Cardiothoracic Surgery

Focused SVS guideline update refines management of blunt thoracic aortic injury

This SVS focused update issues 13 graded recommendations for blunt thoracic aortic injury (BTAI) management across indications, timing, technique, and surveillance. The guideline emphasizes tailoring timing of definitive repair to concomitant injuries, including traumatic brain and solid-organ hemorrhage. Thoracic endovascular aortic repair, left subclavian artery management, and perioperative anticoagulation are specifically addressed for contemporary trauma practice. The document endorses anti-impulse medical therapy and structured imaging surveillance to optimize outcomes and detect late complications. Substantial evidence gaps are highlighted, signaling the need for prospective studies despite growing clinical experience since the 2011 guideline. 1

Higher cell-salvage volumes drive coagulopathy surrogates but not major complications in cardiac surgery

In 883 adult cardiac surgery patients receiving intraoperative cell salvage, salvaged volume showed a strong dose-dependent association with coagulation product transfusion. Higher cell-salvage volumes correlated with increased intraoperative FFP, platelet, and cryoprecipitate use, but not with packed red blood cell transfusion. Discriminative thresholds for increased coagulation product use clustered around 0.66–0.88 L of salvaged blood. Greater salvage volumes were associated with more postoperative chest drainage and longer ICU stay, yet not with major complication rates. Overall complication rates remained favorable versus published benchmarks, supporting cell salvage use while underscoring the need to mitigate high-volume coagulopathy. These observational findings suggest perfusion and surgical teams should monitor salvage volume and be vigilant about hemostasis at higher returns. 2

Hypothermic oxygenated perfusion enables 48-hour ex vivo heart preservation with preserved function in pigs

In a porcine model, hypothermic oxygenated perfusion (HOPE) preserved donor hearts for 48 hours with maintained cardiomyocyte viability and structure versus static cold storage. Serial histology, flow cytometry, transcriptomics, and metabolomics showed preserved energy substrate profiles under HOPE and progressive ischemic metabolites with cold storage. During bench-top normothermic reperfusion, all HOPE-preserved hearts rapidly re-established stable sinus rhythm after up to 48 hours of preservation. Static cold storage hearts demonstrated inferior structural integrity and metabolic profiles, suggesting time-limited tolerance to conventional preservation. These preclinical data support HOPE as a strategy to extend safe preservation windows and potentially widen geographic access to donor hearts. 3