Cardiothoracic Surgery

Prophylactic high-flow nasal oxygen after cardiac surgery shows no benefit over standard oxygen

In this multicenter RCT of 1280 adults at increased pulmonary risk after nonemergent cardiac surgery, prophylactic HFNOT was compared with standard oxygen postextubation. HFNOT or standard oxygen was delivered for at least 16 hours immediately after extubation with concealed allocation and blinded outcome assessment. Median 90-day days alive and at home without increased support were identical between groups, with a median difference of 0 (P = .75). Secondary outcomes, including days alive and at home ignoring support needs, were also similar between HFNOT and standard oxygen. 1

Frailty scoring plus minimally invasive access refine risk and outcomes in older valve surgery

This cohort of 568 patients aged ≥70 years undergoing valve surgery evaluated frailty indices and surgical access versus 1-year outcomes. Adding the Edmonton Frailty Scale to EuroSCORE II significantly improved prediction of death or cardiovascular hospitalization (Harrell’s C increase 0.054, p < 0.05). For 1-year mortality, the Edmonton Frailty Scale again provided the greatest incremental prognostic gain over EuroSCORE II. In frail patients, minimally invasive cardiac surgery was protective for mortality but did not improve the composite primary endpoint. 2

Transfusion-associated capillary leak phenotype predicts worse ICU outcomes after cardiac surgery

In this prospective cohort of 405 cardiac surgery patients, perioperative transfusions were linked to inflammatory and capillary-leak changes. Transfusion of red cells, plasma, or platelets was associated with higher postoperative IL-6 and IL-8 levels in a dose-dependent fashion. Patients receiving at least five units of individual blood components had higher ICU mortality. Transfusion was associated with modest extracellular water increases and elevated angiopoietin-2 and syndecan-1, consistent with capillary leak syndrome. 3

Timing lung resection 4–6 weeks after immunochemotherapy improves outcomes in locally advanced NSCLC

This multicenter retrospective cohort included 205 patients undergoing radical resection after neoadjuvant immunochemotherapy for locally advanced NSCLC. Patients were grouped by interval from therapy completion to surgery: <4 weeks, 4–6 weeks, and >6 weeks. Compared with 4–6 weeks, surgery <4 weeks was associated with substantially lower pathologic complete response rates (OR 0.15; 95% CI, 0.06–0.38). Disease-free survival was worse when surgery was delayed beyond 6 weeks (HR 2.35; 95% CI, 1.15–4.80). 4