed to understand the benefits and risks of screening outside of USPSTF guidelines.
February 27, 2025
Submitted by: Erica Curcio
This study analyzed mechanisms of repair failure after mitral valve repair using chordal replacement and annuloplasty for degenerative mitral regurgitation. Between 2003 and 2010, 344 patients underwent mitral valve repair at the German Heart Center Munich. After a mean follow-up of 9.7 years, 38 patients (11 percent) required reoperation, with causes of failure being disease progression (39.5 percent), technical failure (38.8 percent), and endocarditis (18.4 percent). Re-repair was performed in 28.9 percent of cases, often involving redo annuloplasty or chordal replacement. Mitral valve replacement was needed in 63.2 percent of cases, particularly in patients with mitral valve sclerosis. Redo mitral valve repair was more common for technical failure, while mitral valve replacement was more often needed for valve sclerosis.
February 27, 2025
Submitted by: Akshay Patel
This article presents findings from the second-ever pig-to-human heart xenotransplant. A 58-year-old patient with end-stage heart failure received a 10-gene-edited porcine heart and was maintained on a novel anti-CD40L immunosuppressive regimen. Initially, the graft functioned well, but by day 31, the patient developed severe diastolic heart failure and required ECMO. The xenograft ultimately failed due to endothelial injury and antibody-mediated rejection (AMR), despite aggressive immunosuppression. No evidence of porcine cytomegalovirus was found, ruling out infection as a contributing factor.
This study is crucial for cardiothoracic surgery, highlighting both the progress and ongoing challenges in xenotransplantation. These findings provide insights into improving immunosuppressive strategies, refining donor selection, and overcoming rejection, bringing xenotransplantation closer to clinical viability as an alternative to human heart transplantation.
February 27, 2025
Submitted by: Mateo Marin-Cuartas
In this official statement, the European Society of Cardiology advocates for the evolution of the Medical Device Regulation (MDR) system to facilitate priority access for innovative devices addressing unmet needs and orphan cardiovascular medical devices in the European Union. It also calls for global regulatory harmonization to streamline cardiovascular medical device authorization across jurisdictions, enabling reprocessing of single-use devices, and encouraging early feasibility studies to assess initial safety and performance, thus accelerating device development and adoption. This report presents a proposal to improve medical device authorization worldwide while protecting patient safety.
February 27, 2025
Submitted by: Joel Dunning
Heart transplants from donation after circulatory death (DCD) donors are well-established for adults in the United Kingdom, but extending this practice to pediatric heart transplants has been slow and difficult despite a severe donor shortage. Barriers include ethical concerns, technology gaps, and logistical challenges. This article urges action to establish a sustainable pediatric DCD cardiac program in the United Kingdom and offers insights for other countries facing similar issues.
February 20, 2025
Submitted by: Javeria Tariq
This study reported the initial experiences of 115 patients who underwent robot-assisted thoracic surgery using the da Vinci single-port robotic system. The procedures included thymectomy, mediastinal mass excision, anatomical pulmonary resection, esophagectomy, and esophageal tumor enucleation. No conversions to thoracotomy or sternotomy were required, and only one patient required conversion to video-assisted thoracic surgery, with minimal postoperative complications. The findings suggest that single-port robot-assisted thoracic surgery is feasible and safe, with the potential for expanded use as robotic technology continues to advance.
February 20, 2025
Submitted by: Javeria Tariq
This study compared perioperative and oncological outcomes between modified subxiphoid video-assisted thoracoscopic surgery (VATS) thymectomy and median sternotomy thymectomy for locally advanced thymic malignancies. A propensity score–matched analysis of 144 patients revealed that the VATS approach resulted in shorter operative duration, less blood loss, faster recovery, and fewer complications, with no significant difference in complete resection rates. Survival analyses indicated similar recurrence-free and overall survival between the two groups. These findings suggest that modified subxiphoid VATS thymectomy is a safe and effective alternative for selected patients, although further prospective studies are needed for long-term evaluation.
February 20, 2025
Submitted by: Jade Qu
This retrospective single-center study evaluates the outcomes of isolated single lung transplants (SLT) (one usable, one declined lung) compared to split SLTs (both lungs are used for different recipients). Approximately 80 percent of lung transplants are bilateral, leading to a paucity of literature on isolated SLT outcomes. A total of 164 patients underwent split SLT, and 271 received an isolated SLT. Survival rates did not differ significantly between isolated and split SLT recipients (HR 0.97, CI 0.72–1.33, p = 0.87), with no significant differences found in the need for ECMO, postoperative ventilation, or length of hospitalization. These findings suggest that isolated SLT is a safe and viable option, offering survival outcomes comparable to those of split SLT. This could indicate that well-selected isolated donor lungs can be used safely, expanding the limited donor pool and reducing waitlist mortality.
February 20, 2025
Submitted by: Akshay Patel
This group presents a standardized, step-by-step technique for robotic-assisted lung transplantation. The authors describe port placement strategies, dissection techniques, and sequential anastomosis to optimize surgical precision while minimizing trauma. The study highlights key benefits of robotic lung transplantation, including reduced postoperative pain, faster recovery, and improved wound healing. Special considerations, such as anesthetic management, extracorporeal membrane oxygenation (ECMO) strategies, and gas insufflation techniques, are also addressed to enhance surgical feasibility and patient safety.
This research is highly relevant to the cardiothoracic surgery community as it introduces a minimally invasive alternative to conventional lung transplantation, potentially revolutionizing the field. The findings provide valuable insights into adopting robotic-assisted techniques, improving surgical outcomes, and expanding the role of advanced technology in complex thoracic procedures.