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Journal and News Scan
October 2, 2025
Submitted by: Francesco Pollari
The article aimed to assess the long-term survival outcomes following surgical repair in patients with type A aortic dissection (ATAAD) and to evaluate the correlation with the preoperative German Registry for Acute Type A Aortic Dissection (GERAADA)-score value. The authors enrolled patients from nine hospitals. Follow-up information was obtained by matching the clinical patient data with a national administrative database. A total of 1,110 patients were analyzed. The median age was 67 years (IQR 57–75), and females comprised 30.8 percent of the cohort. The median GERAADA score was 14.3 percent (10.2–22]). The mean length of follow-up was 4.19 years. Discrimination was poor but remained stable over time (AUC at 1-year follow-up: 0.66; 95 percent CI 0.63–0.70; AUC at 10-year follow-up: 0.64; 95 percent CI 0.61–0.68). Calibration plots showed under-prediction until a 50 percent predicted probability and progressive over-prediction afterward. There was a steep mortality rate in the first couple of months after surgery, while afterward, the mortality rate was constantly lower. The GERAADA-score was found to be a predictor of long-term mortality with a nonlinear association.
October 2, 2025
Submitted by: Ali Mashadi
Sanad and colleagues report promising early- to mid-term outcomes of aortic valve neocuspidization (AVNeo), commonly known as the Ozaki procedure, in patients with rheumatic heart disease.
The study was conducted in Egypt, where rheumatic heart disease remains prevalent. Over a nearly four-year period, 33 patients with rheumatic disease underwent AVNeo, with a mean age of approximately 39 years. Overall survival was excellent, with no early mortalities and only two late deaths: one due to infective endocarditis and aortic root abscess three years postoperatively, and the other from COVID-19 approxiamtely two weeks after surgery. Two patients required early reoperations: one for bleeding and the other for aortic insufficiency due to failure of the right neo-cusp, which the authors attribute to suture line dehiscence. One patient required permanent pacemaker implantation one year after surgery, potentially due to conduction tissue injury during debridement.
Despite the relatively young age of the cohort, AVNeo was favored over other valve replacement options for its potential to reduce the need for future reoperations and to avoid lifelong anticoagulation. The authors also emphasize the cost-effectiveness of AVNeo, particularly highlighting its relevance in low- to middle-income and resource-limited settings.
Overall, this study supports AVNeo as a promising surgical option with favorable early and mid-term outcomes in a challenging patient population.
October 2, 2025
Submitted by: Vincent Sier
This systematic review and meta-analysis evaluated whether three-dimensional (3D) reconstruction and virtual simulation improve outcomes in thoracoscopic segmentectomy. Ten studies (n=1,424; 772 3D vs 652 non-3D) were included. Overall, 3D-assisted planning significantly reduced inadequate surgical margins (OR 0.09, p=0.006) and postoperative complications (OR 0.53, p<0.001). In subgroup analysis, complex segmentectomies performed with 3D planning had shorter operative times (mean difference–10.9 minutes) and less blood loss (–5.4 ml). No differences were found in lymph node yield, chest tube duration, total drainage, or hospital stay. While benefits were most pronounced in anatomically complex resections, heterogeneity across studies was high, and most studies were retrospective, limiting generalizability. The authors conclude that patient-specific 3D reconstruction enhances surgical precision and safety by lowering complication and margin failure rates, and in complex cases, it reduces operative burden, supporting its adoption as a tool for procedural planning in minimally invasive segmentectomy.
October 2, 2025
Submitted by: Vincent Sier
The authors measured inlet and outlet orifice diameters and flow channel height of eight surgical bioprosthetic aortic stented valve models using an optical method. They demonstrated that in most valves (89 percent) the outlet orifice diameter is smaller than the inlet, resulting in a converging flow channel, while one model showed cylindrical geometry and another a diverging shape. Porcine valves exhibited higher gradient multipliers than bovine valves, with the Medtronic Avalus demonstrating the most favorable hemodynamic profile. The ratio between inlet and outlet diameters was consistent within each model type. The authors conclude that the outlet diameter is often the smallest and, therefore, hemodynamically most relevant dimension. They further emphasize that information on valve metrics is incomplete, scarce, and confusing, highlighting the need for more transparent and accessible reporting by manufacturers.
September 25, 2025
Submitted by: Vincent Sier
This single-center ambidirectional cohort study analyzed 617 patients with acute type A aortic dissection (ATAAD) who had coronary ostial involvement from 2019–2023. Patients underwent either isolated coronary ostial reconstruction (COR, n=507) or protective coronary artery bypass grafting (CABG, n=110), following COR or suture closure in severe cases (Neri A >50 percent margin, Neri B with distal entry, Neri C). Despite presenting with more severe coronary involvement and higher rates of malperfusion, the CABG group had significantly less procedural myocardial injury (2.7 percent vs 9.3 percent) and a trend toward fewer serious adverse events (2.7 percent vs 8.1 percent). Multivariable regression confirmed that protective CABG reduced serious adverse events (OR 0.24, P=0.028). The median follow-up was 26 months. Long-term survival did not differ between groups, although graft occlusion occurred in approximately 22 percent of CABG patients at two years. The authors conclude that protective CABG enhances perioperative safety in severe ATAAD coronary involvement without compromising long-term survival.
September 25, 2025
Submitted by: Akshay Patel
This article reviews lymph node dissection and its relationship to postoperative chylothorax in thoracic surgery. The authors analyze patterns of nodal involvement, technical considerations during mediastinal lymphadenectomy, and factors contributing to thoracic duct injury. They highlight that while comprehensive lymph node dissection is essential for accurate staging and potentially improved oncologic outcomes, it carries a measurable risk of chylothorax, particularly with extensive mediastinal nodal clearance. The paper emphasizes early recognition, standardized management strategies, and the importance of balancing oncological thoroughness with the risk of complications.
This work is significant because chylothorax remains a challenging and sometimes underreported complication in cardiothoracic surgery, associated with increased morbidity, prolonged hospitalization, and complex decision-making around reintervention. The paper provides both practical insights for surgical techniques and evidence-based strategies for managing complications, making it directly relevant to daily thoracic surgical practice and multidisciplinary perioperative care worldwide.
September 25, 2025
Submitted by: Joel Dunning
This article argues that emergency resternotomy should be routinely practiced in all cardiac surgery centers, as it is a critical procedure for managing cardiac arrest such as tamponade or refractory bleeding. The authors stress the importance of training and protocols to ensure quick and effective resternotomy, which can significantly improve patient outcomes compared to standard resuscitation methods, ultimately reducing the risk of neurological damage and mortality.
September 25, 2025
Submitted by: Vincent Sier
This single-center retrospective study compared the outcomes of mitral valve (MV) surgery vs transcatheter edge-to-edge repair (TEER) in octogenarians with moderate-to-severe or severe mitral regurgitation (MR). Between 2014 and 2024, 744 patients aged 80 years and older underwent MV intervention. After exclusions and 1:1 propensity matching, 252 patients (126 per group) were analyzed. Thirty-day mortality was low and similar between the groups (1.6 percent for surgery vs 0.8 percent for TEER). Surgery was associated with higher early morbidity (atrial fibrillation, prolonged ventilation, and longer ICU/hospital stays), but echocardiography at discharge showed less residual MR and tricuspid regurgitation, as well as lower right ventricular systolic pressure. At the median follow-up of 3.9-years, recurrent MR was significantly less frequent after surgery (6 percent vs 33 percent), and five-year survival favored surgery (68 percent vs 56 percent). While TEER offered advantages such as shorter hospitalization and fewer immediate complications, surgery provided superior valve durability, fewer reinterventions, reduced heart failure readmissions, and improved long-term survival in appropriately selected octogenarians.
September 25, 2025
Submitted by: Akshay Patel
This article reports the first pig-to-human lung xenotransplantation, marking a major milestone in thoracic transplantation research. A six-gene-edited porcine lung was transplanted into a 39-year-old brain-dead human recipient and monitored for 216 hours. The xenograft remained viable without evidence of hyperacute rejection or infection, demonstrating the feasibility of this approach. However, challenges emerged. Severe edema resembling primary graft dysfunction occurred within 24 hours, likely due to ischemia-reperfusion injury, and antibody-mediated rejection contributed to graft injury on postoperative days three and six, with partial recovery by day nine. The study employed an intensive multidrug immunosuppressive regimen tailored to the immune status throughout the monitoring period.
This case is highly significant for the CTSNet global cardiothoracic surgery audience, as it represents a proof-of-concept step toward lung xenotransplantation as a potential solution to donor shortages. While rejection and immunologic barriers remain formidable, these findings provide critical insights that will guide future preclinical and translational research.
September 18, 2025
Submitted by: Ali Mashadi
This study reported favorable early outcomes in 11 intermediate- and high-risk patients who underwent a modified Bio-Bentall procedure with a rapid deployment valve between January 2018 and December 2022.
The technique involved inserting an inverted 8 cm Valsalva graft into the left ventricular outflow tract using a single-layer continuous suture anastomosis. The graft was then exteriorized, and the coronary buttons were reimplanted. Three simple interrupted anchoring sutures were placed and the valve was deployed.
The median patient age was 71 years, with the most common primary indication being annuloaortic ectasia with aortic insufficiency in six out of 11 patients. The median cardiopulmonary bypass and aortic cross-clamp times were 99 and 73 minutes, respectively. No early mortalities, reoperations, or paravalvular leaks were reported during follow-up. At one year, survival was 90.9 percent, and at three years, it was 54.5 percent. Permanent pacemaker implantation was required in three patients, with the authors attributing only one case to the rapid deployment technique.