Journal and News Scan

This article addresses the evolving role of invasive mediastinal restaging in managing resectable stage II and III NSCLC in the era of neoadjuvant chemoimmunotherapy. It emphasizes that while invasive restaging is not routinely required for all patients after neoadjuvant therapy, it remains essential in cases with suspected disease progression—particularly to exclude new N3 status or differentiate between true disease progression and benign nodal immune flare. The authors underscore that surgical resection continues to be a critical component of curative-intent treatment, even for patients with persistent N2 disease, due to the lack of definitive evidence supporting radiation-based or systemic-only alternatives in such scenarios. 
 
This article is significant to the cardiothoracic surgery community as it highlights the need for multidisciplinary decision-making and ongoing research to refine treatment strategies. This article also provides practical insights into integrating novel therapeutic paradigms with surgical care to optimize outcomes in NSCLC. 

This study evaluates the outcomes of bilateral lung transplantation (LTx) using grafts from donors aged 70 years or older, compared with those from younger donors. Conducted at a single center in Leuven, Belgium, the retrospective cohort study included 69 older donors, matched 1:1 with younger donors based on key variables. Primary endpoints included the incidence of primary graft dysfunction (PGD) grade 3 within 72 hours post-transplant, five-year patient survival, and chronic lung allograft dysfunction (CLAD)-free survival. 

There were no significant differences in PGD-3 rates (26 percent in older donors versus 29 percent in younger donors), five-year survival (73.6 percent versus 73.1 percent), or CLAD-free survival (51.5 percent versus 59.2 percent).  

Carefully selected older donors (mean age 74 years) demonstrated similar short- and long-term outcomes as younger donors.  

The study indicates that using lungs from donors aged 70 years or older can effectively address organ shortages, thus expanding the donor pool, without compromising recipient outcomes. 

This study evaluates the impact of antegrade stenting of the distal arch and proximal descending aorta in patients with acute type A aortic dissection (ATAAD) who underwent nontotal arch procedures. The analysis includes 733 nonsyndromic patients treated between 2005 and 2022, of whom 95 received antegrade stenting. A propensity-score analysis matched 95 pairs from each group. 
 
The survival rates at 10 years were similar between the two groups. Additionally, the cumulative incidence of reintervention, accounting for the competing risk of death, was also similar between the two groups, with the nonstented group showing a 27 percent incidence of reintervention and the stented group showing 22 percent (P = 0.44). 
 
The study suggests that antegrade thoracic endovascular aortic repair may not improve long-term survival or reduce the need for reintervention in acute type A aortic dissection. However, it may offer benefits for remodeling the aorta and facilitating future endovascular interventions, particularly in cases of malperfusion. Therefore, while the procedure does not appear to significantly affect survival or reintervention rates, it could still play a major role in the management and future treatment of these patients, particularly by reducing the need for later interventions related to malperfusion. 

This study investigated the impact of patient-prosthesis mismatch (PPM) on long-term mortality and reoperation rates over a 15-year follow-up in patients who underwent biologic aortic valve replacement. A total of 645 patients were included, all of whom had their PPM status evaluated via echocardiographic examinations six months post-surgery, with PPM defined by an indexed effective orifice area of less than 0.85 cm²/m².  
  
Of the patients studied, 256 (40 percent) exhibited PPM, categorized into 175 with moderate PPM and 81 with severe PPM. The analysis revealed that survival rates were not significantly impaired for patients with moderate PPM compared to those without PPM. However, patients with severe PPM demonstrated a marginally significant increase in mortality risk, with a hazard ratio (HR) of 1.40 (95 percent CI, 0.99-1.97; P = .054).  
  
Factors associated with reduced survival included older age (HR, 1.12; P < .001), arterial hypertension (HR, 1.78; P < .001), and diabetes mellitus (HR, 1.67; P < .001). Regarding reoperation rates, there were 10.1 events per 1,000 patient-years for patients without PPM, 8.5 for those with moderate PPM, and 14.8 for those with severe PPM. The 10-year cumulative incidence of reoperation was 8.3 percent, 6.7 percent, and 12.1 percent, respectively.  
  
Notably, multivariable analysis showed that PPM category was not significantly associated with the risk of reoperation (P > .2). In conclusion, while PPM had a marginal relationship with long-term survival, it was not statistically linked to reintervention risk. These findings suggest that other clinical factors may play more crucial roles in patient outcomes after aortic valve replacement.