ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
Journal and News Scan
October 31, 2024
Submitted by: Mujtaba Mubashir
The role of transcatheter aortic valve replacement (TAVR) for the treatment of aortic stenosis in the pre- and post-lung transplant population is limited. This specific patient population is considered high risk for general anesthesia and for surgical aortic valve replacement. The authors report a series of 10 patients, which is the largest series to date. Of these patients, five underwent TAVR before and five underwent TAVR after a lung transplant. All transplants were performed via a transfemoral approach, with the majority (9/10) performed under monitored anesthesia care (MAC). The only TAVR-related complication in each group was a heart block requiring a pacemaker (2/10), while morbidity was related to transplant medical issues or end-stage lung disease itself. The authors’ initial experience suggests that TAVR is a safe and feasible option for treatment of aortic stenosis both in patients awaiting lung transplant and patients who have already undergone lung transplant.
October 31, 2024
Submitted by: Jessica Luc
This study investigates racial and ethnic disparities in representation and salary among academic cardiothoracic surgeons in the United States. The authors analyzed data from the Accreditation Council of Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) from 2021 and 2022. They noted that salary information was limited for groups with fewer than six surgeons.
The findings revealed that out of 758 academic cardiothoracic surgeons, 64.9 percent were White, 25.2 percent were Asian, and underrepresented groups included 3.3 percent Black or African American, 4.9 percent Hispanic or Latino, and 1.7 percent from other ethnicities. Specifically, at the professor level, the demographics were even less diverse, with 74.6 percent White.
Salary disparities were significant. Asian faculty earned between 89 percent to 171 percent, Black or African American faculty between 59 percent to 94 percent, and Hispanic or Latino faculty between 84 percent to 165 percent of the median salaries earned by White faculty. Notably, Black or African American faculty consistently received lower median salaries compared to their White counterparts across all academic ranks, with a statistically significant difference (P = .002).
This study highlights the lack of diversity in the academic cardiothoracic surgery workforce, particularly in higher ranks, and underscores the complex nature of salary equity among different racial and ethnic groups. The persistent underrepresentation and salary disparities faced by Black or African American surgeons calls for further investigation and action to address these inequities in academic medicine.
October 31, 2024
Submitted by: Akshay Patel
This article explores the outcomes of chest wall resection and reconstruction (CWRR) in patients with primary chest wall sarcomas. Key findings of this study include an R0 resection rate of 95.5 percent, a median overall survival rate of 58.8 months and a disease-free survival rate of 53.6 months. Survival rates were significantly better in patients with chondrosarcoma compared to those with other sarcoma types. Significant predictors of mortality and recurrence were identified and included factors such as prior radiotherapy, tumor grade, and adjuvant therapy. Extended resections were also associated with higher long-term mortality, but did not significantly impact recurrence rates.
This study highlights the importance of multidisciplinary decision-making and careful patient selection in achieving favorable outcomes in complex chest wall sarcoma cases, while also providing insights into long-term functional status and survival.
October 31, 2024
Submitted by: Jessica Luc
This study reports on the seven-year outcomes of an international trial, which evaluated a novel bioprosthetic aortic valve prosthesis aimed at improving tissue durability. The trial was conducted between January 2013 and March 2016, and included 689 patients with a mean age of 66.9 years and a relatively low Society of Thoracic Surgeons risk score of 2.0 percent. The follow-up included annual assessments with a subset reconsented for an extended 10-year follow-up.
The five-year follow-up was completed by 512 patients, and 225 patients continued for the extended period. By seven years, 194 patients completed follow-up, showing impressive results: freedom from all-cause mortality was 85.4 percent and freedom from structural valve deterioration was 99.3 percent. The effective orifice area was 1.82 cm² with a mean gradient of 9.4 mm Hg. Paravalvular and transvalvular regurgitation rates were low, with most patients experiencing none or trivial leakage.
This study highlights the durability and excellent performance of this novel tissue bioprosthesis, setting a new standard for future aortic valve replacements in both surgical and transcatheter procedures.
October 24, 2024
Submitted by: Akshay Patel
This article evaluates the effectiveness of neoadjuvant immunotherapy combined with chemotherapy (IC+Chemo) in treating non-small cell lung cancer (NSCLC). This large-scale study involved 1,092 patients from 11 medical centers and compared outcomes between those who received IC+Chemo and those who received chemotherapy alone. Key findings show significantly better outcomes for the IC+Chemo group, with higher rates of pathologic complete response (32.8 percent) and disease-free survival (82 percent) at two years. Patients with squamous cell carcinoma benefited the most from the combined treatment. Additionally, adjuvant therapy following surgery was identified as a critical factor in improving long-term survival, particularly in patients with lower pathologic responses.
This study validates the superiority of neoadjuvant immunochemotherapy in improving survival outcomes for NSCLC, helping surgeons and oncologists in refining treatment strategies for better patient care.
October 24, 2024
Submitted by: EACTS Staff
There is limited data available from randomized trials comparing outcomes between transcatheter aortic valve replacement (TAVR) and surgery in patients with different risks and follow-up periods of at least four years or longer. In this population-based cohort study, long-term mortality and morbidity were investigated in 18,882 patients in Austria undergoing surgical aortic valve replacement (SAVR) for severe aortic stenosis using a surgically implanted bioprosthesis. The primary outcome assessed was all-cause mortality in the overall and propensity score-matched populations, with secondary outcomes of reoperation and cardiovascular events. The study found that selection for TAVR was significantly associated with higher all-cause mortality compared to SAVR in patients 65 years and older with severe, symptomatic aortic stenosis over a follow-up period exceeding two years.
October 24, 2024
Submitted by: Jessica Luc
This study evaluates the early safety of a new technique called branched stented anastomosis frozen elephant trunk repair (B-SAFER) for treating multisegment thoracic aortic disease, which aims to improve outcomes in high-risk patients undergoing total aortic arch replacement. A total of 178 patients were enrolled between May 27, 2021, and December 31, 2022, with varying aortic conditions, including acute syndrome, chronic dissection, degenerative aneurysm, and congenital disorders.
Patients underwent surgery using different configurations of stented anastomoses. The procedure involved median cardiopulmonary bypass time of 188 minutes, and 97 percent of patients underwent antegrade cerebral perfusion for a median of 46 minutes. The study found an operative mortality rate of 5.6 percent, with additional serious complications including disabling stroke (2.9 percent), respiratory failure (11.4 percent), and acute kidney injury (10 percent). Survival rates were 95 percent at 30 days, 88 percent at 90 days, 84 percent at six months, and 79 percent at one year, with variability based on the underlying aortic condition.
Overall, B-SAFER demonstrated early safety and effectiveness, but further follow-up is needed to refine the technique and develop new devices.
October 24, 2024
Submitted by: EACTS Staff
This retrospective study compared outcomes for 90-day mortality and five-year overall survival estimates in patients who underwent lobectomy, segmentectomy, or wedge resection for stage c-IA lung carcinoma between 2016-2022. Of the 19,453 patients, 72.2 percent underwent lobectomy, 21.5 percent underwent segmentectomy and 6.3 percent underwent wedge resection. The multivariable proportional hazards regression analysis found that wedge resection was associated with worse overall survival compared to lobectomy, with no significant difference between lobectomy and segmentectomy. The authors’ analysis of contemporary real-world patients with clinical stage IA lung carcinoma supports lobectomy as the reference treatment in daily practice for those able to undergo surgery.
October 17, 2024
Submitted by: Jessica Luc
This study investigated the impact of complete revascularization (CR) versus incomplete revascularization (IR) on long-term survival in patients who underwent multivessel coronary artery bypass grafting (CABG) with either multiple arterial grafts (MAG) or a single artery with saphenous vein grafts (SAG). The analysis revealed that IR did not negatively affect long-term survival in patients who received MAG but was linked to lower survival rates in those receiving SAG. Specifically, patients with MAG IR had better long-term outcomes than those with SAG IR. Furthermore, CR combined with MAG resulted in better long-term survival compared to CR with SAG. Within the MAG cohort, no significant survival differences were observed among patients with perfect CR, imperfect CR, and IR. However, in the SAG cohort, perfect CR was associated with better survival compared to imperfect CR and IR. The study supports the advantage of MAG over SAG in terms of long-term survival, regardless of CR or IR status. The benefit of MAG may be attributed to better graft patency and reduced progression of atherosclerosis compared to SAG. The results suggest that MAG is preferable even when CR is not achievable. The limitations of this study include potential biases inherent in observational studies and a lack of functional assessment of IR.
October 17, 2024
Submitted by: Jessica Luc
The long-term benefits of total arch replacement (TAR) versus hemiarch replacement for treating aortic dissection have been debated, with most studies showing no difference in survival rates between the two methods. However, TAR may be more effective in preventing distal aortic events, particularly in patients under 70 years old. This study analyzed data to determine if age affects the benefits of TAR. The findings suggest that patients younger than 70-years-old benefit more from distal extended surgery to address primary entry tears in the descending aorta. In contrast, older patients (70 years and older) do not experience significant long-term benefits from TAR compared to hemiarch replacement. The study used a cutoff of 70 years based on receiver operating characteristic curve analysis. The German Registry for Acute Aortic Dissection Type A (GERAADA) supports these findings, noting more extensive dissection and organ malperfusion in younger patients. Although TAR with the frozen elephant trunk (FET) technique has shown promising results, especially in younger patients, the risks and benefits must be carefully weighed. The study concludes that aggressive TAR may be more beneficial for younger patients, while hemiarch replacement could suffice for older patients, even when the primary tear remains in the descending aorta.