Journal and News Scan

The NeoCOAST-2 trial, published in Nature Medicine, evaluates the efficacy and safety of neoadjuvant durvalumab-based combination regimens for resectable stage IIA–IIIB non-small cell lung cancer (NSCLC). This phase II, open-label, multicenter study randomized patients to receive durvalumab either alone or in combination with novel immune modulators, including oleclumab (anti-CD73) or monalizumab (anti-NKG2A), alongside platinum-based chemotherapy prior to surgery. The results demonstrated higher major pathological response (MPR) and pathological complete response (pCR) rates with durvalumab combinations compared to durvalumab plus chemotherapy alone, without compromising surgical feasibility or safety. Most patients proceeded to complete resection, with acceptable perioperative complication rates and no new safety signals. 
 
For CTSNet’s global cardiothoracic surgery audience, this study is particularly relevant as it demonstrates how immunomodulatory combinations can enhance tumor clearance preoperatively while maintaining operability and safety. These findings highlight the evolving role of surgery within multimodal immunotherapy protocols, shaping future standards for curative-intent management of resectable NSCLC. 

In this article, the author reflects on 60 years of coronary artery bypass grafting (CABG), outlining its origins, the role of early surgical-cardiology collaboration, and its place alongside advances in medical therapy. Despite improvements in guideline-directed treatment, patients with extensive coronary disease still rely on CABG. The central message is that CABG remains the most durable revascularization strategy and will continue to be needed until true disease modifying therapies emerge. 

The authors analyzed 2,748 adults undergoing aortic root replacement between 2004 and 2021. They report an overall stroke rate of 3.4 percent, which was highest in patients aged 80 years and older (9.7 percent). This group also experienced more renal failure requiring dialysis, prolonged ventilation, longer hospital stays, and the highest in-hospital mortality (13 percent). The 10-year survival was 78 percent overall but declined to 63 percent in ages 70–79 and 4 percent for those aged 80 years and older. Reoperation was required in 4 percent of cases, most often among patients aged 30–49. The authors conclude that outcomes worsen significantly with advanced age. 

Transcatheter aortic valve implantation (TAVR) has transformed treatment for high-risk aortic stenosis patients, but its recent use in low-risk younger populations and those with bicuspid aortic valves (BAV) raises concerns about valve durability and increased mortality and stroke rates. Emerging data suggests that TAVR risks may accumulate over time, particularly in patients with BAV. This article highlights the need for further research to inform clinical decisions regarding TAVR in younger patients.