Journal and News Scan

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. 

The Evolut Low Risk trial demonstrated that transcatheter aortic valve replacement (TAVR) was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at two years. In this new publication, the authors report the five-year outcomes of the Evolut Low Risk trial. In this trial, low-risk patients with severe aortic stenosis were randomly assigned to TAVR or surgery. The primary endpoint was a composite of all-cause mortality or disabling stroke. Secondary endpoints included clinical, echocardiographic, and quality-of-life outcomes through five years. 
 
A total of 1,414 patients underwent attempted valve implantation (n = 730 for TAVR, n = 684 for surgery). The mean age was 74 years (range 51-88 years), and women accounted for 35 percent of the patients. At five years, the Kaplan-Meier estimate for the primary endpoint of all-cause mortality or disabling stroke was 15.5 percent for the TAVR group and 16.4 percent for the surgery group (P = 0.47). The Kaplan-Meier estimates in the TAVR and surgery groups for all-cause mortality were 13.5 percent and 14.9 percent (P = 0.39) and for disabling stroke were 3.6 percent and 4.0 percent (P = 0.57). Cardiovascular mortality was 7.2 percent in the TAVR group and 9.3 percent in the surgery group (P = 0.15). Noncardiovascular mortality in the TAVR group was 6.8 percent and 6.2 percent in the surgery group (P = 0.73). A site-level vital status sweep was performed for patients who were lost to follow-up or withdrew from the study. With the addition of these patients, the all-cause mortality rate at five years for patients undergoing TAVR was 14.7 percent, and for surgery, it was 15.2 percent (P = 0.74). Over five years, the valve reintervention rate was 3.3 percent for TAVR and 2.5 percent for surgery (P = 0.44). A sustained improvement in quality of life was observed in both treatment arms, with a mean Kansas City Cardiomyopathy Questionnaire summary score of 88.3 plus or minus 15.8 in TAVR and 88.5 plus or minus 15.8 in surgery.