Journal and News Scan

This narrative review examines the impact of depression on outcomes after cardiac surgery. The authors synthesized evidence from PubMed and Google Scholar, focusing on the epidemiology, mechanisms, and management of depression in this context. They report that preoperative depression is common, affecting up to 60 percent of patients, and is consistently linked to worse outcomes, including higher mortality, rehospitalizations, postoperative delirium, cognitive dysfunction, longer hospital stays, and reduced quality of life. Proposed mechanisms include inflammation, sympathetic overactivity, endothelial dysfunction, and platelet activation, compounded by adverse health behaviors and socioeconomic or psychosocial stressors. Women are diagnosed with depression more frequently, although male presentations may be underrecognized. The authors emphasize that depression is underdiagnosed in surgical practice, despite clear prognostic implications. They highlight evidence that the continuation of antidepressants, cognitive behavioral therapy, and structured exercise can improve outcomes. The review concludes that routine depression screening and the integration of psychological care into multidisciplinary perioperative pathways are essential. 

In this multicenter retrospective study of 1,454 consecutive patients undergoing isolated coronary artery bypass grafting (CABG), the SYNTAX Score II was externally validated for predicting four-year mortality. Mortality was 8.4 percent, with tertiles of SYNTAX Score II significantly stratifying survival, although the anatomical SYNTAX Score alone was not predictive. Independent predictors of mortality included age, creatinine clearance, left ventricular ejection fraction (LVEF), and chronic obstructive pulmonary disease (COPD). Calibration analysis showed systematic overestimation of mortality, particularly at higher scores (observed/expected ratio 0.61), while discrimination was acceptable (c-statistic 0.73), comparable to European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, logistic EuroSCORE, and Age, Creatinine, and Ejection Fraction (ACEF). These findings suggest that although the SYNTAX Score II provides reasonable prognostic accuracy in real-world CABG patients, its predictions should be interpreted with caution, especially at higher values, due to its improved surgical outcomes since its development. Simpler scores, such as ACEF, may offer equivalent predictive value while being easier to use. Additionally, newer recalibrated models like SYNTAX Score II 2020 may better reflect contemporary practices. 

Robotic-assisted thoracoscopic surgery provides significant advantages for complex pulmonary resections such as high-definition 3D visualization and enhanced precision, resulting in reduced morbidity and quicker recovery compared to open thoracotomy. Although sublobar resections such as segmentectomies are technically challenging due to anatomical variations, the introduction of 3D reconstruction imaging facilitates tailored surgical planning. This video tutorial showcases a robotic left segmentectomy for a metastatic pulmonary lesion, highlighting how 3D imaging aids in surgical accuracy and decision-making.  

This article explores emerging innovations aimed at addressing the critical challenges of organ transplantation, particularly organ scarcity, rejection, and the burden of lifelong immunosuppression. Key advances include artificial intelligence (AI) for optimizing organ allocation, refining rejection monitoring, and personalizing immunosuppressive therapy; xenotransplantation using multigene–edited donor pigs with improved immunosuppression to overcome hyperacute rejection; and regenerative medicine approaches such as stem cell therapies, three-dimensional organoids, and bioprinting to create patient-specific tissues that reduce the risk of rejection. Additionally, biomaterials and cell encapsulation offer targeted immunosuppression, potentially reducing systemic therapy needs. The authors emphasize that while these strategies hold transformative potential, successful translation requires rigorous clinical validation, ethical oversight, and interdisciplinary collaboration. 
 
This is highly relevant to CTSNet’s global cardiothoracic surgery audience because it highlights technologies that could redefine heart and lung transplantation, potentially mitigating donor shortages, improving graft longevity, and expanding access to life-saving therapies for patients with end-stage cardiothoracic disease.