Journal and News Scan

The updated guidelines for managing chronic coronary symptoms (CCS) provide a framework for diagnosing and treating suspected and confirmed cases of CCS. They emphasize using a risk factor-weighted model to better estimate the likelihood of obstructive coronary artery disease (CAD), which improves upon the previous 2019 ESC model by more accurately classifying patients into low-risk categories where further testing might not be needed. The guidelines include a new diagnostic algorithm for moderate or high-risk patients and expand on the diagnosis and treatment of angina with no or nonobstructive CAD (ANOCA-INOCA). They offer detailed recommendations for anti-anginal medications, therapies to prevent events, adherence strategies and the selection of revascularization techniques based on recent research. The guidelines also address management strategies for recurrent or refractory angina and ischemia.  

The authors aimed to analyze the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis (IE) undergoing valve surgery. This study utilized data from the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry, which includes patients with IE who underwent valve surgery between 1994 and 2018 at six German centers. Patients were categorized based on the presence or absence of preoperative septic cerebral embolism. A total of 4,917 patients were included in the analysis, with 3,909 (79.5 percent) without preoperative septic cerebral embolism and 1,008 (20.5 percent) patients with preoperative septic cerebral embolism. Among patients with preoperative cerebral embolism, 286 (28.4 percent) patients had no stroke signs (silent stroke). There were no statistically significant differences in 30-day mortality (20.1 percent vs. 22.8 percent; p = 0.14) or 5-year survival (47.8 percent vs. 49.1 percent; stratified log-rank p = 0.77) between patients with and without preoperative cerebral embolism. Therefore, the authors conclude that preoperative septic cerebral embolism should not be a major factor in deciding whether to perform surgery in patients with IE requiring heart valve surgery. 

This article provides a comprehensive guide for students aiming to enter the field of cardiothoracic surgery, by addressing challenges from premedical stages to residency. This article helps students make informed decisions by detailing various training pathways, including the traditional path, the integrated six-year program, and the fast-track 4+3 pathway. Emphasizing the importance of mentorship, networking, and extracurricular activities such as research and volunteering, the article offers practical advice to build a competitive application. It also discusses future opportunities within the specialty, such as super-fellowships and diverse career paths. This guide is crucial for aspiring cardiothoracic surgeons, demystifying the path to a demanding field and addressing workforce shortages. It is particularly relevant to CTSNet’s global audience, highlighting strategies for success in a competitive and evolving specialty. 

The optimal revascularization strategy after extracorporeal cardiopulmonary resuscitation (ECPR) remains unclear, with limited existing data. This study compared outcomes for patients who underwent coronary artery bypass grafting (CABG) and those who received percutaneous coronary intervention (PCI) after ECPR using databases from two referral centers. Forty patients in each category were compared. Researchers found that the CABG group had better early outcomes (hospital survival- 56.4 percent vs 32.4 percent, p = 0.04 and success of ECPR weaning: 71.1 percent vs 48.7 percent, p = 0.05) compared to the PCI group. Late outcomes were similar among groups, although the PCI group appeared to have more endovascular interventions.