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Journal and News Scan
August 21, 2025
Submitted by: Ali Mashadi
In this expert opinion, the authors highlight the challenges faced by international medical graduates (IMGs) pursuing cardiothoracic (CT) surgery training positions in the United States.
Before training, IMGs face significant barriers in securing residency interviews. A broad survey of National Resident Match Program Directors in 2023 revealed that 78 percent seldom or never offer interviews to U.S. citizen IMGs, a figure that rises to 88 percent for non-U.S. IMGs. As a result, IMGs tend to apply to a larger number of programs to increase their chances, leading to substantially higher application costs.
For those who do successfully match, the next hurdle is visa acquisition. The most common visas, J-1 and H-1B, come with stringent limitations, including time restrictions and service requirements that can disrupt a trainee’s education. Furthermore, the transition to a U.S.-based clinical environment can be difficult, as differences in clinical autonomy and workflow between countries may pose steep learning curves.
Overall, the path to a career in CT surgery for IMGs is fraught with challenges across every stage of training. Nonetheless, as the authors argue, increasing IMG representation in CT surgery is vital for advancing diversity, equity, and inclusion in the field.
August 14, 2025
Submitted by: Vincent Sier
This multicenter randomized trial demonstrated that epicardial-endocardial hybrid ablation (HA) maintained superior effectiveness over endocardial catheter ablation (CA) for nonparoxysmal atrial fibrillation at 24 months (66.3 percent vs. 33.3 percent freedom from AF/atrial flutter/atrial tachycardia), with comparable safety rates and significantly fewer reinterventions after HA.
August 14, 2025
Submitted by: Mujtaba Mubashir
This randomized control trial evaluated the effect of superficial parasternal intercostal plane block (SPIP) on lung function testing in patients undergoing aortic valve replacement via conventional sternotomy. A total of 74 patients were randomized to receive either SPIP or no treatment. The authors found that forced expiratory volume (FEV), forced volume capacity (FVC), and relative FVC changes decreased less in patients treated with SPIP compared to those who did not receive the treatment (P = 0.024, P = 0.042, and P = 0.042). However, there was no statistically significant difference in total oxycodone consumption between the two groups. While these short-term outcomes are promising, the long-term impact of SPIP on patient recovery remains to be seen.
August 14, 2025
Submitted by: Mateo Marin-Cuartas
This article provides a practical summary of the surgical indications from the 2023 European guidelines for the management of infective endocarditis (IE). IE remains a challenging condition with high morbidity and mortality despite advances in diagnosis and management. The 2023 European Society of Cardiology guidelines, endorsed by the European Association of Cardio-Thoracic Surgery, introduce significant updates, including several new recommendations regarding surgical intervention. This review synthesizes current evidence on the surgical management of IE, emphasizing indications, timing, and outcomes.
The multidisciplinary Endocarditis Team approach is highlighted as a key factor in improving patient prognosis by optimizing diagnosis and treatment strategies. Advanced imaging techniques, such as positron emission tomography-computed tomography, have enhanced diagnostic accuracy, particularly for prosthetic valve endocarditis. Despite the clear survival benefits associated with surgery, only a minority of eligible patients undergo surgical treatment, underscoring the need for better patient selection and timely intervention. Furthermore, the worse prognosis is found in patients with indications for surgery who do not undergo surgical intervention. The updated IE guidelines provide detailed timing recommendations for surgery based on the clinical scenario, including new considerations for patients with stroke. Additionally, novel recommendations regarding partial oral antibiotic therapy following surgery have been introduced. Finally, important measures for the prevention of IE recurrence are discussed.
In conclusion, timely surgical intervention, based on defined recommendations guided by multidisciplinary collaboration and enhanced diagnostic tools, is crucial in improving outcomes for IE patients.
August 14, 2025
Submitted by: Jade Qu
This large single-center retrospective study of 682 patients compared outcomes after sleeve lobectomy for non-small cel lung cancer (NSCLC) with and without buttressing the bronchial anastomosis using autogenous flaps. After propensity weighting, perioperative outcomes, including postoperative complications, bronchopleural fistula, and anastomotic stenosis, were similar between groups, with the exception of a longer operative time in the wrapping group. Five-year recurrence-free and overall survival rates did not differ significantly. Multivariable analyses confirmed that buttressing was not associated with reduced complications or improved long-term survival. These results suggest that routine bronchial anastomosis wrapping does not confer additional benefits and may be unnecessary.
August 14, 2025
Submitted by: Mujtaba Mubashir
This cadaver-based study evaluated the variations in vascular perfusion territories of the descending thoracic aorta, including variations in the anatomy of the artery of Adamkiewicz. The authors found important variations in origin and location of the artery of Adamkiewicz and demonstrated its importance, along with the anterior spinal arteries in spinal cord perfusion. This was based on the differential dye staining of the anterior and posterior aspects of the spinal cord along its entire length. A pictorial representation of these differences is shown, as well as variations in the anatomy of the arterial supply itself.
August 7, 2025
Submitted by: Joel Dunning
This article outlines best practice for achieving safe on-table extubation following cardiac surgery. It focuses on optimizing patient fitness postoperatively and emphasizes the importance of multidisciplinary coordination. The guidelines aim to reduce complications, enhance recovery times, and promote faster rehabilitation by implementing structured approaches to patient selection and anesthetic management.
August 7, 2025
Submitted by: Jade Qu
This single-institution study evaluated 78 patients undergoing single-anesthetic robotic bronchoscopy with intraoperative biopsy, followed by possible lung resection. Intraoperative frozen section diagnoses showed almost perfect agreement with final pathology (Cohen’s kappa 0.94), supporting their reliability for surgical decision-making. The diagnostic yield improved over time, reaching 80.8 percent in the late phase. The rate of unnecessary benign resections decreased significantly as experience grew, dropping to zero percent in the late phase. No malignancies were missed when surgery was aborted based on benign biopsy.
August 7, 2025
Submitted by: Erica Curcio
This study examines the impact of the 2018 United Network for Organ Sharing (UNOS) heart transplant allocation criteria change on posttransplant stroke rates. The study included 19,512 patients from the UNOS database who received a heart transplant between October 18, 2014, and October 17, 2022, divided into precriteria change (n = 9768) and postcriteria change (n = 9744) cohorts. The primary outcome was stroke, and secondary outcomes included mortality and adverse events. The study found that the 2018 donor heart allocation criteria change is associated with a higher risk of posttransplant stroke. Posttransplant stroke increased the risk of mortality by six-fold during the early posttransplant period.
August 7, 2025
Submitted by: Mujtaba Mubashir
Frozen elephant trunk (FET) is an established surgical option for the single-stage treatment of acute type A aortic dissection. The authors studied 222 patients who underwent FET and compared outcomes and reintervention rates. The authors found significantly improved 30-day mortality with a zone 2 repair technique (7 percent) compared to a zone 3 repair technique (18 percent). Early mortality was driven by the presence of complicated dissection, including the presence of malperfusion syndrome, rupture, the need for presurgical intubation, or the need for cardiopulmonary resuscitation. Secondary distal aortic interventions were frequently performed after FET (37.4 percent); however, this did not adversely affect five-year survival. The authors also discuss the importance of patient selection for FET vs more expeditious procedures in type A dissections, since this could affect both short- and long-term outcomes, although further investigation in this area is necessary.