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 July 2026 issue...

Velotta, Bueno, and coauthors 

An international, multidisciplinary panel developed PICO-based (Population, Intervention, Comparison, Outcomes) questions and conducted a literature review to create consensus statements regarding the multimodal treatment of pleural mesothelioma. There was consensus that diagnosis depends on adequate pleural biopsy with CT and PET imaging. Surgery should be part of a multimodal treatment plan, with pleurectomy/decortication or extended pleurectomy/decortication favored over extrapleural pneumonectomy. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Salazar, Lorusso, and coauthors

In this literature review on temporary mechanical circulatory support (tMCS) in adult cardiac surgery from 52 studies (2000-2024), the authors frame the concept of protected cardiac surgery; the early initiation of tMCS as a preemptive tool to prevent irreversible hemodynamic collapse in high-risk cardiac surgery patients.  Physiologic evidence supporting the rationale for early intervention is provided, along with strategies for identifying hemodynamic decline and implementing the shock team approach toward prevention rather than rescue from hemodynamic collapse. Success depends on accurate identification of high-risk patients, and structured institutional and regional coordination models for the purpose of improving both in-hospital and long-term survival. 

-Robbin Cohen, MD, MMM 
Senior Editor 

Valderrama, Velotta, and coauthors

In this invited perspective, the authors discuss the importance of optimizing the time interval between diagnosis and resection of early-stage non-small cell lung cancer. Determinants of surgical delay include patient-, system-, and societal-level factors, many of which are modifiable. The evidence regarding delayed time to surgery (TTS) and its effect on survival, as well as multiple society recommendations, suggest that 8 weeks should be the current benchmark for TTS.  

-Robbin Cohen, MD, MMM 
Senior Editor 
 

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Tchitchinadze, Jondeau, and coauthors

This analysis of 1898 FBN1 pathogenic variant carrier patients from a large prospective French registry examined clinical results over three time intervals from 1995-2023. The median age of first clinic visit declined from 27.76 years to 21.36 years over the study periods (P = .001), and 51.48% of patients were female. Type A aortic dissections decreased over the three time periods (6% vs 4.7% vs 2.7%, P < .001); however, type B dissections remained stable (1.7% vs 1.4% vs 2.1%) with 52% occurring after the first visit. There was a trend toward valve sparing procedures at the expense of Bentalls. Survival to age 75 years according to the year of first visit increased from 52%, to 63%, to 79.4% over the three time periods.  

-Robbin Cohen, MD, MMM 
Senior Editor 

Mehaffey, Badhwar, and coauthors

This retrospective analysis of the Premier Healthcare Database looked at patients aged 40-65 who underwent aortic valve replacement from 2016-2024. From the results, the authors emphasize 5 important points:

1. This nationally representative analysis highlights a 360% rise in utilization of TAVR in young patients.
2. Young TAVR use peaked at 41% in 2020 at the time of the pandemic, with subsequent stabilization to one-third of all young AVRs by 2024.
3. Young TAVR was used more frequently in female patients and in those with greater frailty and higher comorbidity burden, including those with Medicare coverage before the age of 65 years.
4. Despite higher comorbidity burden, TAVR was associated with similar periprocedural stroke, lower mortality, and higher cost compared with SAVR.
5. Greater than 12% of US-based centers performed TAVR in young patients >50% of the time, and these were predominantly large, high-volume teaching hospitals with a higher percentage of Black and Hispanic populations.

-Robbin Cohen, MD, MMM 
Senior Editor 
 

Ramlawi, Reardon, and coauthors

A total of 1164 patients underwent isolated AVR (667 TAVR, 497 SAVR). TAVR valves included CoreValve, Evolut R, or Evolut PRO bioprostheses (Medtronic, Inc). At 5 years, the composite of all-cause mortality or disabling stroke (15.5% TAVR, 14.6% SAVR; P = .84), all-cause mortality (13.5% TAVR, 12.8% SAVR; P = .85), and cardiovascular mortality (6.9% TAVR, 8.4% SAVR; P = .36) were similar. The 5-year rate of aortic valve reintervention (3% TAVR, 2.2% SAVR; P = .51) and rate of moderate or greater paravalvular regurgitation (0.5% TAVR, 0% SAVR; P = .52) were also similar. New permanent pacemaker implantation was higher with TAVR (27.3% TAVR, 8.9% SAVR; P < .001).

-Robbin Cohen, MD, MMM 
Senior Editor 

W. Zhang, H. Zhang, and coauthors

At a median age of 3.5 years, 287 patients underwent primary aortic valve repair, of which acceptable repair (< moderate AS and < mild AI) was achieved in 183 (64%). Repairs not meeting “acceptable” criteria were designated as having residual lesions. At median follow-up of 2.5 years, acceptable repair yielded superior 4-year freedom from suboptimal outcomes (>moderate AS/AI or reintervention after discharge) vs patients with residual lesions (75% vs 51%, p < .001). Independent predictors for suboptimal outcomes were smaller preoperative annulus z-score, higher preoperative peak gradient, and prior balloon aortic valvuloplasty. For mixed/pure AI patients, leaflet extension/augmentation was associated with suboptimal outcomes on univariate but not multivariable analysis.  

-Robbin Cohen, MD, MMM
Senior Editor

Li, Swanson, and coauthors

This retrospective review evaluated 208 patients who underwent curative sublobar resection for invasive lung adenocarcinoma in mixed ground-glass nodules < 3 cm in diameter. Median follow-up was 64 months. The median long-axis diameter of the lung nodules was 18 mm, and the median surgical margin distance was 12 mm (range 7-20mm). Patients who had a margin-tumor diameter ratio (MTR) > 0.2 had significantly improved locoregional recurrence-free survival and reduced recurrence when compared with those with MTR <0.2. In multivariable Cox regression, MTR > 0.2 remained an independent predictor of improved local recurrence-free survival (P = .003). 

-Robbin Cohen, MD, MMM 
Senior Editor 

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Jeffrey Shuhaiber

In this letter of correspondence, Dr Shuhaiber makes the case that the right internal mammary artery (RIMA) is structurally and functionally identical to the left internal mammary artery (LIMA), with long-term patency to the left anterior descending artery exceeding 90%. He argues that when both the RIMA and LIMA show “similar vulnerability under specific technical conditions, the signal is more consistent with a technique-dependent issue than with a conduit-specific deficiency.” In his Reply, Dr Lamy agrees that the LIMA and RIMA may share anatomy, biology, and physiology, but its proponents have yet to share their “special knowledge” regarding both specific results and operative strategy and technique. Unraveling this controversy will require randomized controlled trials dedicated to harvesting technique, connections to other grafts, and target vessel choice.

-Robbin Cohen, MD, MMM 
Senior Editor