Editors' Choice

Discover the featured content in this month’s The Annals of Thoracic Surgery issue, personally selected by Editor-in-Chief Dr. Joanna Chikwe & Senior Editor Dr. Robbin Cohen, who highlight the authors' important findings, with select illustrations from Dr. Sarah Chen, Associate Editor/CMI. As an additional benefit to your STS Membership and Annals subscription, this monthly newsletter aims to bring expert perspectives on recently published research, straight to your digital doorstep. 

Featured in the November 2026 issue...

Goldberg, Wyler von Ballmoos, and coauthors 

A balanced, unbiased multidisciplinary writing group from The Society of Thoracic Surgeons Workforce on Evidence Based Surgery developed 18 consensus statements surrounding key topics regarding tricuspid valve endocarditis in people who inject drugs (PWID). Key topics included vegetation size, impact of infectious organisms on surgical decision-making, persistent bacteremia, prosthetic valve infections, surgical strategy, emerging technologies, and ethical considerations. Examples of important consensus statements regarding tricuspid endocarditis with PWID include:

1. Current data do not support the use of vegetation size as a sole surgical indication.
2. The presence of a specific organism should not be the sole surgical indication and has less impact than left-sided endocarditis.
3. Tricuspid valve repair is preferred over tricuspid replacement when technically possible.
4. Valvectomy should not be performed.
5. Mechanical valves should generally not be used in PWID. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Weiss, Smedira, and coauthors 

The authors provide a framework for the identification and management of postcardiotomy cardiogenic shock by providing 10 guiding principles, along with explanations for each, and supporting clinical vignettes. The 10 principles include: 1) Systematically characterize preoperative risk; 2) Have a game plan and prepare for the worst; 3) Expect the unexpected; 4) Recognize and acknowledge problems early; 5) Simplify the problem by addressing “noise”; 6) Address technical concerns the first time; 7) Vent the heart; 8) Recognize the goals of temporary mechanical circulatory support; 9) Tailor device selection to the ventricular phenotype and clinical trajectory; and 10) Plan for the future: exit strategies, recovery, and futility. Read author Aaron Weiss’ invited commentary on Contemporary Outcomes of Temporary Mechanical Support Use in Ischemic VSD: A US Multicenter Analysis, also in this issue of The Annals of Thoracic Surgery.

-Robbin Cohen, MD, MMM 
Senior Editor 

Sundt

In this invited perspective, Dr. Thoralf Sundt discusses the trend toward subspecialization in cardiothoracic surgery. As procedures become more complex and surgical volume takes on a growing importance toward optimizing results, the concept of the surgical “generalist” is becoming increasingly threatened. Few training programs offer adequate subspecialty training across the entire spectrum of cardiothoracic surgery. As a result, it is essential that all training programs provide trainees with the fundamentals of decision making, risk analysis, contingency options, and technical skill. Smaller programs should facilitate access to subspecialty training in areas where they lack expertise. Dr. Sundt makes the point that there is no single “best” training program or paradigm, and that the program fit with the trainee’s career aspirations is the most important. The curriculum “depends more on role models than program size or statistics.”  

-Robbin Cohen, MD, MMM 
Senior Editor 

Image

Lorenz, Neri, and coauthors

This single center analysis of acute type A aortic dissections retrospectively analyzed 429 patients with clearly classifiable Debakey type 1 (n = 258) or type 2 (n = 171) dissections. Patients with type 1 dissection were significantly younger than type 2 (65.5 vs 77 years, P < .001). Type 2 dissections occurred in larger (56.2 vs 46.7 mm; P < .001) and longer ascending aortas (128 vs 109 mm; P < .001), reflected in higher TAIPAN scores (2.4 vs 0.7; P < .001). Aortic tear morphology was predominately transverse in type 1 (85%) vs longitudinal in type 2 (61%). Cardiovascular risk factors, anthropometric variables, and congenital and genetic markers were comparable between groups. These findings support continued use of the Debakey classification, as well as incorporating aortic length and geometric indices into risk assessment for type A dissection.  

-Robbin Cohen, MD, MMM 
Senior Editor 

Glance, Maddox, and coauthors

This retrospective analysis of the Vizient Clinical Database studied 13,907 adults aged <65 years who underwent aortic valve replacement (AVR) with a bioprosthesis between 2018 and 2023. Hospital-level variation in transcatheter AVR (TAVR) vs surgical AVR (SAVR) was evaluated using multilevel multivariable logistic regression. The median hospital TAVR rate was 52.9%, whereas 46.5% of patients in the lowest surgical risk (predicted mortality <0.5%) underwent TAVR. Patients treated at hospitals with higher risk-adjusted TAVR vs SAVR use had 2.7-fold higher odds of undergoing TAVR than patients treated at hospitals with a lower risk-adjusted rate (median odds ratio, 2.69; 95% CI 2.43-3.02). Lower-volume hospitals (based on total AVR volume) performed fewer TAVRs vs SAVRs compared with higher-volume hospitals. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Juarez, Andersen, and coauthors

Forty patients previously considered for single ventricle palliation underwent 51 biventricular repair (BVR) procedures at a median age of 1.1 years between 2023 and 2024. Sixteen BVR patients underwent staged repair. BVR patients were compared with 155 contemporary Fontan operations (median age 4.2 years). In the perioperative period, mortality, length of stay, extracorporeal membrane oxygenation (ECMO) requirements, pacemaker, and reoperation were similar between the two groups, though BVR patients had increased ventilator days. One year after surgery, all-cause mortality was 0 for BVR and 9 (5.8%) for Fontan procedures. Freedom from a composite end-point of mortality, ECMO, heart transplant, pacemaker, and unplanned re-intervention was similar between BVR and Fontan at a mean follow-up of 1.4 years for BVR patients. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Güler, Aydin, and coauthors

This retrospective single-center study compared 129 consecutive adult patients (62 robotic, 67 open surgery) who underwent surgical repair for partial anomalous pulmonary venous drainage between 2012 and 2025. Hospital length of stay was significantly shorter in the robotic group (4.7 + 1.8 vs 6.0 + 3.7 days, P = .002), and blood product use was lower (1.3 + 1.6 vs 2 + 2.0 units; P = .04). Despite longer cardiopulmonary bypass durations in the robotic group (138.6 + 37.2 vs 74.1 + 33.1 minutes; P < .001), complication rates were comparable, and thirty-day mortality was similar between the two groups (1.6% vs 1.5%; P = .99).  

-Robbin Cohen, MD, MMM 
Senior Editor 

Guorgui, Shrager, and coauthors

This retrospective single-center review analyzed 558 patients (309 lobectomy, 249 sublobar resection: 54 segmentectomy, 195 wedge resection) who underwent resection for stage 1A adenocarincoma <2 cm between 2005 and 2024. The optimal maximum standard uptake value (SUVmax) threshold for recurrence-free survival was identified using maximally selected rank statistics and categorized patients into high and low standard uptake value (SUV) groups. The optimal SUVmax cutoff was 3.0. On multivariate analysis, high SUVmax was an independent predictor of recurrence in both the entire cohort (odds ratio (OR) 2.29; 95% CI, 1.17-4.5; P = .02) and the sublobar resection group (OR, 3.16; 95% CI, 1.19-8.44; P = .02). Among patients who underwent wedge resection alone, high SUV remained an independent predictor of disease recurrence (OR, 4.18; 95% CI, 1.44-12.48; P = .01). In the high SUV group, disease free survival (DFS) was inferior after sublobar vs lobar resection (62.5% vs 78.7%; P = .022) whereas no DFS difference was seen between procedures among low-SUV patients. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Vinogradsky, Elmously, and coauthors

The authors utilized a sternal wound infection (SWI) prevention bundle, consisting of interdisciplinary pathways and checklists, to decrease the incidence of SWI after sternotomy for cardiac surgery. Between 2021 and 2024, 2,185 patients were stratified to pre- and post-era bundles. Propensity score matching yielded two groups of 802 patients. The SWI rate decreased from 2.7% to 1.1%, with a three-fold reduction in deep SWI (2.1% vs .7%, P = .04). Thirty-day readmissions also decreased (1.3% vs 0.4%, P = .01). A greater number and proportion of culture isolates were fungal in the post-bundle era. For further analysis of this study, please see my invited commentary, also published in this issue.

-Robbin Cohen, MD, MMM 
Senior Editor 

Image