Journal and News Scan

This article reviews lymph node dissection and its relationship to postoperative chylothorax in thoracic surgery. The authors analyze patterns of nodal involvement, technical considerations during mediastinal lymphadenectomy, and factors contributing to thoracic duct injury. They highlight that while comprehensive lymph node dissection is essential for accurate staging and potentially improved oncologic outcomes, it carries a measurable risk of chylothorax, particularly with extensive mediastinal nodal clearance. The paper emphasizes early recognition, standardized management strategies, and the importance of balancing oncological thoroughness with the risk of complications.  
 
This work is significant because chylothorax remains a challenging and sometimes underreported complication in cardiothoracic surgery, associated with increased morbidity, prolonged hospitalization, and complex decision-making around reintervention. The paper provides both practical insights for surgical techniques and evidence-based strategies for managing complications, making it directly relevant to daily thoracic surgical practice and multidisciplinary perioperative care worldwide. 

This single-center retrospective study compared the outcomes of mitral valve (MV) surgery vs transcatheter edge-to-edge repair (TEER) in octogenarians with moderate-to-severe or severe mitral regurgitation (MR). Between 2014 and 2024, 744 patients aged 80 years and older underwent MV intervention. After exclusions and 1:1 propensity matching, 252 patients (126 per group) were analyzed. Thirty-day mortality was low and similar between the groups (1.6 percent for surgery vs 0.8 percent for TEER). Surgery was associated with higher early morbidity (atrial fibrillation, prolonged ventilation, and longer ICU/hospital stays), but echocardiography at discharge showed less residual MR and tricuspid regurgitation, as well as lower right ventricular systolic pressure. At the median follow-up of 3.9-years, recurrent MR was significantly less frequent after surgery (6 percent vs 33 percent), and five-year survival favored surgery (68 percent vs 56 percent). While TEER offered advantages such as shorter hospitalization and fewer immediate complications, surgery provided superior valve durability, fewer reinterventions, reduced heart failure readmissions, and improved long-term survival in appropriately selected octogenarians. 

This study reported favorable early outcomes in 11 intermediate- and high-risk patients who underwent a modified Bio-Bentall procedure with a rapid deployment valve between January 2018 and December 2022. 
 
The technique involved inserting an inverted 8 cm Valsalva graft into the left ventricular outflow tract using a single-layer continuous suture anastomosis. The graft was then exteriorized, and the coronary buttons were reimplanted. Three simple interrupted anchoring sutures were placed and the valve was deployed. 
 
The median patient age was 71 years, with the most common primary indication being annuloaortic ectasia with aortic insufficiency in six out of 11 patients. The median cardiopulmonary bypass and aortic cross-clamp times were 99 and 73 minutes, respectively. No early mortalities, reoperations, or paravalvular leaks were reported during follow-up. At one year, survival was 90.9 percent, and at three years, it was 54.5 percent. Permanent pacemaker implantation was required in three patients, with the authors attributing only one case to the rapid deployment technique. 

This manuscript reports a pregnant patient who developed thrombosis of her mechanical pulmonary valve, necessitating re-replacement of the valve and the trunk. 
 
A 30-year-old woman at 18 weeks of gestation presented with severe fatigue. Her medical history was significant for congenital pulmonary atresia with a ventricular septal defect, prior placement of a Blalock-Taussig shunt, multiple graft replacements, and a mechanical pulmonary valve replacement. The authors were concerned about prosthetic valve thrombosis after echocardiography, which was subsequently confirmed by cardiac MRI. 
 
Given her pregnancy, conventional medical therapy was attempted first but proved unsuccessful; therefore, surgical intervention was deemed necessary. 
 
The patient underwent re-replacement of the pulmonary valve and trunk using a pulmonary homograft. The procedure was performed on a beating heart, with cardiopulmonary bypass (CPB) initiated via a pulsatile roller pump. Her postoperative course was favorable, and she subsequently delivered a healthy infant at 38 weeks of gestation. 
 
This case highlights that pulmonary valve re-replacement can be performed safely during pregnancy in the setting of mechanical valve thrombosis. The authors attribute the favorable outcome in part to the use of a beating-heart technique and optimized CPB parameters.