Cardiothoracic Surgery

Endoscopic mitral surgery safely expands to older, higher-risk, and more complex patients

This 11-year single-center series reports 1,037 consecutive endoscopic mitral procedures, mostly repairs, with progressively older and higher-risk patients over time. Coronary artery disease, endocarditis, and concomitant procedures such as LAA closure, ablation, and tricuspid repair increased significantly in later years. Despite rising complexity, bypass and cross-clamp times decreased, and ventilation, ICU stay, and hospital stay remained short. Thirty-day mortality was 0.6% excluding endocarditis, with five-year survival 94% and low reoperation rates up to 11 years. These data support totally endoscopic mitral surgery as a durable option when performed in experienced, high-volume centers. 1

Intraluminal thrombosis after frozen elephant trunk is frequent and clinically consequential

This systematic review and meta-analysis included five observational studies totaling 999 frozen elephant trunk procedures. Pooled intraluminal thrombosis incidence was about 9%, highlighting this as a relatively frequent complication rather than a rarity. Intraluminal thrombosis was associated with significantly increased embolic events and higher early mortality, though stroke rates were similar. Higher thrombosis incidence correlated with greater proportions of women, older age, and aortic aneurysm pathology in meta-regression analyses. The authors advocate close imaging follow-up and consideration of anticoagulation, especially in older female patients with aneurysmal disease. 2

Minimally invasive lung resection maintains long-term oncologic outcomes in NSCLC

This narrative review synthesizes data on long-term oncologic outcomes after VATS and robotic anatomical lung resections for resectable NSCLC. Across retrospective and prospective series and meta-analyses, VATS provides overall and disease-free survival comparable or superior to thoracotomy, particularly in early stages. Robotic approaches generally achieve oncologic outcomes similar to open surgery, including in advanced or technically complex resections, though evidence is largely retrospective. Comparisons between VATS and robotic surgery show similar overall survival, with some data suggesting a disease-free survival advantage for robotics. The authors conclude minimally invasive lung resection is oncologically safe, while ongoing randomized trials are needed to refine approach selection. 3