Cardiothoracic Surgery

Early mechanical reperfusion on V-A ECMO for massive PE shows no clear mortality advantage

Among 492 high-risk PE patients on V-A ECMO, 28% underwent early catheter or surgical reperfusion within 48 hours. In propensity-matched groups, 90-day mortality was 32% with early reperfusion versus 39% with ECMO alone (HR 0.68; 95% CI, 0.45-1.03; p = 0.07). ECMO duration and overall weaning rates were similar, but early reperfusion improved weaning in patients without prior thrombolysis. Major bleeding occurred in half of patients, with no significant difference between strategies. These data support a stepwise, individualized approach often starting with ECMO alone, reserving early reperfusion for selected profiles. 1

Frailty markedly raises early mortality and failure-to-rescue after lobectomy in older adults

In 110,460 lobectomy patients aged ≥65 years, frailty prevalence ranged from 5.7% to 19.8% depending on the instrument used. Frail patients had far higher complication rates, higher hospitalization costs, and were less likely to be discharged home. Fourteen-day mortality and failure-to-rescue were several-fold higher in frail versus non-frail patients by both frailty definitions. Adjusted models showed frailty independently increased odds of failure-to-rescue and early mortality by roughly two- to ninefold. Frailty accounted for most early deaths among frail patients and a notable share of all deaths, supporting routine screening and enhanced surveillance. 2

Delayed-release diameter reduction PMEG-FEVAR supports reliable sequential visceral vessel cannulation

This PS-IDE single-center trial applied non-uniform posterior diameter reduction with dissolvable sutures for PMEG-FEVAR in 203 complex aneurysm patients. The design molded the graft to the visceral aorta while maintaining partial constraint, enabling sequential, one-at-a-time target vessel cannulation. Celiac, SMA, and renal arteries were cannulated and bridged percutaneously with 100% technical success and no intraoperative deaths. This approach met Society for Vascular Surgery 30-day and 1-year safety and effectiveness benchmarks, supporting use where commercial fenestrated devices are unavailable. 3

Routine bronchoscopic guidance does not reduce tracheostomy complications and worsens intraprocedural mechanics

In four ICUs, 442 adults were randomized to bronchoscopic versus non-bronchoscopic percutaneous dilatational tracheostomy by experienced operators without high-risk features. Perioperative complication rates were similar, 11.3% with bronchoscopy and 13.1% without, with no statistically significant difference. Bronchoscopic guidance produced higher peak inspiratory pressures and higher end-procedure PaCO2 compared with unguided tracheostomy. Hospital mortality was similar between groups, indicating no survival benefit. For low-risk patients, routine bronchoscopy adds physiologic burden without complication reduction and can reasonably be omitted. 4