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This retrospective cohort study evaluated the impact of preoperative ischemic heart failure with reduced ejection fraction on long-term outcomes following coronary revascularization using either single or multiple arterial grafting techniques. Data from 59,641 patients (mean age 65.8 years; 81 percent male) across 59 cardiac centers (2001–2020) were analyzed, with patients stratified by perioperative left ventricular ejection fraction (EF). Over a median follow-up of five years, multiarterial grafting was associated with a 19 percent reduction in all-cause mortality for those with normal EF (hazard ratio [HR]=0.81, P<0.001), and similar benefits were observed in patients with mild (HR=0.83), moderate (HR=0.82), and severe left ventricular (LV) impairment (HR=0.82, P=0.01). Cox regression analysis showed no significant interaction between survival benefit and EF (P=0.75). Total arterial revascularization provided additional survival benefits except in cases with EF less than 30 percent (HR=0.87, P=0.30). These findings support the consistent survival advantage of multiarterial grafting across LV function levels and advocate for the broader use of these strategies. 

This retrospective analysis compared three-port and four-port robotic-assisted thoracoscopic surgery (RATS) lobectomy for non-small cell lung cancer (NSCLC)(n=121, 2020–2021). Demographics, tumor characteristics, complications, and lymph node yields were similar between groups. While the three-port group showed trends toward shorter operative time (117.32 vs. 136.83 minutes), console time (90 vs. 103 minutes), less blood loss (94.34 vs. 102.73 mL), shorter chest tube duration (2.43 vs. 2.79 days), and shorter hospital stay (4.55 vs. 5.14 days), these differences were not statistically significant (p>0.05). However, three-port patients reported significantly less postoperative pain. In line with the trend toward uniportal video-assisted thoracoscopic surgery (VATS), the authors propose that fewer ports in RATS may offer benefits, warranting further investigation. 

Women with severe symptomatic aortic stenosis are underrepresented in clinical trials. The Randomized Research in Women All Comers with Aortic Stenosis (RHEIA) trial investigates the balance of benefits and risks of transcatheter aortic valve implantation (TAVI) compared to surgery in women. Women were randomized 1:1 to received either transfemoral TAVI with a balloon-expandable valve or surgical intervention. The primary composite endpoint was defined as death, stroke, or rehospitalization related to the valve, procedure, or heart failure within one year. Non-inferiority testing was conducted using a prespecified margin of 6 percent, alongside superiority testing in the as-treated population. 
 
At 48 European centers, 443 women were randomized, with 420 receiving treatment as randomized. The mean age of participants was 73 years, and the mean estimated surgical risk of death was 2.1 percent, as determined by the Society of Thoracic Surgeons risk score. Kaplan–Meier estimates of the primary endpoint event rates at one year were 8.9 percent in the TAVI group and 15.6 percent in the surgery group. This difference of −6.8 percent, with an upper 95 percent confidence limit of −1.5 percent, demonstrated the non-inferiority of TAVI (P < 0.001). The two-sided 95 percent confidence interval of −13.0 percent to −0.5 percent further resulted in superiority (P = 0.034). The one-year incidence of the primary endpoint components was as follows: 0.9 percent for TAVI vs. 2.0 percent for surgery for death from any cause; 3.3 percent vs. 3.0 percent for stroke; and 5.8 percent vs. 11.4 percent for rehospitalization. 
 
The authors concluded that among women with severe aortic stenosis, the incidence of the composite of death, stroke, or rehospitalization at one year was lower in the TAVI group compared to the surgery group. 

This article addresses the challenges of transitioning from cardiothoracic training to becoming a practicing cardiothoracic surgeon. It discusses the role of additional training in the form of “super-fellowships,” the selection of job opportunities, techniques for building a successful practice, strategies for becoming a productive researcher, and how to transition into a senior career role. This article provides insight from experienced surgeons, as well as advice and strategies to make this transition easier.