Journal and News Scan

This article reports the long-term outcomes of the concomitant Cox-Maze IV procedure in patients with atrial fibrillation who underwent mitral valve surgery. The authors found that the concomitant Maze procedure provided freedom from atrial tachyarrhythmias of 80 percent at five years and 65 percent at 10 years, respectively. In terms of freedom from symptomatic atrial fibrillation recurrence, the rates were 94 percent and 83 percent, respectively. Interestingly, the 10-year survival rate in the propensity-matched group who underwent concomitant Cox Maze group was 54 percent, compared to 43 percent in those without ablation, indicating a significant survival benefit in patients receiving concomitant ablation. 

The use of mechanical support devices in the pediatric population is an area of active investigation. The authors evaluated all pediatric patients at a single institution who presented in cardiogenic shock and were treated with an Impella device. A total of six patients were observed, who received Impella 2.5, Impella CP, and Impella 5.5, with a median duration of support of seven days (range: 4-45 days). Of these, two patients were bridged to recovery, three to left ventricular assist device (LVAD), and one to heart transplant. Given the absence of mortality or neurological complications, the authors suggest that use the of the Impella device is safe and feasible in this patient population. 

This article discusses a promising diagnostic approach aimed at improving patient selection for immune checkpoint inhibitor (ICI) therapies, particularly in non-small cell lung cancer (NSCLC). The current reliance on PD-L1 immunohistochemistry (IHC) as a biomarker has limited sensitivity and specificity. The concept of "touching" refers to the direct molecular interaction between PD-1 and PD-L1 proteins, which can be detected through proximity-based assays such as proximity ligation assay (PLA), Förster resonance energy transfer (FRET), and quantitative immunofluorescence (QIF). The authors highlight new evidence showing that higher PD-1/PD-L1 proximity scores—measured using second-generation PLA—correlate with better treatment responses and survival in ICI-treated patients with NSCLC. 
 
This article is important to the cardiothoracic surgery and thoracic oncology communities, including CTSNet’s global audience, as it signals a potential paradigm shift in how surgical candidates for immunotherapy are selected. As immunotherapy becomes increasingly integrated into multimodal treatment, improved predictive biomarkers such as proximity assays could enhance personalized treatment strategies. 

This article reviews recent efforts to evaluate the use of osimertinib, a third-generation EGFR tyrosine kinase inhibitor (TKI), in the neoadjuvant setting for patients with resectable EGFR-mutant non-small cell lung cancer (NSCLC). While adjuvant osimertinib has shown benefits in delaying recurrence, as shown in the ADAURA trial, its effectiveness as a neoadjuvant monotherapy remains under evaluation. The NORA trial, along with the NEOS trial and a U.S.-based study, showed good tolerability and universal R0 resection rates; however, the objective response rates (ORRs) and low pathologic response were modest, especially in patients with nodal disease. 
 
This editorial discusses how these findings suggest that neoadjuvant osimertinib may be insufficient as monotherapy, particularly when compared to immunotherapy-based combinations used in EGFR-wildtype disease. It calls for future trials to refine patient selection, explore combination strategies (e.g., with chemotherapy), and validate surrogate endpoints such as ctDNA clearance or residual viable tumor. 
 
These insights are highly relevant to the CTSNet community, as it informs surgical planning and the integration of targeted therapies in the evolving landscape of personalized lung cancer treatment.