Journal and News Scan

Surgeons at Baylor St Luke’s Medical Center in Houston, Texas, successfully performed the first robotic heart transplant in the U.S. without opening the chest, using small abdominal incisions. This minimally invasive procedure reduced trauma, blood loss, and infection risk, allowing for quicker recovery. The patient, who had been hospitalized since November 2024, underwent the transplant in March 2025, recovering without complications. Lead surgeon Dr. Kenneth Liao, chief of cardiothoracic transplantation and mechanical circulatory support at Baylor, emphasized the advantages of avoiding chest opening. Dr. Todd Rosengart, chair of the department of surgery at Baylor, noted that this innovative approach significantly enhances safety in complex surgery.  

This study investigates the prognostic impact of tumor spread through air spaces (STAS) in early-stage synchronous multiple primary lung adenocarcinoma (sMPLA) and its interaction with surgical strategies. Among 131 patients with cT1-3N0M0 sMPLA, STAS was detected in 52 percent, including 16 percent with STAS in both tumors (bi-STAS). Bi-STAS independently predicted significantly worse overall survival and recurrence-free survival compared to mono-STAS or no STAS. Patients with bi-STAS exhibited higher mortality and recurrence rates, regardless of whether they underwent lobectomy or sublobar resection, indicating limited benefit from more extensive surgery. Prognostic factors also included tumor size, pleural invasion, and lung diffusion capacity. These findings underscore the importance of comprehensive STAS evaluation in all dominant tumors for postoperative risk stratification in sMPLA. 

This review article aims to examine the surgical approach to patients with failed mitral transcatheter edge-to-edge repair (M-TEER), focusing on operative challenges, decision-making, and contemporary outcome data. Technical considerations, including device removal and the management of complex mitral valve (MV) anatomy, are discussed. The authors performed a comprehensive literature review and gathered experience from high-volume centers in the surgical management of failed M-TEER. 
 
The key messages from this review are: MV surgery after failed M-TEER is a complex but increasingly necessary procedure as the use of M-TEER grows. It occurs in up to six percent of patients, with a median age of 70–76 years at the time of failure and a median time to failure of less than six months. MV surgery following M-TEER is associated with high mortality and morbidity, with a reported 30-day mortality ranging from 10–40 percent and one-year survival below 60 percent. Functional device failure, structural device failure, MV disease progression, and infective endocarditis are frequent mechanisms of M-TEER failure. Surgical MV repair is the preferred management strategy; however, due to the technical and anatomical complexity, MV replacement is performed much more frequently (with MV repair rates below 10 percent). 
 
The authors concluded that MV surgery after failed M-TEER poses technical challenges due to the presence of altered anatomy, the need for concomitant procedures, and the patient′s comorbidities. While surgical intervention carries increased risks, it remains the definitive treatment for failed M-TEER, offering durable relief from mitral regurgitation (MR). Due to the technical complexities associated with these procedures, strong consideration should be given to transferring patients requiring MV surgery after failed M-TEER to high-volume MV centers. 

This prospective observational study examined the association between Pain Catastrophizing Scale (PCS) scores and postoperative pain in 100 patients undergoing multiportal video-assisted thoracic surgery (VATS) lobectomy. The PCS is a 13-item self-report tool measuring catastrophic thinking related to pain, including rumination, magnification, and helplessness, with scores ranging from 0 to 52. Patients completed the PCS preoperatively, and pain was assessed twice daily for two days postoperatively during rest, coughing, use of a positive expiratory pressure (PEP) device, and a five-meter walk test. Those with high PCS scores (greater than or equal to 20) reported significantly greater pain during coughing and walking and were more likely to experience moderate-to-severe pain. Linear regression confirmed PCS as a strong predictor of increased pain. All patients received standardized ERAS protocol pain management. Incorporating PCS may enable more targeted analgesia for breakthrough pain, moving beyond opioid dose titration alone.