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Journal and News Scan

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Alina-Maria Budacan, Akshay J. Patel, Pavithra Babu, Haitham Khalil, Sumathi Vaiyapuri, Michael Parry, Maninder S. Kalkat

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. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Thomas Beaver, Joseph E. Bavaria, Bartley Griffith, Lars G. Svensson, Philippe Pibarot, Michael A. Borger, Omar M. Sharaf, David A. Heimansohn, Vinod H. Thourani, Eugene H. Blackstone, John D. Puskas

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. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Zhenlin Yang, Shuaibo Wang, Haitang Yang, Yina Jiang, Linhai Zhu, Bin Zheng,  Honghao Fu, Junliang Ma, Hounai Xie, Zhiqiang Wang, Huayu He, Chuanbao Xia, Renda Li,   Jiachen Xu, Jiefei Han, Xuhua Huang, Yixing Li, Baicheng Zhao, Chenhui Ni, Huajie Xing,  Yangtian Chen, Jingdi Wang, Yuequan Jiang, Yongxiang Song, Yousheng Mao,  Chun Chen, Feng Yao, Guangjian Zhang, Jian Hu, Qi Xue, Shugeng Gao, Jie He

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​.  

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Johann Auer, Pavla Krotka, Berthold Reichardt, Denise Traxler, Ralph Wendt, Michael Mildner, Hendrik Jan Ankersmit, Alexandra Graf

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. 

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Eric E. Roselli, Patrick R. Vargo, Faisal Bakaeen, Marijan Koprivanac, Daniel Burns, Yuki Kuramochi, Marc Gillinov, B-SAFER Investigators

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. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Pascal Alexandre Thomas, Agathe Seguin-Givelet, Pierre-Benoît Pages, Marco Alifano, Laurent Brouchet, Pierre-Emmanuel Falcoz, Jean-Marc Baste, Matthieu Glorion, Yaniss Belaroussi, Marc Filaire, Maxime Heyndrickx, Anderson Loundou, Alex Fourdrain, Marcel Dahan, Laurent Boyer, EPITHOR Working Group

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. 

Source: The Annals of Thoracic Surgery
Author(s): Sleiman Sebastian Aboul-Hassan, Ahmed K. Awad, Tomasz Stankowski, Bartlomiej Perek, Jakub Marczak, Michal Rodzki, Marek Jemielity, Lukasz Moskal, Michel Pompeu Sá, Gianluca Torregrossa, Mario Gaudino, Romuald Cichon

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. 

Source: The Annals of Thoracic Surgery
Author(s): Koji Kawahito, Naoyuki Kimura, Atsushi Yamaguchi, Kei Aizawa

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. 

Source: European Heart Journal
Author(s): Marko Banovic, Svetozar Putnik, Bruno R Da Costa, Martin Penicka, Marek A Deja, Martin Kotrc, Radka Kockova, Sigita Glaveckaite, Hrvoje Gasparovic, Nikola Pavlovic, Lazar Velicki, Stefano Salizzoni, Wojtek Wojakowski, Guy Van Camp, Sinisa Gradinac, Michael Laufer, Sara Tomovic, Ivan Busic, Milica Bojanic, Arsen Ristic, Andrea Klasnja, Milos Matkovic, Nikola Boskovic, Katarina Zivic, Miodrag Jovanovic, Serge D Nikolic, Bernard Iung, Jozef Bartunek

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. 

Source: JAMA Network
Author(s): Benjamin O’Brien, Niall G. Campbell, Elizabeth Allen, Zahra Jamal, Joanna Sturgess, Julie Sanders, Charles Opondo, Neil Roberts, Jonathan Aron, Maria Rita Maccaroni, Richard Gould, Bilal H. Kirmani, Ben Gibbison, Gudrun Kunst, Alexander Zarbock, Maren Kleine-Brüggeney, Christian Stoppe, Keith Pearce, Mark Hughes, Laura Van Dyck, Richard Evans, Hugh E. Montgomery, Diana Elbourne

This study examined whether potassium supplementation at a lower threshold (below 3.6 mEq/L) is as effective as the standard practice (below 4.5 mEq/L) in preventing atrial fibrillation after coronary artery bypass graft (CABG) surgery. A trial involving 1,690 patients at 23 cardiac surgical centers showed no significant difference in new-onset atrial fibrillation or other clinical outcomes between the two groups. The findings suggest that the current practice of maintaining high-normal potassium levels postoperatively can be reconsidered, potentially lowering healthcare costs and minimizing unnecessary interventions. 

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