30-Second Takeaway
- High-volume Ross centers and surgeons achieve substantially lower operative mortality, supporting centralization of this demanding procedure.
- Frailty in older lobectomy patients strongly predicts complications, early mortality, and failure-to-rescue, warranting routine frailty screening.
- Cerebral atherosclerosis burden scoring plus machine learning may sharpen ischemic stroke prediction and neuroprotection in CABG.
Week ending March 7, 2026
Refining perioperative risk, hemodynamics, and structural innovation in contemporary cardiac and aortic practice
Higher Ross program volume associates with lower operative mortality as adult use rises
Among 2,268 adult Ross procedures at 194 centers, utilization increased sharply after a 2017 nadir, especially in patients ≤60 years. Ross procedures rose from 0.9% to 6.7% of aortic valve replacements in adults ≤60 years between 2017 and 2023. Operative mortality decreased from 4.4% in 2008 to 1.0% in 2020, with a subsequent increase to 2.5% in 2023. Higher center and surgeon Ross volumes were independently associated with lower operative mortality, with substantial benefit beyond roughly 10 cases annually.
Frailty powerfully predicts early adverse outcomes 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 frailty index used. Frail patients experienced markedly higher complication rates, higher hospitalization costs, and were less likely to be discharged home than non-frail peers. Frailty was independently associated with increased failure-to-rescue and 14-day in-hospital mortality across both frailty definitions. Frailty accounted for most early deaths within frail patients and a notable share of deaths in the overall cohort.
TCAB score and machine learning enhance stroke prediction after CABG
In 909 CABG patients, those with in-hospital ischemic stroke had substantially higher Total Cerebral Atherosclerosis Burden (TCAB) scores than those without stroke. A TCAB score >3 predicted in-hospital ischemic stroke with an AUC of 0.756, indicating moderate discrimination. Higher TCAB independently predicted in-hospital and 1-year ischemic stroke, as well as 1-year MACCE, after multivariable adjustment. A gradient boosting model incorporating TCAB yielded AUCs around 0.87 for in-hospital and 1-year stroke, and 0.75 for 1-year MACCE.
References
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Additional Reads
Optional additional studies from this edition.