30-Second Takeaway
- VA cardiac surgery maintains low mortality despite older, sicker patients, aiding benchmarking and referral planning.
- ACCP lung resection algorithm holds up clinically, but age >70 and pneumonectomy warrant explicit intermediate-risk weighting and 90-day outcomes.
- Post–cardiac surgery pneumonia is hard to predict; focus on modifiable intraoperative factors, especially CPB duration and transfusion exposure.
Week ending February 14, 2026
Cardiothoracic surgery updates: VA outcomes, lung resection risk, post-op pneumonia, AF ablation, TAVI conduction disease, TEER remodeling, post-CABG atherosclerosis, pediatric SND
VA cardiac surgery delivers low mortality over 20 years despite rising comorbidity and volume shifts
Among 94,694 cardiac surgery patients at 43 VA centers from 2005–2024, age, comorbidity, and racial and ethnic diversity increased significantly. Case volumes peaked in 2006, dipped after 2019, then stabilized, reflecting changing demand and system-level policy shifts. Despite higher Age-Adjusted Charlson Comorbidity Index scores, adjusted 30-day mortality in 2020–2024 remained low for isolated CABG (0.8%) and isolated AVR (1.6%). More complex combined procedures had higher mortality, but overall risk-adjusted outcomes were stable across 5-year intervals. These data support VA hospitals as credible providers for CABG and valve surgery and offer realistic institutional benchmarks for quality review.
ACCP lung resection algorithm validated; age >70 and pneumonectomy strongly drive 90-day mortality
This registry-based cohort (2011–2023) showed postoperative mortality after anatomical lung resection rising from 3.1% at 30 days to 5.5% at 90 days. Independent mortality predictors were older age, ACCP intermediate-risk category, and pneumonectomy, while VATS conferred lower risk. Age >70 years, ACCP intermediate risk, and pneumonectomy each produced large increases in odds of 30-, 60-, and 90-day mortality. The ACCP algorithm remained useful, but findings support explicitly incorporating age >70 and pneumonectomy as intermediate-risk determinants. Extending standard outcome surveillance to 90 days better captures procedure risk and informs comparisons with non-surgical options.
Key risk factors for post–cardiac surgery pneumonia highlight CPB duration, ischemic cardiomyopathy, and transfusion-related surrogates
In the STERNOCAT ancillary cohort of 1,470 cardiac surgery patients, postoperative pneumonia occurred in 5.3% and increased 30-day mortality from 1.5% to 14.1%. Independent risk factors were ischemic cardiomyopathy, longer cardiopulmonary bypass duration, and intraoperative catecholamine use. The meta-analysis of 24 studies (172,079 patients) identified 14 pneumonia risk factors, predominantly non-modifiable clinical characteristics and urgency of surgery. Four partially modifiable factors emerged: active smoking, cardiopulmonary bypass duration, and presence and amount of intraoperative transfusion. Externally tested pneumonia prediction models performed poorly, emphasizing perioperative strategies targeting CPB management, transfusions, and smoking cessation.
Pulsed field ablation maintains favorable 4-year outcomes versus thermal ablation in paroxysmal AF
ADVENT-LTO followed 364 paroxysmal AF patients from the ADVENT trial for about 4 years after pulsed field or thermal ablation. Four-year treatment success was similar but numerically higher with pulsed field ablation (72.8%) than thermal ablation (64.3%; P = 0.12). Freedom from hospital-based arrhythmia intervention favored pulsed field ablation (85.6% vs 78.6%; HR 0.64, 95% CI 0.38–1.05). Repeat ablations were significantly fewer after pulsed field ablation (10.4% vs 17.7%; P = 0.04), with a trend toward less progression to persistent AF. Durable safety and efficacy support pulsed field ablation as a preferred catheter modality when planning hybrid AF management pathways.
References
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Additional Reads
Optional additional studies from this edition.