A recent Cardiothoracic Surgery digest,
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Study Type: Case series

Key Question: Is totally endoscopic repair through aortotomy alone feasible for treating ruptured sinus of Valsalva aneurysm with concomitant ventricular septal defect?

Key Findings:

• Two young adults with RSVA and infundibular VSD successfully treated via totally endoscopic approach through aortotomy alone
• Complete elimination of residual shunt demonstrated on postoperative echocardiography in both cases
• Mild aortic regurgitation developed but remained stable at mid-term follow-up

Clinical Relevance: This minimally invasive endoscopic technique could offer UK cardiothoracic surgeons an alternative to conventional open repair for this rare congenital condition, potentially reducing surgical morbidity while maintaining efficacy.

Limitations: Very small case series (n=2) with limited follow-up data prevents assessment of long-term durability and generalisability of this technique.

Study Type: Systematic review and meta-analysis

Key Question: Does intercostal nerve cryoablation reduce postoperative pain and opioid requirements compared to standard care in thoracic and cardiac surgery patients?

Key Findings:

• INC significantly reduced inpatient opioid consumption by 102 morphine milligram equivalents (95% CI: -180.00, -23.87) across 24 studies involving 18,465 patients
• Greatest benefit observed in bilateral thoracotomy/thoracosternotomy for lung transplantation
• No significant difference in hospital length of stay, and post-discharge opioid reduction was non-significant (89 MME, 95% CI: -182.00, 4.56)

Clinical Relevance: This evidence supports INC as an effective adjunctive technique for reducing inpatient opioid requirements in UK cardiothoracic practice, potentially supporting enhanced recovery pathways and addressing opioid-related complications.

Limitations: Only 10.6% of patients received INC, suggesting potential selection bias and limited generalisability of findings.

Study Type: Retrospective cohort study

Key Question: What are the long-term outcomes of cone reconstruction without prosthetic materials in children with Ebstein anomaly?

Key Findings:

• Zero operative mortality in 17 patients with 8.2-year median follow-up; no reoperations or significant tricuspid regurgitation recurrence
• Tricuspid valve annulus z-score normalised from +1.81 preoperatively to -1.74 postoperatively (mean difference -3.55, 95% CI -4.30 to -2.80, p<0.001) and remained stable
• Left ventricular volumes increased significantly over time, suggesting favourable biventricular remodelling with reduced right heart volume parameters

Clinical Relevance: Demonstrates that cone reconstruction without prosthetic materials offers excellent durability in paediatric Ebstein repair, potentially avoiding future reoperations while preserving valve growth—important for UK centres managing congenital heart disease.

Limitations: Small single-centre series of 17 patients limits generalisability of findings.

Study Type: Retrospective comparative cohort study

Key Question: Does a total body perfusion (TBP) strategy providing continuous organ perfusion improve outcomes compared to conventional hypothermic circulatory arrest in elective aortic arch surgery?

Key Findings:

• TBP reduced myocardial ischaemia time (65 vs 122 minutes, p<0.001) and circulatory arrest use (18.4% vs 86.7%, p<0.001)
• TBP patients had shorter ICU stay (2 vs 4 days, p=0.006) and improved one-year survival (92.1% vs 72.3%, p=0.025) despite greater surgical complexity
• Multivariable analysis confirmed independent survival benefit for TBP (HR 0.187, 95% CI 0.044-0.807, p=0.025)

Clinical Relevance: This technique may offer UK cardiothoracic centres an alternative approach for complex aortic arch cases, potentially expanding surgical candidacy for high-risk patients whilst improving organ protection.

Limitations: Single-centre retrospective design with potential selection bias, as TBP patients had more complex pathology but were treated in a later era with possible improvements in overall care.

Study Type: Systematic review

Key Question: What are the current techniques, materials, and clinical applications of 3D printing technology in mitral valve disease management?

Key Findings:

• 63 studies identified using CT (most common), 3D TOE, and MRI imaging with software including Mimics, 3D Slicer, and Philips QLAB for model generation
• Processing time from image acquisition to completed 3D model ranged from 45 minutes to 72 hours depending on complexity
• Primary applications were procedural planning, surgical training, and development of simulation-based educational devices using stereolithography, fused deposition modelling, and PolyJet techniques

Clinical Relevance: This technology could enhance UK cardiothoracic surgical practice by improving pre-operative planning accuracy and training capabilities for complex mitral valve procedures, potentially reducing operative time and improving outcomes.

Limitations: The review identifies ongoing challenges with standardisation and accessibility that may limit widespread clinical implementation.

Study Type: Case report

Key Question: Can a combined median sternotomy and lateral cervical incision provide safe access for upper thoracic vertebral stabilization in complex cases?

Key Findings:

• Combined anterior extrapleural approach via median sternotomy and lateral cervical incision successfully provided excellent visualization of T1-T5 vertebral bodies
• Technique enabled decompression and stabilization of T2 pathological burst fracture in a 16-year-old with spinal hemangioma and osteopenia
• Approach avoided complications associated with traditional access routes in the presence of great vessels and trachea

Clinical Relevance: This technique may benefit UK cardiothoracic surgeons managing complex upper thoracic spinal pathology requiring anterior access, particularly when traditional approaches are contraindicated due to anatomical constraints.

Limitations: Single case report limits generalizability of findings and safety profile assessment.

Study Type: Case report

Key Question: How should delayed carotid artery occlusion secondary to graft displacement be managed following frozen elephant trunk aortic arch replacement?

Key Findings:

• Graft displacement caused left carotid occlusion 11 months post-operatively, presenting with transient dysarthria
• Compensatory retrograde flow through external carotid maintained some internal carotid perfusion
• Surgical bypass from aortic graft to left common carotid artery successfully restored perfusion without neurological sequelae

Clinical Relevance: Highlights the need for long-term surveillance imaging after frozen elephant trunk procedures to detect late graft complications that may cause cerebrovascular compromise in NHS patients.

Limitations: Single case report limits generalisability of management approach and surveillance strategies.

Study Type: Technical note/surgical technique description

Key Question: How can left atrial/left ventricular vent placement be optimised during robotic mitral valve surgery to prevent complications?

Key Findings:

• Transpericardial vent placement technique may reduce vent dislodgement during robotic mitral procedures
• Method is described as practical and easy to implement for cases performed under fibrillation
• Technique potentially prevents air embolism and left ventricular distension-related subendocardial ischaemia

Clinical Relevance: Relevant for UK centres performing robotic mitral surgery, particularly as redo procedures increase in frequency and require reliable de-airing strategies to prevent neurological complications and myocardial injury.

Limitations: No comparative data or outcomes provided to validate the claimed benefits of this technique.