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Journal and News Scan
February 13, 2025
Submitted by: Jessica Bogensberger
Proper preservation of the myocardium during intraoperative ischemia is a critical predictor of satisfactory clinical outcomes. However, there can be a wide degree of diversity in myocardial damage among patients receiving the same cardioplegic solution. The efficacy of cardioplegia-induced arrest can be affected by other factors, which may become apparent in more demanding clinical scenarios, such as in patients with impaired contractility at baseline. This study aims to identify these factors and assess their impact on postoperative myocardial damage.
Cardioprotection is important in patients with heart failure, as the effects of inadequate cardioprotection are particularly pronounced in this patient population. Two well-established protocols are used for cardioplegia in these cases: del Nido cardioplegia (DN) and cold blood cardioplegia (CB). Several prospective trials have evaluated the use of the del Nido protocol, but none specifically address patients with significantly impaired contractility. Therefore, current guidelines on cardiopulmonary bypass in adult cardiac surgery recommend applying the DN protocol in low-risk cases with short aortic cross-clamp times (CCTs) to minimize surgical interruptions caused by repeated perfusion of cardioplegia. Blood cardioplegia has a longer history, and its efficacy is well documented. Many surgeons consider it the most efficient protocol, particularly in ischemic or damaged myocardium, as supported by clinical studies.
The decision on whether to use DN or CB is made by the surgeon, with each case treated individually. Factors that are taken into consideration include the complexity of the procedure, the estimated duration of the CCT, the risk of fluid overload in patients with heart failure or kidney disease, the potential for allergies to lidocaine, the rationale for additional cardioplegia doses (selective graft perfusion), and the patient's blood morphology parameters.
Due to the differences in protocols, it is necessary to address the entire cohort and evaluate the impact of the analyzed determinants for each cardioplegia method separately. The leading hypothesis is that patients' baseline characteristics and operative determinants may impact the efficacy of cardioprotection during surgery, but this effect may vary depending on the solution used.
February 13, 2025
Submitted by: Javeria Tariq
This study explores how disparities between actual and predicted total lung capacity (TLC) in patients with interstitial lung disease (ILD) affect lung function parameters and long-term outcomes after lung transplantation. A total of 170 ILD patients who underwent lung transplantation between 2011 and 2022 were included. They were stratified based on the preoperative median ratio of recipient actual to predicted (a/p) TLC. Of these, 85 patients had a low a/p TLC ratio corresponding to <0.55, while the remaining 85 patients had a high a/p TLC ratio of ≥0.55. There were no significant differences between the two groups in tracheostomy and reintubation rates, mechanical ventilation duration, ICU and hospital stays, or five-year overall survival. Although early post-LTx lung function was better in the high a/p TLC ratio group, long-term outcomes were similar in both groups. These findings may suggest remodeling of chest wall compliance in severely restricted ILD patients after LTx.
February 6, 2025
Submitted by: Wei-Guo Ma
This study analyzed the incidence of malperfusion in acute Type A aortic dissection using data from 9,958 patients in the Society of Thoracic Surgeons Adult Cardiac Surgery Database 2017-2020. Preoperative malperfusion occurred in 27.7 percent of cases and was linked to significantly higher operative morality, particularly for contrary and mesenteric malperfusion. The findings indicated that partial arch replacement did not increase mortality compared to ascending aorta or hemiarch replacement alone, regardless of malperfusion status.
February 6, 2025
Submitted by: Javeria Tariq
This study aimed to explore the impact of socioeconomic disparities on the uptake of neoadjuvant therapy in patients with locally advanced esophageal cancer. Using data from the American National Cancer Database, 19,748 patients were identified with clinical stage II-III esophageal cancer who underwent surgical resection between 2006 and 2020. Overall, 85 percent received neoadjuvant therapy, while the remaining patients underwent upfront surgery. In a propensity-matched cohort, neoadjuvant therapy was associated with improved five-year overall survival compared to upfront surgery. Over time, the uptake of neoadjuvant therapy increased, but lower uptake was associated with factors such as age (≥70), female sex, Black race, increased comorbidities (as measured by the Charlson Comorbidity Index), and government insurance compared to private insurance. This study highlights the potential inequities in cancer care delivery.
February 6, 2025
Submitted by: Mateo Marin-Cuartas
In this study, the authors evaluated the organ-protective efficacy of postoperative glucocorticoid in patients with type A aortic dissection. Patients were randomly assigned to receive either postoperative glucocorticoid or standard-of-care treatment. Intravenous methylprednisolone was administered for three days. The primary outcome was the reduction of Sequential Organ Failure Assessment (SOFA) score on postoperative day four compared to baseline (on postoperative day one, before methylprednisolone administration). A total of 212 patients (106 patients in each group) were included in the intention-to-treat analysis. The primary outcome differed significantly between groups: SOFA score reduction was 3.16 plus or minus 2.52 in the control group versus 4.36 plus or minus 2.82 in the glucocorticoid group (absolute difference 1.20 [95 percent CI 0.52–1.93], P = 0.001). The glucocorticoid group showed markedly lower median high-sensitivity C-reactive protein levels compared to the control group (91.0 mg/l vs 182.0 mg/l; absolute difference: –91 [95 percent CI –122 to –57], P = 0.009) on postoperative day four. Fewer patients in the glucocorticoid group required continuous renal replacement therapy (8.5 percent vs 19.8 percent in the control group; absolute difference: –10.4 [95 percent CI –19.1 to –1.3], P = 0.03). These findings advocate for the implementation of glucocorticoids in the early phase after type A aortic dissection surgery for enhanced organ protection.
February 6, 2025
Submitted by: Javeria Tariq
This retrospective cohort study investigated the use of extracorporeal membrane oxygenation (ECMO) in neonates with transposition of the great arteries at a single center from 2009 to 2024. A total of 22 neonates received ECMO, with a median age at initiation of 6.5 days. Of these, 12 underwent preoperative ECMO for issues such as severe pulmonary hypertension or respiratory failure, while 11 received it postoperatively due to failure to wean from cardiopulmonary bypass, low cardiac output, or cardiac arrest. The overall median ECMO duration was 75 hours, with a survival rate of 59 percent to hospital discharge. In the preoperative ECMO group, 42 percent died (four before surgery and one postoperatively while still on ECMO), whereas the postoperative group had a survival rate of 60 percent. This study highlights the role of ECMO as a bridge to recovery in TGA patients, demonstrating similar survival rates for preoperative and postoperative ECMO support.
January 30, 2025
Submitted by: Akshay Patel
This murine model study investigated a novel combination treatment for pleural mesothelioma using intracavitary cisplatin-fibrin gel (cis-fib) and adjuvant irradiation (IR). Conducted on an orthotopic immunocompetent rat model, the study demonstrates that the combination therapy significantly delayed tumor growth compared to single treatments. A 20 Gy dose of irradiation combined with cis-fib showed the most pronounced effect, reducing tumor growth by up to 71 percent compared to controls. Importantly, the treatment was well-tolerated, with only transient side effects such as mild weight loss and reduced lymphocyte counts observed after irradiation. The current approach to mesothelioma treatment is not straightforward, and while some advocate for purely non-surgical treatments, insights into disease behavior and response could pave the way for standardized multimodality treatment regimens.
January 30, 2025
Submitted by: Mateo Marin-Cuartas
In this article, major international surgical societies (i.e., LACES, STS, AATS, ASCVTS) join EACTS in endorsing the recommendations of the 2024 ESC guidelines for the management of chronic coronary syndromes. EACTS had already officially endorsed the guidelines at the time of their publication. The endorsing societies consider the 2024 ESC guidelines a comprehensive review of the best available evidence, resulting in reliable, internationally endorsed coronary guidelines. These guidelines are seen as an important and timely data-driven correction to recent developments in the coronary guideline arena, offering a thoughtful perspective that aligns with the scientific arguments and considerations raised by multiple global professional societies.
Click here to view the recent CTSNet webinar with Dr. Faisal Bakaeen that addresses the 2024 ESC guidelines for the management of chronic coronary syndromes.
January 30, 2025
Submitted by: Akshay Patel
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.
January 30, 2025
Submitted by: Joel Dunning
This study evaluated long-term outcomes of bioprosthetic and mechanical aortic valve replacement (AVR) using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD). It focused on patients who underwent primary isolated AVR, excluding those with certain conditions such as endocarditis, emergency/salvage status, or prior cardiac surgeries. The study found that, after adjusting risks, mechanical valves were associated with lower all-cause mortality compared to bioprosthetic valves for patients aged 60 or younger. These findings provide valuable information for decision-making in choosing between bioprosthetic and mechanical valves, particularly in younger patients.