Journal and News Scan

The article evaluates the outcomes of a paradigm shift in lung transplantation. Traditionally, the lung with the lowest perfusion was implanted first to minimize intraoperative hemodynamic instability. However, this single-center study of 696 cases from 2008 to 2021 investigated the impact of consistently implanting the right lung first, irrespective of perfusion. 
 
The main findings revealed that the right-first strategy significantly reduced the need for intraoperative extracorporeal membrane oxygenation (ECMO) during second-lung implantation and showed a trend toward reduced incidence of primary graft dysfunction (PGD) grade 3. Secondary outcomes, including survival and ICU stays, did not differ between groups. 

This meta-analysis evaluates the clinical outcomes of totally endoscopic coronary artery bypass (TECAB) in patients with symptomatic coronary artery disease. A comprehensive search of PubMed, Scopus, and Cochrane was conducted, analyzing data from 18 eligible studies published up to December 2022, involving 2,774 patients. The average age of the patients was 63.2 years, and 77.5 percent were male. 
 
The study found that the mean operative time for TECAB was 304.2 minutes, with an internal mammary artery takedown time of 38.3 minutes. Conversion to open surgery occurred in 4.7 percent of cases. Long-term outcomes were favorable, with 93.4 percent of patients remaining free from major adverse cardiac events (MACE). Survival rates were 95.2 percent at one year, 83.2 percent at five years, and 81.7 percent at 10 years. Additionally, 3.3 percent of patients required reintervention during a mean follow-up period of 42.5 months. 
 
The findings suggest that TECAB is a safe and viable option for selected patients, offering favorable short-term and long-term outcomes. The technique is associated with relatively low complication rates, and its survival rates are comparable to those of traditional coronary artery bypass grafting (CABG). However, the need for further research with longer follow-up is emphasized to better understand the role of robotic and endoscopic approaches in coronary revascularization, especially in comparison to standard open surgery. 

This article examines the malignancy potential of pure ground-glass nodules (pGGNs) under 30 mm, challenging the notion that these nodules carry minimal invasive cancer risk. After analyzing 28 observational studies with a total of 3,874 nodules, the study found a pooled prevalence of invasive or minimally invasive adenocarcinoma in 42.4 percent of cases. The study highlights significant variability in malignancy risk, primarily driven by patient selection rather than nodule size or geographic region. Current classification systems, such as the IASLC's, which label such nodules as "probably benign,” may underestimate their true invasive potential. 
 
This research is pivotal for the cardiothoracic surgery community, as it underscores the need for vigilance in managing small pGGNs. These findings could influence preoperative planning, surgical decision-making, and guideline revisions to improve lung cancer outcomes. 

In this study, the authors conducted an in-depth analysis of the health status of patients enrolled in the TRISCEND II pivotal trial (Edwards EVOQUE Transcatheter Tricuspid Valve Replacement: Pivotal Clinical Investigation of Safety and Clinical Efficacy Using a Novel Device) to help quantify the benefit of intervention for these patients. The TRISCEND II pivotal trial randomized 400 patients with symptomatic and severe or greater tricuspid regurgitation (TR) to transcatheter tricuspid valve replacement (TTVR) with the EVOQUE tricuspid valve plus optimal medical therapy (OMT), or OMT alone. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ-OS) and the 36-Item Short Form Health Survey. Changes in health status in the span of one year were compared between treatment groups using mixed-effects repeated-measures models. The analysis cohort included 392 patients, of whom 259 underwent attempted TTVR and 133 received OMT alone (mean age 79.2 plus or minus 7.6 years, 75.5 percent women, 56.1 percent with massive or torrential TR). Patients had substantially impaired health status at baseline (mean KCCQ-OS 52.1 plus or minus 22.8; mean 36-Item Short Form Health Survey physical component summary score 35.2 plus or minus 8.4). TTVR plus OMT patients reported significantly greater improvement in both disease-specific and generic health status at each follow-up point. Mean between group differences in the KCCQ-OS favored TTVR plus OMT at each point: 11.8 points (95 percent CI: 7.4-16.3 points) at 30 days, 20.8 points (95 percent CI: 16.1-25.5 points) at six months, and 17.8 points (95 percent CI: 13.0-22.5 points) at one year. Furthermore, TTVR plus OMT improved health status to a greater extent among patients with torrential or massive TR compared to those with severe TR (treatment effect 23.3 versus 22.6 versus 11.3; interaction P = 0.049). At one year, 64.6 percent of TTVR plus OMT patients were alive and well (KCCQ-OS greater than or equal to 60 points and no decline of greater than or equal to 10 points from baseline) compared with 31.0 percent in the OMT-only group. In conclusion, compared with OMT alone, treatment of patients with symptomatic and severe or greater TR with TTVR plus OMT resulted in substantial improvement in patients’ symptoms, function, and quality of life. These benefits were evident 30 days after TTVR, continued to increase through six months, and remained durable through one year.