Patient Outcomes

A new study sheds light on the challenges of pediatric mitral valve replacement (MVR) and evaluates the potential of the balloon-expandable Melody valve as an alternative to traditional mechanical prostheses. The findings offer important insights for treating young children with small mitral annuli, a population for whom MVR carries significant risks of morbidity and mortality.

A team of researchers, led by Morgan Moroi, MD, New York-Presbyterian/Columbia University Medical Center, conducted a retrospective review of 36 children under 2 years of age who underwent MVR at a single center between 2005 and 2023. Using propensity score matching to minimize baseline differences, the study compared outcomes between 12 patients receiving the Melody valve and 12 patients treated with mechanical prostheses.

The primary outcome was a composite measure of death, transplant, or surgical reintervention on the mitral valve prosthesis. Median follow-up was 1.6 years.

Key Findings

Both groups had similar baseline characteristics, with a median age of 5.2 months and median weight of 6.5 kg at the time of surgery. The study revealed several important differences and similarities in outcomes:

• Hospital Stay: Melody valve patients had shorter hospital stays (median: 20.5 days) compared to mechanical valve patients (median: 59.0 days), though the difference was not statistically significant (P=0.11).
• Mitral Valve Gradients: The Melody valve group had significantly lower mitral valve gradients at discharge (5.5 mmHg vs. 8.7 mmHg, P=0.046).
• Permanent Pacemakers: No patients in the Melody group required a permanent pacemaker, while 41.7% of the mechanical group did (P=0.04).
• Reintervention Rates: Both groups experienced early surgical reinterventions at similar rates (33.3% vs. 25%, P=1.00).
• Survival Outcomes: At 1 and 3 years, transplant-free survival was comparable between the groups, with no significant difference (P=0.92).
   

Implications 

The findings suggest that the Melody valve offers several advantages over mechanical prostheses in young children with small mitral annuli, including lower rates of permanent pacemaker insertion and no need for lifelong anticoagulation. While early reintervention rates were high across both groups, the Melody valve demonstrated equivalent survival outcomes and may provide a safer and more effective option for this vulnerable patient population. However, the study authors emphasize the need for further research with larger cohorts and longer follow-up to confirm these promising results.
 

During the Top Adult Cardiac Surgery Abstracts session on Sunday, Jan. 25, J. Hunter Mehaffey, MD, a cardiothoracic surgeon from West Virginia University, will examine results comparing two treatment options— Transcatheter vs. Surgical Aortic Valve Replacement in Medicare Beneficiaries with Aortic Stenosis and Significant Coronary Disease. The study aimed to assess the relative benefits of a surgical approach with CABG/SAVR vs a transcatheter approach with TAVR/PCI (elective +/- 3 months) and safety of these procedures, focusing on early and late outcomes such as mortality, complications, and hospital readmissions.

Dr. Mehaffey’s presentation will highlight the study’s findings that TAVR/PCI is associated with lower hospital mortality, bleeding, and kidney injury but higher incidence of new pacemaker and vascular complications compared to SAVR in this patient group. However, CABG/SAVR was associated with significantly lower longitudinal all-cause mortality and improved freedom from the composite of death, stroke, MI, or valve reintervention. Furthermore, subgroup analysis of single vessel coronary patients confirmed CABG/SAVR was associated with superior freedom from the composite of death, stroke, MI, or valve reintervention compared to PCI/TAVR particularly in surgical patients who received arterial grafts.  

This study uses real-world contemporary data highlighting the longitudinal benefits of a surgical approach compared to a transcatheter approach in patients undergoing aortic valve replacement with significant coronary disease. “These data provide important information to guide heart team discussion and decision making in patients needing aortic valve replacement,” said Dr Mehaffey.
 

Reassessing Efficacy: Understanding Failures in Lung Cancer Screening Despite Low-Dose CT Protocol Adherence, a study presented at the 2025 STS Annual Meeting by Case Western Reserve University medical student Victoria Shiqi Wu, analyzes clinical and demographic factors contributing to lung cancer deaths among patients undergoing low-dose CT (LDCT) screening. Despite the substantial benefits of LDCT in detecting lung cancer early, some patients still succumb to the disease, raising important questions about the effectiveness of current screening approaches for certain populations.

The study utilized data from the National Lung Screening Trial, examining 16,081 patients with negative (normal) initial LDCT scans. Screening success was defined as either remaining cancer-free or surviving lung cancer. Screening failure was characterized by:

•    Receiving three negative scans but dying of lung cancer.
•    Being diagnosed with stage 4 lung cancer.
•    Having a positive scan but still succumbing to the disease.
 

Key Findings

Out of the total cohort, 98.1% (15,775 patients) experienced screening success. Among the 306 patients diagnosed with lung cancer, 33.3% had successful outcomes, while 66.6% faced screening failure.

The study identified several factors significantly associated with screening failure, including:

• Age over 70: Patients in this age group faced a 2.65 times higher risk (95% CI: 1.66-4.12).
• Male sex: Male patients were 1.56 times more likely to experience failure (95% CI: 1.13-2.17).
• Current smoking: Smokers had a 2.03 times higher likelihood of screening failure (95% CI: 1.52-2.73).
• Chronic obstructive pulmonary disease (COPD): Patients with COPD had 2.20 times the risk (95% CI: 1.35-3.46).
• Emphysema and sarcoidosis: Patients with these conditions faced elevated risks, with sarcoidosis showing an especially strong association (OR=7.99; 95% CI: 1.24-29.0).
• Firefighting work: Although less common, individuals in this occupation showed higher failure odds (OR=2.14; 95% CI: 0.99-4.07).
  Implications

The findings underscore the need for tailored interventions to improve LDCT screening outcomes for high-risk populations. Enhanced strategies may include:

•    Developing personalized screening protocols.
•    Implementing more aggressive smoking cessation programs.
•    Increasing surveillance for patients with comorbidities like COPD and emphysema.
 

The study highlights the importance of understanding the limitations of LDCT screening and targeting vulnerable groups to maximize its lifesaving potential. By addressing the identified risk factors, healthcare providers can take meaningful steps toward reducing lung cancer mortality.

A groundbreaking study to be presented at the 2025 Society of Thoracic Surgeons Annual Meeting sheds light on an important decision point for patients requiring aortic valve replacement. Utilizing data from the STS Adult Cardiac Surgery Database, researchers have delivered the most extensive analysis to date on the outcomes of prosthetic valve types for patients aged 60 and younger.

The study, to be presented by Dr. Michael Bowdish, Cedars-Sinai Medical Center, examines the impact of valve choice—mechanical versus bioprosthetic—on long-term survival. By linking patient-level data from the STS ACSD with the National Death Index, researchers offer fresh insights into the critical question of how age and valve type affect surgical outcomes.

With its rigorous methodology and focus on tailoring care to individual needs, the study underscores the potential of advanced surgical techniques and data analytics to improve patient outcomes. It also highlights the pivotal role of the STS National Database, which provides robust national benchmarks for cardiothoracic procedures in the US, in driving impactful research and clinical innovation.

In presenting the Adult Cardiac Clark Paper on day two of STS 2025, Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement with Concomitant Valve Disease, Dr. Robert Hawkins explores the heightened mortality risk for patients undergoing reoperation after transcatheter aortic valve replacement (TAVR) compared to those who have undergone surgical aortic valve replacement (SAVR).

Using data from the STS Adult Cardiac Surgery Database, which covers the years 2011 to 2021, Dr. Hawkins and his team examine the impact of concomitant mitral and tricuspid valve diseases on reoperation outcomes, with a particular focus on TAVR explants.

As part of the “Aortic Valve Surgery: What Do Our Patients Need to Know?” session on Saturday, Jan. 25 from 4:30 – 5:45 p.m., Dr. Hawkins will discuss findings that show patients with prior TAVR are more likely to suffer from severe concomitant valve diseases, such as mitral regurgitation, compared to those who underwent SAVR. These patients demonstrated a higher mortality rate during reoperation, particularly TAVR explants with an increase in the odds of mortality. The study further finds that severe valve disease is associated with significantly higher mortality in both TAVR explant and redo-SAVR cases.

During this session, Dr. Hawkins will share findings indicating that heart teams should consider these risks when deciding between TAVR and SAVR, as well as when addressing dysfunctional TAVR valves to avoid the heightened risks of reoperation. 

On Saturday, Jan. 24, from 10:15 to 10:25 a.m., Tomaz Mesar, MD, from the University of Pittsburgh Medical Center, will present An Age-Based Analysis of Transcatheter and Surgical Outcomes in Low-Risk Patients. The study compares outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients with aortic stenosis, with a particular focus on the impact of age on treatment outcomes.

Using a combined STS and TVT database, Dr. Mesar analyzed low-risk patients who underwent either SAVR or TAVR for degenerative aortic stenosis over a 13-year period, categorizing them into three age groups: under 65, 65-74, and over 75.

As part of the “Updates in Structural Heart: Surgeons are Still in the Game” session, Dr. Mesar will present on the crucial role of age in determining the optimal approach—TAVR or SAVR—for structural heart interventions. His presentation will address how current findings suggest that TAVR may not be suitable for younger, low-risk patients due to observed higher mortality rates. 

For patients aged 65-74, the choice between TAVR and SAVR requires a personalized assessment, as neither procedure demonstrates a clear survival advantage. Finally, for patients over 75, while TAVR may offer a reduction in certain complications, SAVR appears to provide better long-term survival outcomes for this patient population.

Evaluating the performance of congenital heart surgery centers is essential for improving patient outcomes. However, traditional methods of assessing performance have their limitations. At yesterday’s STS 2025 session, Sharon-Lise Normand, PhD, a professor of health care policy at Harvard Medical School, presented Improving Risk Adjustment in the Assessment of Congenital Heart Center Surgical Quality, which explored the use of modern causal inference techniques. These techniques aimed to better account for differences in case mix across centers, enhance risk adjustment, and provide a more accurate evaluation of center performance.

Utilizing data from the STS Congenital Database over a five-year period, the study examined 115 heart surgery centers across the United States. It compared two approaches for predicting postoperative mortality rates:

1. Traditional Method: This approach employed a statistical model that included data from all types of heart surgeries, even those that differed significantly from the procedures performed at the specific center.
2. Causal Inference Method: In contrast, this method focused on identifying other centers that performed similar surgeries and compared the outcomes of patients at those centers to those at the center under study.

Key findings

Dr. Normand discussed how the study revealed that causal inference methods yielded significantly higher and more variable estimates of expected mortality compared to traditional regression models. This suggests that traditional methods may underestimate the complexity of risk adjustment and the variability in performance across different centers. Additionally, causal inference methods were more effective in aligning the distribution of risk factors between comparison and target centers, leading to more accurate estimates of expected mortality.

Implications

These findings emphasize the potential of causal inference methods to provide a more tailored approach to risk adjustment, enhancing the accuracy of performance assessments across various centers. “Further research is needed to explore the implications of these methods for quality improvement and reporting,” said Dr. Normand. “By refining risk adjustment techniques, we can more effectively identify high-performing centers, pinpoint areas for improvement, and ultimately contribute to better outcomes for patients with congenital heart disease.”
 

At the 2025 Society of Thoracic Surgeons Annual Meeting, researchers will unveil a late-breaking study exploring the long-term survival outcomes of different surgical approaches for early-stage non-small cell lung cancer (NSCLC). The analysis leveraged the robust STS General Thoracic Surgery Database (GTSD), combined with long-term follow-up data, to evaluate the effectiveness of anatomic lung resections versus alternative techniques.

The study, to be presented by Dr. Christopher Seder, Rush University Medical Center, examined data from more than 32,000 patients, provides valuable real-world insights that complement existing randomized controlled trials, offering a comprehensive perspective on how surgical decisions influence outcomes over time. With findings drawn from diverse healthcare settings, this research underscores the potential of leveraging large-scale databases to refine treatment strategies and optimize patient care.

The STS GTSD remains a leading resource for capturing detailed surgical and patient data, driving advancements in cardiothoracic surgery. This latest study adds to its legacy by highlighting the importance of integrating real-world evidence into clinical practice.

The Congenital Heart Surgery Clark Paper, Understanding Mortality Following Congenital Heart Surgery: What Do Procedure-Specific Factors (PSF) Add? will assess the contribution of PSFs beyond standard risk factors in estimating mortality in this population.

Meena Nathan, MD, a pediatric cardiac surgeon at Children’s Hospital Boston, will present this paper on Friday, Jan. 24, from 2:16 to 2:24 p.m. as part of the "The Tribulations of Trials: Challenges in CHD Clinical Studies" session. During her talk, she will discuss data from The Society of Thoracic Surgeons Congenital Heart Surgery Database, a crucial resource for enhancing the quality of congenital heart surgery. In 2013, the Database expanded to include 82 Patient Safety Factors (PSFs) for benchmark operations (BMOs), though the impact of these PSFs on mortality prediction has yet to be fully explored.

To address this knowledge gap, Dr. Nathan and her team analyzed the contribution of PSFs to mortality estimation beyond standard STS risk factors. The study included a large cohort of BMOs from 115 U.S. centers between 2017 and 2022.

Dr. Nathan will present study findings, which emphasize the complexity of mortality prediction in congenital heart surgery and highlight the need for continued research to identify the most relevant risk factors and PSFs for each procedure, with the goal of developing more accurate prediction models that enhance patient care and support informed decision-making.