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 May 2026 issue...

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Badhwar, Geirrson, and coauthors

This collaboration between the STS Workforce on Evidence Based Surgery, the STS Robotic Cardiac Surgery Task Force, and multinational leaders in the field was created to outline a systematic approach toward mastering the technical skills of robotic cardiac surgery and designing and sustaining clinical robotic programs with optimal patient safety and outcomes. A five-phase approach is outlined, which includes planning, team training, initial clinical application, program consolidation, and advancement and mastery. The specifics of robotic surgery for intracardiac procedures vs coronary revascularization are discussed including case selection, proctoring, and outcome metrics.    

-Robbin Cohen, MD, MMM 
Senior Editor 

Yankah, Chikwe, and coauthors

The Accra Declaration is the product of the 1st Pan-African Cardiothoracic Surgery Summit (2025) in Accra, Ghana. Given the burden of both congenital and acquired cardiovascular disease in Africa and the widespread lack of access to cardiac surgery, leaders discussed comprehensive solutions aimed at improving the delivery of African cardiovascular healthcare at all levels. Key recommendations included:

1. The development of cost-effective cardiac surgical programs to increase case volumes and improve access to cardiac surgery, with staffing according to three surgeon models.
2. An economic structure of enhanced efficiency and cooperation when it comes to obtaining equipment and consumables.
3. An enhanced educational system with simulation skills training and African heart team fellowship programs.
4. An African regional cardiothoracic surgery database.
5. Specialized working groups to guide cardiovascular diagnostic and cardiac surgical therapies. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Koprivanac, Svensson, and coauthors

An analysis of 47,936 acute type-A dissection repairs from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (from 2011–2023) shows a marked shift away from femoral cannulation toward axillary and direct aortic approaches, and increased use of antegrade cerebral perfusion; however, operative mortality (18%) and stroke (15%) remained unchanged. In patients who had antegrade cerebral perfusion, risk-adjusted outcomes were similar with aortic or axillary cannulation. Higher mortality was associated with femoral compared to aortic or axillary cannulation, and any strategy not using cerebral perfusion. Femoral cannulation was also associated with higher stroke risk.

-Joanna Chikwe, MD 
Editor-in-Chief 

Sawma, Crestanello, and coauthors

In a single-center analysis of 934 octogenarians (median age 83 years) undergoing valve reoperation (2004–2023), operative mortality was 6%, median survival was 5.6 years—comparable to an age- and sex-matched U.S. population (5.9 years)—and most patients reported sustained improvements in physical activity and general health at 1–5 years. Late mortality was driven by comorbidity burden (renal failure, lung disease, cerebrovascular/peripheral vascular disease, atrial fibrillation) and procedural complexity (notably concomitant tricuspid surgery), rather than age per se.

-Joanna Chikwe, MD 
Editor-in-Chief 
 

Kisamori, d’Udekem, and coauthors

This retrospective review of the STS Congenital Heart Surgery Database compared Lateral Tunnel Fontan (LT, 2012 pts, 18%) with Extracardiac Conduit Fontan (ECC, 9417 pts, 82%) regarding short-term outcomes. Patient characteristics were similar between the groups in most respects, although the age at surgery was younger in the LT group (median age, 2.7 yrs vs. 3.6 yrs) with fenestration in 85% of LT pts. and 57% ECC. Although operative mortality was similar among the groups (1.1% LT vs. 1.3% ECC), ECC patients had a higher rate of 30-day readmission, prolonged length of stay, pleural effusion requiring drainage, chylothorax, and stroke. By multivariable analysis, predictors of mortality were smaller weight, neurologic deficit, concomitant pulmonary artery reconstruction, associated genetic syndrome, fenestration, and right ventricular dominance.  

-Robbin Cohen, MD, MMM 
Senior Editor 
 

Bostock, Silvestri, and coauthors, for the American Cancer Society National Lung Cancer Round Table Working Group

In total, 165 (12%) of 1336 STS Member surgeons responded to a 24-item emailed survey, of whom 98% were general thoracic surgeons. The goal was to determine how surgeons define bulky mediastinal or multi-station lymphadenopathy, and how these definitions affect their decision to operate for lung cancer. Although most respondents agreed on the definition of an enlarged lymph node (LN) as > 1 cm (90.3%), there was considerable variation regarding the definition of bulky LN, with 39% at > 2cm, 24% at > 3 cm, and 33% did not define bulky by size alone. Of respondents, 89% considered 2 or more stations as multi-station disease. In patients with technically resectable stage IIIA disease, respondents considered surgery to be contraindicated in the presence of bulky mediastinal disease (49.7%), multi-station disease (41.8%), and resection requiring more than lobectomy (46.1%).  

-Robbin Cohen, MD, MMM 
Senior Editor 
 

Wang, Liang, and coauthors

This prospective study utilized the HUAWEI Watch-D (Huawei Device Co., Ltd.) to track physiological metrics in addition to electronic patient reporting to compare perioperative outcomes between the tubeless (no intubation) and intubated techniques after thoracic surgery for early lung cancers in two propensity matched groups (80 pts per group). Compared with the intubation group, the tubeless group had shorter length of stay (2.78 vs. 3.91 days, p < .001), shorter chest tube duration, and lower drainage volume. Wearable devices showed improved oxygen saturation on postoperative days 1 and 2. Patients electronically reported less pain, coughing, dyspnea, and distress in the tubeless group.   

-Robbin Cohen, MD, MMM 
Senior Editor

Barron, Ahmad, and coauthors

Veterans in need of lung transplantation have a choice between the VA Lung Transplant Program (via affiliated academic centers) as well as centers outside the VA system. This study compared survival after waitlisting and transplant for veterans vs non-veterans, and for veterans treated through the VA vs non-VA programs. One-year waitlist survival of veterans vs non-veterans was 83% vs. 80% (P = .27), while survival of veterans waitlisted at VA vs non-VA programs was 80% vs 85% at 0.75 year (P = .65). Five-year survival after transplant was 62% vs 58% (P = .065) for veterans vs non-veterans, and 66% vs 61% (P = .39) at VA vs non-VA programs.  

-Robbin Cohen, MD, MMM 
Senior Editor 

Erkmen, Cooke, and coauthors

This is a 6-year overview of the Thoracic Surgery Directors Association In-Training Exam (TSITE), with descriptions of exam governance, question development, exam administration, scoring and feedback, psychometric evaluation, and qualitative evaluation. In 2025, 567 trainees took the exam, which consists of 160 multiple choice questions (80 cardiac, 80 thoracic), with one correct answer and two distractors per question. A summary of scores by percentage from 2020-2025 is seen below.

-Robbin Cohen, MD, MMM 
Senior Editor 

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