Journal and News Scan

This study evaluates the early safety of a new technique called branched stented anastomosis frozen elephant trunk repair (B-SAFER) for treating multisegment thoracic aortic disease, which aims to improve outcomes in high-risk patients undergoing total aortic arch replacement. A total of 178 patients were enrolled between May 27, 2021, and December 31, 2022, with varying aortic conditions, including acute syndrome, chronic dissection, degenerative aneurysm, and congenital disorders. 
 
Patients underwent surgery using different configurations of stented anastomoses. The procedure involved median cardiopulmonary bypass time of 188 minutes, and 97 percent of patients underwent antegrade cerebral perfusion for a median of 46 minutes. The study found an operative mortality rate of 5.6 percent, with additional serious complications including disabling stroke (2.9 percent), respiratory failure (11.4 percent), and acute kidney injury (10 percent). Survival rates were 95 percent at 30 days, 88 percent at 90 days, 84 percent at six months, and 79 percent at one year, with variability based on the underlying aortic condition. 
 
Overall, B-SAFER demonstrated early safety and effectiveness, but further follow-up is needed to refine the technique and develop new devices. 

This study investigated the impact of complete revascularization (CR) versus incomplete revascularization (IR) on long-term survival in patients who underwent multivessel coronary artery bypass grafting (CABG) with either multiple arterial grafts (MAG) or a single artery with saphenous vein grafts (SAG). The analysis revealed that IR did not negatively affect long-term survival in patients who received MAG but was linked to lower survival rates in those receiving SAG. Specifically, patients with MAG IR had better long-term outcomes than those with SAG IR. Furthermore, CR combined with MAG resulted in better long-term survival compared to CR with SAG. Within the MAG cohort, no significant survival differences were observed among patients with perfect CR, imperfect CR, and IR. However, in the SAG cohort, perfect CR was associated with better survival compared to imperfect CR and IR. The study supports the advantage of MAG over SAG in terms of long-term survival, regardless of CR or IR status. The benefit of MAG may be attributed to better graft patency and reduced progression of atherosclerosis compared to SAG. The results suggest that MAG is preferable even when CR is not achievable. The limitations of this study include potential biases inherent in observational studies and a lack of functional assessment of IR. 

The AVATAR Trial addressed the question of when and how to treat asymptomatic patients with severe aortic stenosis (AS) and normal left ventricular (LV) systolic function. In the current report, the authors present the extended follow-up. The AVATAR trial randomly assigned patients with severe, asymptomatic AS (negative exercise stress testing in all patients) and LV ejection fraction greater than 50 percent to undergo either early surgical aortic valve replacement (SAVR) or conservative treatment with a watchful waiting strategy. The primary endpoint was a composite outcome of all-cause death, acute myocardial infarction, stroke, or unplanned hospitalization for heart failure (HF). A total of 157 low-risk patients were randomly assigned to either the early SAVR group (n=78) or the conservative treatment group (n=79). In an intention-to-treat analysis, after a median follow-up of 63 months, the primary composite endpoint outcome event occurred in 18 out of 78 patients (23.1 percent) in the early SAVR group and 37 out of 79 patients (46.8 percent) in the conservative treatment group (hazard ratio (HR) early SAVR versus conservative treatment 0.42; 95 percent confidence interval (CI) 0.24–0.73, p=0.002). The Kaplan-Meier estimates for individual endpoints of all-cause death and HF hospitalization were significantly lower in the early SAVR group compared to the conservative group (HR 0.44; 95 percent CI 0.23–0.85, p=0.012 for all-cause death, and HR 0.21; 95 percent CI 0.06–0.73, p=0.007 for HF hospitalizations). The authors conclude that after an extended follow-up, asymptomatic patients with severe AS and normal LV ejection demonstrate better clinical outcomes with early SAVR than patients treated with conservative treatment and watchful waiting. 

CT-guided transthoracic needle biopsy (TNB) has allowed for increased detection of small pulmonary nodules in lung cancer patients. However, it also poses a risk of iatrogenic damage. This single-center study aimed to investigate the risk profile of preoperative CT-guided TNB. A total of 1,077 patients with stage 1A non-small cell lung cancer (NSCLC) and no visceral pleural invasion was included; 190 of whom underwent preoperative TNB and 823 were in the non-TNB group. Postoperative CT-TNB surveillance was monitored for locoregional recurrence, and propensity score-matched cohorts were compared. The locoregional five-year recurrence-free survival (RFS) in the non-TNB cohort was 96.8 percent and 88.3 percent in the TNB cohort, with no significant difference observed. In the TNB cohort, 21.6 percent of patients experienced post-TNB pneumothorax. Based on multivariable analysis, the history of TNB was a risk factor for locoregional recurrence and a negative prognostic factor for both locoregional and overall RFS. While not conclusive, the high rate of complications associated with TNB and its effect on RFS should be considered when offering TNB preoperatively to those with early-stage lung cancer.