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 April 2026 issue...

Budd, Hensley, and coauthors 

This joint consensus statement provides guidance to cardiac surgeons and anesthesiologists surrounding the management of patients taking direct oral anticoagulants (DOACs) who require elective, urgent, or emergent cardiac surgery. Summary statements are provided regarding the preoperative timing of cessation of DOACs prior to surgery, preoperative laboratory determination of DOAC activity and effect, indications for heparin bridging during the DOAC cessation period, strategies for reversing DOACs prior to emergency cardiac surgery, and suggestions regarding the reinstitution of DOACs after surgery.  

-Robbin Cohen, MD, MMM 
Senior Editor 

Kumar, Eghtesady, and coauthors 

The STS Congenital Heart Surgery Database (CHSD) is the largest congenital and pediatric cardiothoracic surgical clinical data registry in the world, supported by data from over 670,000 operations. The 37th data harvest (Spring, 2024) includes data from 144,979 procedures performed by 418 surgeons from 116 congenital cardiothoracic surgical programs. There was an aggregate mortality of 2.6%, with survival improvement in all benchmark operative groups. The authors describe the extensive audit process to ensure data integrity, as well as the research initiatives that rely on CHSD data. They also discuss future refinements in data analytics and risk model analysis aimed at benchmarking performance and improving quality.  

-Robbin Cohen, MD, MMM 
Senior Editor 

Takamochi, Suzuki, and coauthors 

This multicenter, prospective, randomized controlled trial compared a digital pleural drainage system setting of -8 cm H₂O (experimental group A, n = 98) to a setting of -15 cm H₂O (control group B, n = 112) in patients with moderate air leaks after pulmonary segmentectomy or lobectomy. Patients were randomized on postoperative day 1, once it was established that their chest tube air flow was between 100 and 1000 mL/min. There was no significant difference in the incidence of prolonged air leaks (67.7% vs 60.4%; P = .303), the overall duration of postoperative air leaks (median, 6 vs 5 days; P = .429), duration of chest tube drainage, or postoperative hospital stay (median, 9 vs 9.5 days; P = .55) between the two groups.  

-Robbin Cohen, MD, MMM 
Senior Editor

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Koprivanac, Tong, and coauthors

The authors retrospectively compared radical pericardiectomy (425 patients, 81% on CPB) with partial pericardiectomy (109 patients, 62% on CPB) in consecutive patients between the years 2000 and 2022 at the Cleveland Clinic. There were 89 well-matched pairs. Operative mortality was 3.4% with radical vs 17% in the partial group (P = .0029). Improvements in postoperative cardiac index and drop in central venous pressure were more pronounced with radical, though more transfusions and reoperations for bleeding were seen with the use of CPB. Ten-year survival was 62% for radical vs 23% for partial (adjusted hazard ratio, 3.1; 95% CI, 2.1-4.6). 

-Robbin Cohen, MD, MMM 
Senior Editor 

Awad, Elgharably, and coauthors

In this retrospective analysis, 644 patients underwent surgical intervention for native aortic valve endocarditis (NAVE). Forty percent (260 patients) had evidence of invasion, consisting of perivalvular extension of infection involving the aortic annulus, root, or surrounding structures. Preoperative echocardiography detected invasion in only 43% of patients (52% sensitivity for transesophageal echocardiography and 35.3% for transthoracic echocardiography). The most performed operation for extensive invasive disease was aortic root replacement with an allograft, followed by AVR plus patch repair for focal invasion. Patients with invasion had prolonged CPB times, ventilation duration, and intensive care stays, but survival at 15 years between propensity-matched invasive NAVE and noninvasive NAVE was not significantly different (40% vs 39%; P = .76).  

-Robbin Cohen, MD, MMM 
Senior Editor 

Shetty, Shetty, and coauthors

This retrospective analysis from India reviewed 252 patients who underwent the Ross procedure between 2001 and 2023. The mean age of patients was 19.6 years, with 53.2% < 18 years, 34.9% between the ages of 21-40, and 5.9% between the ages of 41-50. A handmade Dacron valve conduit with polytetrafluoroethylene (PTFE) leaflets was utilized instead of a pulmonary autograft in 75 patients. Early mortality was 1.6%, with 94.3% freedom from all-cause mortality and 89% freedom from Ross-related reintervention at 10 years. Dacron valved conduits had similar mean right ventricular outflow tract gradients and comparable overall reintervention rates to pulmonary autografts.

-Robbin Cohen, MD, MMM 
Senior Editor 

Lee, Nathan, and coauthors

The authors retrospectively compared valve-sparing pulmonary repair (VS, 60%) with transannular patch repair (TAP, 37%) for pulmonary stenosis in 607 infants with tetralogy of Fallot, focusing on timing of post-discharge reinterventions. Median follow-up was 7.3 years. There were 88 (14%) valvular, 11 (2%) main pulmonary artery, 58 (9%) branch pulmonary artery, and 50 (8%) other reinterventions. There was no significant difference in time to valvular intervention between the two groups, with the VS group demonstrating a longer time to composite reinterventions. Neonatal age and preoperative PV z score < -2.5 were associated with PV reinterventions.  TAP, neonatal age, and preoperative left or right pulmonary artery Z-score < -2.5 were associated with composite reintervention.

-Robbin Cohen, MD, MMM 
Senior Editor

Szeto, Brown, and coauthors

This was a retrospective review of 584 patients who underwent coronary artery bypass grafting (CABG) with a radial artery graft from 2016 to 2023. Patients were grouped by preoperative duplex ultrasonography, either normal (>20 cm/s, 72.1%), marginal (10-20 cm/s, 23.8%), or low (10 cm/s, 4.1%), using palmar arch reversal velocity during radial artery occlusion. The overall incidence of ischemic hand symptoms at 30 days was 5.8%, with no significant association between preoperative palmar arch reversal velocity and postoperative symptoms. No ischemic events required intervention. On multivariable analysis, only diabetes was associated with an increased risk of symptoms.  

-Robbin Cohen, MD, MMM 
Senior Editor 

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Korukonda, DeRoo, and coauthors 

The authors describe a case of type A aortic dissection with extensive head vessel dissection. On initiation of cardiopulmonary bypass using central canulation with the Seldinger technique, cerebral saturations plummeted. Samurai cannulation of the severely dissected innominate artery was performed by clamping the artery proximally and transecting it to directly cannulate the true lumen with an 8F pediatric cannula, allowing for antegrade cerebral perfusion. This resulted in improved bilateral head saturations on cardiopulmonary bypass and an excellent postoperative neurologic result.