Cardiothoracic Surgery

Five-year outcomes of three-branched in-situ laser fenestration TEVAR for zone-0 acute type A dissection

In 152 patients with zone-0 acute type A dissection, three-branched ISLF-assisted TEVAR achieved 95.4% immediate technical success. Thirty-day outcomes included 3.9% mortality, 7.2% stroke, 3.3% spinal cord ischemia, and 2.6% proximal stent-induced dissection. Branch-stent patency remained high at 94.7% at 5 years, with complete false-lumen thrombosis in the covered segment in 82.6%. Five-year all-cause mortality was 7.9% and reintervention 12.5%, suggesting acceptable durability for a fully endovascular arch strategy. These results support ISLF-TEVAR as a feasible option for high-risk zone-0 disease, pending comparative multicenter confirmation. 1

MISACE before F/BEVAR linked to lower spinal cord ischemia and shorter hospitalization

This single-center cohort compared 42 MISACE-preconditioned F/BEVAR patients with 50 historical F/BEVAR patients without MISACE. In-hospital spinal cord ischemia was less frequent with MISACE (9.5% vs 30%, p=0.016), with similar technical success and extent of coverage. Hospital stay was shorter after MISACE (median 7 vs 11 days), without increased in-hospital mortality or procedural complications reported. On univariate analysis, MISACE was associated with reduced odds of spinal cord ischemia, but this effect was not independent on multivariable modeling. Prior aortic surgery, rather than MISACE itself, independently predicted lower spinal cord ischemia, underscoring confounding and selection concerns. 2

Selective operating-room extubation after sternotomy with parasternal blocks appears safe

This retrospective series of 2,294 adult cardiac surgery patients compared OR extubation with SPIP blocks to fast-track ICU extubation with or without blocks. Reintubation (1.2% vs 0.7% vs 1.2%) and NIPPV use (4.8% vs 4.8% vs 5.1%) were similar across ORE-B, FTE-B, and FTE groups. ORE-B and FTE-B patients had shorter hospital length of stay than FTE patients (5 vs 6 days). Time to extubation was shorter with SPIP blocks versus no blocks among ICU-extubated patients (2.5 vs 3.8 hours). These data support selective OR extubation within a structured fast-track pathway when robust parasternal regional analgesia is available. 3

ECSTATIC trial shows feasibility of randomized platelet thresholds in children on ECMO

The ECSTATIC multicenter RCT enrolled 50 children on ECMO to higher (90×10^9/L) versus lower (50×10^9/L) prophylactic platelet thresholds. Enrolled patients were predominantly very young (median age 0.2 years) and mostly on veno-arterial ECMO (88%). Pre-transfusion platelet counts differed by 32×10^9/L between groups, with 99.2% protocol compliance, demonstrating clear threshold separation. Overall, 22% experienced severe bleeding, severe clotting, or death, with similar rates between thresholds reported. Severe bleeding occurred in 14% and severe clotting in 4%, suggesting both thresholds may be acceptable for testing in a larger efficacy trial. 4