Journal and News Scan

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​.  

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. 

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. 

The AVATAR Trial addressed the question of when and how to treat asymptomatic patients with severe aortic stenosis (AS) and normal left ventricular (LV) systolic function. In the current report, the authors present the extended follow-up. The AVATAR trial randomly assigned patients with severe, asymptomatic AS (negative exercise stress testing in all patients) and LV ejection fraction greater than 50 percent to undergo either early surgical aortic valve replacement (SAVR) or conservative treatment with a watchful waiting strategy. The primary endpoint was a composite outcome of all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure (HF). A total of 157 low-risk patients were randomly assigned to either the early SAVR group (n=78) or the conservative treatment group (n=79). In an intention-to-treat analysis, after a median follow-up of 63 months, the primary composite endpoint outcome event occurred in 18 out of 78 patients (23.1 percent) in the early SAVR group and 37 out of 79 patients (46.8 percent) in the conservative treatment group (hazard ratio (HR) early SAVR versus conservative treatment 0.42; 95 percent confidence interval (CI) 0.24–0.73, p=0.002). The Kaplan-Meier estimates for individual endpoints of all-cause death and HF hospitalization were significantly lower in the early SAVR group compared to the conservative group (HR 0.44; 95 percent CI 0.23–0.85, p=0.012 for all-cause death, and HR 0.21; 95 percent CI 0.06–0.73, p=0.007 for HF hospitalizations). The authors conclude that after an extended follow-up, asymptomatic patients with severe AS and normal LV ejection demonstrate better clinical outcomes with early SAVR than patients treated with conservative treatment and watchful waiting.