BACKGROUND: Redo coronary artery bypass grafting (redo-CABG) is technically challenging and carries a higher perioperative risk than primary CABG. Whether avoiding cardiopulmonary bypass is beneficial in this setting rem...BACKGROUND: Redo coronary artery bypass grafting (redo-CABG) is technically challenging and carries a higher perioperative risk than primary CABG. Whether avoiding cardiopulmonary bypass is beneficial in this setting remains unclear. We compared perioperative and long-term outcomes of off-pump versus on-pump redo-CABG in a high-volume center. METHODS: All patients undergoing redo-CABG between 2009 and 2024 were retrospectively analyzed. Perioperative, in-hospital, and long-term outcomes were evaluated. Propensity score matching was performed using preoperative covariates. Survival analyses included a subgroup of beating-heart on-pump cases. Completeness of revascularization was likewise assessed. RESULTS: Among 370 patients (175 off-pump group; 195 on-pump group), 184 were propensity score-matched. Off-pump surgery had shorter operative time (183 vs. 208 min; = 0.015) and reduced red blood cell transfusion requirements (3 vs. 5 units; = 0.014). Myocardial injury biomarkers were reduced with off-pump surgery (CK-MB: 45 vs. 68 ng/mL, = 0.01; high-sensitivity troponin: 3,388 vs. 7,744 ng/L, = 0.001). In-hospital mortality was comparable (off-pump group 2.2 vs. 1.1% in the on-pump group; = 0.621; relative risk: 1.34). Rates of stroke, myocardial infarction, cardiopulmonary resuscitation, and hemofiltration did not differ. Five-year repeat revascularization rates were similar (off-pump group: 18.5 vs. 19.6% in the on-pump group; = 0.854). Long-term survival did not differ between strategies. In multivariable analysis, surgical strategy (off-pump, on-pump, beating-heart) was not an independent predictor of survival. CONCLUSION: Off-pump redo-CABG is safe and yields outcomes similar to on-pump surgery. Pump strategy should be individualized based on patient's anatomy and surgical expertise.
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is rare in children and published experience with pulmonary endarterectomy (PEA) is limited. METHODS: We retrospectively reviewed six patients (<18 years)...BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is rare in children and published experience with pulmonary endarterectomy (PEA) is limited. METHODS: We retrospectively reviewed six patients (<18 years) who underwent seven PEA procedures at our center between December 2011 and September 2025. Clinical characteristics, perioperative findings, hemodynamic outcomes, and follow-up data were analyzed. RESULTS: Median age was 13 years (range, 2-17), and five patients were female. Five had a history of pulmonary embolism, while one presented with hydatid cyst. Risk factors for CTEPH were hydrocephalus with ventriculoperitoneal shunt (n=2), hydatid cyst disease (n=1), infective endocarditis with left ventricular outflow tract obstruction (n=1), and chronic kidney disease with prior COVID-19 infection (n=1). Preoperative mean systolic pulmonary artery pressure (PAP) was 56 ± 23 mmHg, mean pulmonary artery pressure (mPAP) was 39 ± 15 mmHg, and mean pulmonary vascular resistance index (PVRi) was 7.51 ± 4.56 U·m². Most patients were in World Health Organization (WHO) functional class III or IV. All patients underwent PEA, with concomitant procedures required in most cases. Postoperatively, mPAP decreased to 21 ± 4 mmHg and mean PVRi to 2.36 ± 1.36 U·m². Median intensive care unit (ICU) and hospital stays were 3.5 and 9 days, respectively. There was one in-hospital mortality, all other patients recovered without major complications. CONCLUSIONS: PEA is feasible and effective in carefully selected pediatric patients, including those with complex comorbidities. Significant hemodynamic and functional improvements were achieved, supporting the role of PEA as a potentially curative therapy in this rare and challenging group.
BACKGROUND: Acquired ventricular septal defect (VSD), typically following myocardial infarction (MI) or infective endocarditis (IE), remains a rare but life-threatening condition. Surgical repair represents the standard...BACKGROUND: Acquired ventricular septal defect (VSD), typically following myocardial infarction (MI) or infective endocarditis (IE), remains a rare but life-threatening condition. Surgical repair represents the standard of care, yet data on long-term outcomes and health-related quality of life (HRQoL) are limited. METHODS: We retrospectively analyzed 44 consecutive patients (median age 65 years, interquartile range [IQR] 57-72.5; range 20-83) who underwent surgical VSD closure at our institution between 2008 and 2023. Clinical characteristics, perioperative variables, and outcomes were assessed according to defect etiology and survival status. Long-term survival was assessed using Kaplan-Meier analysis. HRQoL among survivors was evaluated with the European Quality of Life-5-Dimensions-5-Level Version (EQ-5D-5L) questionnaire. RESULTS: Post-MI VSD accounted for 65.9% of cases, and IE-related VSD for 20.5%. Preoperative cardiogenic shock was present in 52.3%. Overall, 30-day mortality was 34.1% (MI-VSD 46.4%, IE-VSD 22.2%). Non-survivors were older (69.2 vs. 60.8 years, = 0.015), more frequently in shock (80.0% vs. 37.9%, = 0.013), and experienced more postoperative complications per patient (1.9 vs. 0.4, = 0.001). Median follow-up among survivors was 10.7 years (IQR 6.6-13.8; range 2.0-17.2). Kaplan-Meier survival at 2 and 5 years was 61.4% and 56.8%, respectively. HRQoL was generally preserved, with favorable mental and social domain scores (e.g., anxiety/depression: mean 1.6/5) and acceptable physical functioning (e.g., pain/discomfort: mean 1.9/5). Younger age at repair and longer follow-up were associated with higher HRQoL. CONCLUSION: Despite substantial perioperative mortality-particularly in post-MI VSD and hemodynamically unstable patients-surgical closure provides durable long-term survival with overall satisfactory HRQoL in survivors.
OBJECTIVE: Surgical aortic valve replacement (SAVR) is now considered the gold standard in the management of aortic regurgitation (AR). However, transcatheter aortic valve replacement (TAVR) is increasingly being used fo...OBJECTIVE: Surgical aortic valve replacement (SAVR) is now considered the gold standard in the management of aortic regurgitation (AR). However, transcatheter aortic valve replacement (TAVR) is increasingly being used for the therapy of high-risk patients. The latest Chinese expert consensus states that TAVR can be used as one of the strategies for the treatment of pure AR, and no longer exists as an off-label option, providing a new way of thinking about the treatment of pure AR patients. METHODS: We comprehensively searched PUBMED, EMBASE, OVID, Web of Science, and Cochrane Library from the construction of the database to March 28, 2024, to obtain eligible clinical trial data for analysis. The study protocol was registered in PROSPERO (CRD42024529532). RESULTS: A total of 21 studies (5,978 patients) were included in the analysis. Device success rates ranged from 74 to 100%. Among these, 23 patients (0.35%) required implantation of a second valve. Thirty-five patients (0.59%) underwent intraoperative conversion to SAVR. The primary outcome-all-cause mortality within 30 days-was observed in 272 patients (4.6%). Secondary outcomes are summarized as follows: 120 patients (2.01%) experienced myocardial infarction within 30 days, and 110 patients (1.84%) experienced cerebrovascular events; major bleeding occurred in 384 patients (6.42%), while major vascular complications were lowest at 51 cases (0.85%). Four hundred two patients (6.72%) required permanent pacemaker implantation, and 266 patients (4.45%) experienced acute kidney injury. The incidence of moderate or severe postoperative AR was 61 cases (1.02%). CONCLUSION: AR could be an indication for transfemoral TAVR, which would benefit patients.
BACKGROUND: Constrictive pericarditis represents the end stage of chronic pericardial inflammation and is characterized by impaired diastolic filling due to pericardial fibrosis and/or calcification, leading to progressi...BACKGROUND: Constrictive pericarditis represents the end stage of chronic pericardial inflammation and is characterized by impaired diastolic filling due to pericardial fibrosis and/or calcification, leading to progressive right-sided heart failure. Pericardiectomy remains the definitive treatment, yet perioperative risk remains substantial in patients with advanced disease. METHODS: We performed a retrospective single-center cohort study of 47 consecutive patients undergoing surgical pericardiectomy for constrictive pericarditis between January 2010 and December 2021. Perioperative characteristics, operative strategy, and early outcomes, including 30-day mortality, postoperative morbidity, and length of stay, were assessed. RESULTS: Mean age was 58 ± 14 years, and 64% of patients were male ( = 30). In the study 65% of patients presented with NYHA functional class III to IV, and operative risk was elevated, with a mean EuroSCORE II of 8.5 ± 2.3 and a mean STS score of 9.4 ± 2.3. Median sternotomy was used in 94% of patients ( = 44), radical pericardiectomy in 64% ( = 30), and a beating-heart strategy without cardiopulmonary bypass in 79% ( = 37), whereas cardiopulmonary bypass was required in 21% ( = 10). We found 30-day all-cause mortality was 6% ( = 3). Major postoperative complications included sepsis in 13% ( = 6) and renal failure requiring dialysis in 8.5% ( = 4). Mean ICU stay was 3.7 ± 4.5 days, and mean total hospital stay was 11 ± 6.7 days. CONCLUSION: Pericardiectomy for constrictive pericarditis can be performed with acceptable early mortality and morbidity even in a high-risk population. In experienced centers, an individualized surgical strategy prioritizing extensive pericardial resection with selective use of cardiopulmonary bypass appears feasible for the management of advanced disease.
BACKGROUND: Surgical pulmonary valve replacement (PVR) is the most common cardiac operation in adults with congenital heart disease (ACHD). Nearly one-quarter of all cardiac procedures in this population are PVRs, and ap...BACKGROUND: Surgical pulmonary valve replacement (PVR) is the most common cardiac operation in adults with congenital heart disease (ACHD). Nearly one-quarter of all cardiac procedures in this population are PVRs, and approximately 96% are redo surgeries. This study aimed to compare operative and early postoperative outcomes in patients undergoing first-, second-, and third-time, or more, PVR. METHODS: We retrospectively analyzed 104 consecutive adult patients with repaired congenital heart disease who underwent total valved pulmonary trunk replacement at our institution between January 2014 and March 2022. RESULTS: A total of 53 patients underwent first-time PVR, 31 second-time PVR, and 20 third-time, or more, PVR. All patients had at least one previous sternotomy. In all redo procedures, extended resection of the degenerated pulmonary valve graft was performed. Operative complexity increased with the number of previous PVRs, reflected by significantly longer cardiopulmonary bypass times (134 versus 185 versus 222 minutes) and aortic cross-clamp times (68 versus 91 versus 114 minutes; < 0.001). Postoperative length of stay was also longer with increasing number of prior PVRs (7 versus 10 versus 8 days; = 0.012). Despite increased surgical complexity, no significant differences ( > 0.05) were observed in intraoperative or postoperative complications, postoperative peak transvalvular gradients, or relevant valve regurgitation. Overall mortality was low. Three patients died, two of whom had a history of endocarditis. CONCLUSION: Patients undergoing multiple PVRs demonstrate early clinical outcomes comparable to those undergoing first-time PVR despite increased surgical complexity. Endocarditis remains a major risk factor in redo PVR surgery.
BACKGROUND: Gender disparities persist across cardiac and thoracic surgical care, influencing access, procedural selection, perioperative risk, and long-term outcomes. Despite major advances in operative technique and pe...BACKGROUND: Gender disparities persist across cardiac and thoracic surgical care, influencing access, procedural selection, perioperative risk, and long-term outcomes. Despite major advances in operative technique and perioperative pathways, women continue to experience delayed diagnosis, lower procedural referral rates, and distinct complication profiles after high-risk procedures, including coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR), and transcatheter edge-to-edge repair (TEER). These patient-level disparities parallel persistent inequities within the cardiothoracic surgery workforce, raising the possibility that structural workforce imbalances may influence clinical outcomes. OBJECTIVE: This study aimed to synthesize contemporary evidence (2020-2025) characterizing sex- and gender-based disparities across cardiac and thoracic surgery, identify interconnected root causes, and outline strategies and research priorities for reducing inequities. METHODS: A narrative review (2020-2025) combined structured database searches of trials and registries with synthesis of mechanistic and health-system literature to interpret heterogeneous evidence. RESULTS: Women undergoing cardiothoracic procedures often present at older age with greater frailty, smaller anatomical dimensions, and more atypical symptoms, increasing procedural complexity and perioperative risk. CABG and SAVR show higher early morbidity in women, while PCI disparities have narrowed but persist due to delayed recognition; TAVR demonstrates higher early complications yet better mid- and long-term survival. In thoracic surgery, women generally have lower perioperative mortality, but experience delayed diagnosis, lower screening rates, and reduced use of minimally invasive approaches. These outcome differences occur alongside persistent workforce inequities, including the underrepresentation of women in surgical practice, leadership, and academia. CONCLUSION: Gender disparities in cardiac and thoracic surgery are multifactorial and closely intertwined with systemic workforce inequities. Solutions require sex-aware risk assessment, equitable referral pathways, inclusive device development, mandated sex-stratified reporting, and targeted workforce reforms. Addressing both patient-level and structural contributors is essential to achieve durable gender equity in cardiothoracic surgical care.
ECMO patients can develop heparin (Hep)-induced thrombocytopenia type II (HIT II). Approval for direct thrombin antagonism is lacking. We analyze if direct thrombin antagonism (DTA) is feasible, safe, and not inferior to...ECMO patients can develop heparin (Hep)-induced thrombocytopenia type II (HIT II). Approval for direct thrombin antagonism is lacking. We analyze if direct thrombin antagonism (DTA) is feasible, safe, and not inferior to heparin.A total of 254 multicenter prospective patients (vv- or va-ECMO) were analyzed in four different cardiothoracic, pulmonary, or anesthesiological intensive care units at university hospitals in Giessen and Frankfurt from 2020 to 2022.Heparin was always received by 153 va-ECMO/101 vv-ECMO patients (95/43), only DTA (8/6) or a switch (50/52) from heparin to DTA in cases of suspected HITII and reduced platelet count (reduction: = 0.017). ICU morbidity, survival, therapeutic stability of anticoagulation, bleeding, thrombosis, and technical integrity were analyzed regarding noninferiority and superiority of DTA versus heparin. Patients who changed anticoagulation showed increased infection levels before the change. Before switching from heparin to DTA, there was only a moderate increase in the INR, a decrease in the Quick, and no therapeutic increase in the PTT with heparin. With regard to thrombosis and system occlusions, there is no difference between heparin and DTA. Weaning rates from extracorporeal support and survival analysis did show noninferiority of DTA. After switching, a clear superiority of DTA in terms of (A) overall complication rate CI((0.6479/0.7871/0.9546)) (defined as bleeding from any cause, stroke, amputation, thrombosis and device-occlusion) and (B) bleeding from any cause alone CI((0.6432/0.7829/0.9513)) and a noninferiority in terms of preventing strokes exists.DTA is not inferior to heparin in ECLS/ECMO therapy. Regarding all complications, stroke, thromboembolism, and amputation DTA is superior.
BACKGROUND: Temporary mechanical circulatory support (tMCS) is increasingly used to stabilize patients in cardiogenic shock as a bridge-to-transplant. While this strategy facilitates listing and organ allocation in criti...BACKGROUND: Temporary mechanical circulatory support (tMCS) is increasingly used to stabilize patients in cardiogenic shock as a bridge-to-transplant. While this strategy facilitates listing and organ allocation in critically ill patients, its effect on post-transplant outcomes remains incompletely defined. METHODS: We conducted a single-center retrospective cohort study including all adult patients undergoing orthotopic heart transplantation (HTX) between September 2010 and December 2024. Patients were stratified by presence or absence of tMCS at the time of transplant. Primary endpoints were resternotomy, perioperative extracorporeal life support (ECLS), in-hospital mortality, and 1-year mortality. Student's -test and chi-square tests were used for comparisons. RESULTS: Among 296 patients (mean age: 55.2 ± 10.8 years; 70.6% male), 15 (5.1%) received tMCS at the time of HTX. Compared with controls, tMCS patients had significantly higher inflammatory markers and lower platelet and hemoglobin levels preoperatively. They were more often listed with high urgency (78.6 vs. 39.4%, < 0.01), required perioperative ECLS more frequently (64.3 vs. 26.9%, < 0.01), and exhibited higher in-hospital (21.4 vs. 7.6%, < 0.01) and 1-year mortality (54.5 vs. 16.7%, < 0.01). Resternotomy rates were similar. Patients bridged with Impella or transitioned from extracorporeal membrane oxygenation to right ventricular-assist device (RVAD) had better outcomes than those transplanted directly from ECLS. CONCLUSION: HTX in tMCS-supported patients is feasible but associated with significantly higher early and mid-term mortality. The type of preoperative support and transition strategy may impact outcomes. Tailored bridging concepts and early conversion to durable or RVAD-based support warrant further investigation.
OBJECTIVE: This study aimed to evaluate the clinical and radiographic outcomes of video-assisted thoracoscopic surgery (VATS) for early-stage empyema, emphasizing the restoration of lung volume as a crucial indicator of...OBJECTIVE: This study aimed to evaluate the clinical and radiographic outcomes of video-assisted thoracoscopic surgery (VATS) for early-stage empyema, emphasizing the restoration of lung volume as a crucial indicator of treatment success. METHODS: A retrospective analysis was conducted on patients with early-stage empyema who underwent VATS between January 2020 and June 2025. Data regarding inflammatory markers, coagulation parameters, and clinical recovery were systematically collected. A key radiographic outcome, specifically the affected lung volume, was quantitatively assessed using computed tomography (CT) volumetry both preoperatively and postoperatively to objectively evaluate lung re-expansion. RESULTS: Thirty patients were included in the study. VATS resulted in significant reductions in postoperative inflammatory markers, including white blood cell, neutrophil percentage, C-reactive protein, interleukin-6, and D-dimer ( < 0.05). CT-based lung volume increased significantly from 1,278.81 cm (interquartile range [IQR]: 1,021.9-1,677.56) preoperatively to 1,587.81 cm (IQR: 1,320.51-1,978.91) at 3 months postoperatively, representing a median absolute increase of 309.0 cm (+24.2%, = 0.002). The mean duration of chest tube drainage was 7.47 ± 3.96 days, and the mean length of hospital stay was 19.70 ± 8.35 days. The 30-day readmission rate was 23.33%. CONCLUSION: VATS is a highly effective intervention for early-stage empyema, resulting in significant resolution of systemic inflammation and, importantly, a substantial increase in lung volume. The restoration of lung volume substantiates the procedural efficacy of VATS in facilitating mechanical lung liberation and promoting functional recovery, thereby highlighting its essential role in the management of this condition.
BACKGROUND: Accurate mediastinal lymph node staging is essential in non-small cell lung cancer (NSCLC) treatment. While 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used...BACKGROUND: Accurate mediastinal lymph node staging is essential in non-small cell lung cancer (NSCLC) treatment. While 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used for noninvasive staging, its diagnostic reliability, particularly for nodal assessment, remains debated. METHODS: A retrospective multicenter analysis included 278 patients with histologically confirmed NSCLC who underwent FDG-PET/CT followed by surgery with systematic lymphadenectomy between 2015 and 2021. PET/CT-based nodal staging was compared with histopathology. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and Cohen's κ. Logistic regression was performed to identify predictors of correct N staging. Patients receiving neoadjuvant therapy were excluded from subgroup analyses ( = 252). RESULTS: Histopathology revealed nodal metastases in 112 patients (40.3%). PET/CT detected nodal involvement with sensitivity of 66.8% and specificity of 85.2%. PPV was 50.7% and NPV 85.5%, with an overall concordance of 43.3%. Sensitivity for N1 disease was 38.2%, whereas N2 and N3 metastases were detected with sensitivities of 55.3% and 100.0%. The false-negative rate was 25.2%, with intrapulmonary nodes (station 11) most frequently missed. False-positive findings occurred in 20.1%, predominantly in hilar nodes. Multivariable analysis identified lymph node involvement and tumor stage as independent predictors of staging accuracy, whereas extracapsular extension showed a non-significant trend. CONCLUSION: FDG-PET/CT demonstrates high specificity and NPV but limited sensitivity for mediastinal nodal staging in NSCLC under real-world conditions. These findings are primarily driven by disease characteristics rather than methodological factors. A multimodal approach remains essential, with histopathological confirmation of PET-positive findings and selective invasive staging in PET-negative patients to ensure accurate treatment allocation.
The rising complexity of cardiac surgery patients, coupled with new regulations reducing working hours for surgical residents, and increased healthcare costs, has led to the growing introduction of physician assistants (...The rising complexity of cardiac surgery patients, coupled with new regulations reducing working hours for surgical residents, and increased healthcare costs, has led to the growing introduction of physician assistants (PAs) into cardiacsurgery teams in German hospitals. This study aims to systematically explore the experience of introducing PAs into the cardiac surgery workforce in a tertiary university hospital in Germany, identifying what is working well and areas for improvement, as well as offering suggestions for appropriate measures.The study was of an observational nature and comprised both quantitative assessments and qualitative interviews. For the quantitative component, a survey was distributed internally to employees of the cardiovascular surgery department. The survey was first distributed within 1 month of the first PAs starting in our department ("baseline") and again 1 year later ("follow-up" [FU]).Forty-one healthcare professionals completed the baseline, and 37 completed the FU survey. Overall satisfaction with PAs was high across all professional groups. Among residents,73.3% reported being satisfied at baseline and 70% at FU. All cardiovascular surgeons (6/6) and PAs (10/10) reported high satisfaction at both time points, and 90% of nursing staff reported being satisfied or very satisfied at baseline, with no dissatisfaction reported at baseline or FU. All PAs reported providing workload relief and feeling fully integrated into the team, while two-thirds of residents reported workload relief due to PAs assuming ward-based clinical and administrative tasks. PAs were consistently perceived as improving continuity of care as a stable point of contact for patients and nursing staff.PAs substantially strengthen cardiac surgery teams in the German healthcare system. To successfully establish the implementation of PAs, the challenges of long-term retention incentives and clear delineation of responsibilities have to be addressed.
Pericardiocentesis is a life-saving intervention in the treatment of cardiac tamponade. This study aims to evaluate the safety, efficacy, and short-term outcomes of fluoroscopy-guided pericardiocentesis performed by card...Pericardiocentesis is a life-saving intervention in the treatment of cardiac tamponade. This study aims to evaluate the safety, efficacy, and short-term outcomes of fluoroscopy-guided pericardiocentesis performed by cardiovascular surgeons in a hybrid operating room setting.Data from 64 patients who underwent fluoroscopy-guided percutaneous drainage for symptomatic pericardial effusion in a hybrid operating room between January 2020 and December 2024 were analyzed retrospectively. Procedures were performed using a standard subxiphoid approach and a pigtail catheter.The etiology was malignancy in 31.2% ( = 20) of the patients. The median maximum effusion diameter measured on preoperative echocardiography was 24 mm (interquartile range [IQR]: 20-28 mm), which decreased significantly to 7 mm (IQR: 5-9 mm) on postoperative evaluation ( < 0.001). The minor complication rate was 1.5% ( = 1, pneumothorax). No surgical conversion (sternotomy) was required during the procedures. Reintervention was required in only two patients (3.1%) during the 3-month follow-up.Fluoroscopy-guided pericardiocentesis performed under hybrid operating room conditions represents a safe option with low complication and recurrence rates, even in high-risk groups such as malignancy. The real-time anatomical visualization provided by fluoroscopy, combined with the surgical infrastructure of the hybrid environment, provides a feasible workflow for cardiac surgeons. However, these findings need to be supported by more extensive and comparative studies.
For the 12th consecutive time, we systematically reviewed the cardio-surgical literature for the past year, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for a results-oriented sum...For the 12th consecutive time, we systematically reviewed the cardio-surgical literature for the past year, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach for a results-oriented summary. In 2025, the discussion on the value of randomized and observational evidence continued, showing converging results in the treatment of coronary artery disease and further diverging results in the field of invasive aortic valve therapies. Across randomized trials, meta-analyses, and registries, coronary artery bypass grafting (CABG) consistently provides superior long-term outcomes compared with percutaneous coronary intervention in complex coronary artery disease, driven primarily by sustained reductions in future myocardial infarctions. In addition, atrial fibrillation after CABG was shown to be more frequent than expected, but its long-term burden was negligible, while prolonged dual antiplatelet therapy after CABG for acute coronary syndrome offered no benefit but increased bleeding risk. The "valve treatment arena" in 2025 was heavily affected by the new guidelines, which clarified many aspects in mitral and tricuspid valve treatment but generated great controversy for aortic stenosis treatment. The latter was based on a reduction of the age cut-off for transcatheter aortic valve implantation to 70 years (unsupported by new data) and the selective reliance on only randomized studies (despite contradictory risk-adjusted registry evidence). Across mitral and tricuspid valve disease, publications showed improvements in symptoms and quality of life without survival benefits with transcatheter therapies and the most consistent long-term outcomes with surgery, particularly when appropriately timed and performed in experienced centers. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but it provides up-to-date information for patient-specific decision-making.
BACKGROUND: The study compared long-term outcomes between off-pump coronary artery bypass grafting (OPCAB) using bilateral internal mammary arteries (BIMA) and hybrid coronary revascularization (HCR). METHODS: We include...BACKGROUND: The study compared long-term outcomes between off-pump coronary artery bypass grafting (OPCAB) using bilateral internal mammary arteries (BIMA) and hybrid coronary revascularization (HCR). METHODS: We included patients who underwent OPCAB with BIMA (2002-2012) and HCR (2002-2020). Emergency procedures, patients in critical preoperative condition, and on-pump surgery cases were excluded. Propensity score matching with a 2:1 ratio was performed to minimize confounding factors. The primary outcome was 10-year survival. RESULTS: Of 687 patients, 552 patients underwent OPCAB with BIMA, and 135 patients received HCR. In-hospital mortality was comparable between groups (BIMA: 1.1% vs. HCR: 3.0%, = 0.11). The HCR group had higher rates of incomplete revascularization (27.2% vs. 15.2%, = 0.001) and revision for bleeding (6.7% vs. 1.8%, = 0.005). After propensity score matching, 10-year survival (BIMA: 71.2% vs. HCR: 69.7%, = 0.81) was similar between groups, while freedom from repeat revascularization was higher in the BIMA group (89.7% vs. 76.3%, = 0.003). CONCLUSION: Complete surgical revascularization using BIMA should be preferred when feasible. However, HCR offers comparable survival and represents a viable option for select patients.