Cardiothoracic Surgery

POAF after cardiac surgery predicts one-year AF and mortality in a large prospective cohort

In this 12-country prospective cohort of 12,234 cardiac surgery patients, 31.8% developed new-onset POAF within 30 days. Discharge antithrombotic strategies varied substantially, with most patients receiving antiplatelet therapy and nearly half receiving amiodarone. At one year, clinical AF occurred in 6.9% with POAF versus 0.6% without (adjusted HR 11.30; 95% CI 8.17–15.70). POAF was also associated with higher all-cause mortality (3.0% vs 1.7%; adjusted HR 1.54; 95% CI 1.18–2.00). 1

Early US TTVR experience confirms high procedural success and rapid symptomatic improvement

This STS/ACC TVT Registry analysis included 1034 attempted TTVR procedures for symptomatic severe TR at 82 US centers. Valve implantation succeeded in 98.4%, with mild or less TR in 98.4% post-procedure and 97.7% at 30 days. At 30 days, all-cause mortality was 3.1%, stroke 0.2%, major bleeding 7.9%, and heart failure hospitalization 3.1%. New CIED implantation occurred in 15.9% of CIED-naive patients, indicating frequent pacing needs after TTVR. Functional status improved, with 82.7% in NYHA I/II and mean KCCQ-OS score improving by 22.4 points at 30 days. 2

CT–pathology discordance around 20 mm may drive lobectomy overuse in small NSCLC

This single-center series analyzed 1096 thoracoscopic clinical stage I NSCLC resections for CT–pathology tumor size agreement. CT overestimated small tumors (T1a: +4.21 mm) and underestimated larger lesions (≥T2: −7.49 mm) compared with pathology. Using CT >20 mm as a lobectomy trigger, 15.8% underwent lobectomy despite pathological size ≤20 mm, indicating potential overtreatment. Restricted cubic spline modeling with bootstrap-validated decision curve analysis suggested a 23 mm CT threshold as a better cutoff. A 23 mm threshold would have reclassified 108 patients to sublobar resection and reduced size-threshold-defined overtreatment by about half. 3

Mobile ICU-supported ECMO rapid response network improves efficiency and weaning

This retrospective cohort of 151 adults evaluated a mobile ICU-based ECMO rapid response team versus prior ad hoc ECMO care. The standardized regional workflow significantly shortened team response, priming, ECMO initiation, and inter-hospital transfer times. Mechanical complications decreased and weaning rates improved with the new model, without a statistically significant survival advantage. Findings support feasibility of a hub-and-spoke, mobile ICU ECMO network and justify prospective multicenter evaluation. 4