Journal and News Scan

In this study, the authors evaluated the organ-protective efficacy of postoperative glucocorticoid in patients with type A aortic dissection. Patients were randomly assigned to receive either postoperative glucocorticoid or standard-of-care treatment. Intravenous methylprednisolone was administered for three days. The primary outcome was the reduction of Sequential Organ Failure Assessment (SOFA) score on postoperative day four compared to baseline (on postoperative day one, before methylprednisolone administration). A total of 212 patients (106 patients in each group) were included in the intention-to-treat analysis. The primary outcome differed significantly between groups: SOFA score reduction was 3.16 plus or minus 2.52 in the control group versus 4.36 plus or minus 2.82 in the glucocorticoid group (absolute difference 1.20 [95 percent CI 0.52–1.93], P = 0.001). The glucocorticoid group showed markedly lower median high-sensitivity C-reactive protein levels compared to the control group (91.0 mg/l vs 182.0 mg/l; absolute difference: –91 [95 percent CI –122 to –57], P = 0.009) on postoperative day four. Fewer patients in the glucocorticoid group required continuous renal replacement therapy (8.5 percent vs 19.8 percent in the control group; absolute difference: –10.4 [95 percent CI –19.1 to –1.3], P = 0.03). These findings advocate for the implementation of glucocorticoids in the early phase after type A aortic dissection surgery for enhanced organ protection. 

This murine model study investigated a novel combination treatment for pleural mesothelioma using intracavitary cisplatin-fibrin gel (cis-fib) and adjuvant irradiation (IR). Conducted on an orthotopic immunocompetent rat model, the study demonstrates that the combination therapy significantly delayed tumor growth compared to single treatments. A 20 Gy dose of irradiation combined with cis-fib showed the most pronounced effect, reducing tumor growth by up to 71 percent compared to controls. Importantly, the treatment was well-tolerated, with only transient side effects such as mild weight loss and reduced lymphocyte counts observed after irradiation. The current approach to mesothelioma treatment is not straightforward, and while some advocate for purely non-surgical treatments, insights into disease behavior and response could pave the way for standardized multimodality treatment regimens. 

This study evaluated outcomes in lung transplantation (LTx) using lungs from donation after brain death (DBD) vs. donation after circulatory death (DCD). After analyzing 21 studies with more than 60,000 patients, researchers found that early mortality was slightly higher in the DCD group (5.5 percent vs. 4.5 percent for DBD). However, long-term survival at one, three, and five years was significantly better for DCD (86.7 percent, 75.5 percent, and 63.2 percent, respectively) compared to DBD (82.1 percent, 65.6 percent, and 51.3 percent). No significant differences were observed in rates of acute rejection, primary graft dysfunction (PGD), or postoperative complications between the groups. 
 
This study is important for the cardiothoracic community because it highlights the potential of DCD to expand the donor pool while achieving comparable, if not superior, long-term outcomes.  

The authors evaluated the five-year outcomes in low-risk patients undergoing isolated surgical aortic valve replacement (SAVR) or SAVR with concomitant procedures within the randomized PARTNER 3 trial. In the PARTNER 3 trial, 454 patients with severe, symptomatic, tricuspid aortic stenosis (AS) underwent surgery and were followed for five years. Patients were stratified into those undergoing isolated SAVR (n=334, 73.6 percent) vs. concomitant SAVR (n=120, 26.4 percent). The mean age was 73.6 plus or minus 6.1 years, and 71.1 percent were male. The median SAVR implant size was 23 mm overall. Five-year all-cause mortality was 9.0 percent for all patients (8.5 percent for isolated SAVR versus 10.2 percent for concomitant SAVR, p=0.58). The average five-year mean gradient was 11.7 plus or minus 5.6 mmHg overall. Reintervention rates were low in both groups (2.3 percent for isolated SAVR vs. 5.0 percent for concomitant SAVR, p=0.21), and the majority of patients (87.9 percent for isolated SAVR vs. 86.1 percent for concomitant SAVR) were alive with no evidence of bioprosthetic valve failure at five years. The authors concluded that SAVR in low-risk patients in the PARTNER 3 trial demonstrated excellent five-year outcomes. Five-year mortality was similar in patients undergoing isolated vs. concomitant SAVR. This was comparable to recently published national SAVR outcomes, supporting the generalizability of these findings.