Journal and News Scan

This study evaluated outcomes in lung transplantation (LTx) using lungs from donation after brain death (DBD) vs. donation after circulatory death (DCD). After analyzing 21 studies with more than 60,000 patients, researchers found that early mortality was slightly higher in the DCD group (5.5 percent vs. 4.5 percent for DBD). However, long-term survival at one, three, and five years was significantly better for DCD (86.7 percent, 75.5 percent, and 63.2 percent, respectively) compared to DBD (82.1 percent, 65.6 percent, and 51.3 percent). No significant differences were observed in rates of acute rejection, primary graft dysfunction (PGD), or postoperative complications between the groups. 
 
This study is important for the cardiothoracic community because it highlights the potential of DCD to expand the donor pool while achieving comparable, if not superior, long-term outcomes.  

The authors evaluated the five-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized PARTNER 3 trial. In the PARTNER 3 trial, 454 patients with severe, symptomatic, tricuspid aortic stenosis (AS) underwent surgery and were followed for five years. Patients were stratified into those undergoing isolated SAVR (n=334, 73.6 percent) vs. concomitant SAVR (n=120, 26.4 percent). The mean age was 73.6 plus or minus 6.1 years, and 71.1 percent were male. The median SAVR implant size was 23 mm overall. Five-year all-cause mortality was 9.0 percent for all patients (8.5 percent for isolated SAVR versus 10.2 percent for concomitant SAVR, p=0.58). The average five-year mean gradient was 11.7 plus or minus 5.6 mmHg overall. Reintervention rates were low in both groups (2.3 percent for isolated SAVR vs. 5.0 percent for concomitant SAVR, p=0.21), and the majority of patients (87.9 percent for isolated SAVR vs. 86.1 percent for concomitant SAVR) were alive with no evidence of bioprosthetic valve failure at five years. The authors concluded that SAVR in low-risk patients in the PARTNER 3 trial demonstrated excellent five-year outcomes. Five-year mortality was similar in patients undergoing isolated vs. concomitant SAVR. This was comparable to recently published national SAVR outcomes, supporting the generalizability of these findings. 

In this article, the authors aimed to assess whether post-implant transcatheter aortic valve prosthesis multi-detector computed characteristics differ between patients with native tricuspid and bicuspid aortic valve stenosis, as well as the effect on valve performance and clinical outcomes. A total of 100 consecutive post-implant multi-detector computed tomography scans were assessed. Echocardiographic prosthesis performance and clinical outcome were also evaluated. Mean eccentricity was significantly higher in the bicuspid group (0.43 (0.09) vs. 0.37 (0.08), p = 0.005, bicuspid vs. tricuspid); valvular and perivalvular thrombosis were also significantly more frequent in the bicuspid than in the tricuspid group (81% vs. 36.9%, p = 0.031); there was no significant difference in terms of the mean prosthetic gradient at follow-up between bicuspid and tricuspid valves (7.31 (5.53 mmHg) vs. 7.09 (3.05 mmHg), respectively, p = 0.825); Indexed effective orifice area (EOAi) was also similar between bicuspid and tricuspid valves (1.08 (0.12 cm2) vs. 1.03 (0.13 cm2), p = 0.101), with no significant changes compared to discharge. However, the bicuspid valve was associated with a significantly higher risk of adverse events (HR:3.72, 95%CI: 1.07-13.4, p = 0.027). In conclusion, a higher level of eccentricity, which indicates prosthesis deformation, is often detected in bicuspid valves. Although echocardiographic performance was not affected, this might have led to an increased incidence of thrombosis at valvular and perivalvular levels and worse outcomes. 

This study compared robotic and video-assisted thymectomy to assess pathological resection status, as well as overall and disease-free survival. Data were retrieved from the European Society of Thoracic Surgeons prospectively maintained thymic database, which includes 82 international centers, 37 of which agreed to participate in this study. Between October 2001 and May 2021, a total of 899 patients with thymic malignancy and who underwent minimal access surgical resection were included. After adjusting for thymoma stage, the odds of incomplete surgical resection were higher in patients undergoing video-assisted surgery than robotic. Further research is required to compare outcomes for different surgical approaches with a standardized pathological work-up.