The bronchial sleeve represents a pivotal advancement in thoracic surgery, allowing for oncological radicality while preserving respiratory function. We present 29 cases of telescopic monofilament continuous suture bronchial sleeves out of a total of 43 bronchial sleeve resections performed by us. There were no mortalities, no bronchial positive margins, no local recurrences, and only one anastomotic fistula requiring pneumonectomy with open window thoracostomy, which closed after a few months (Fig. 2). The telescopic intussusception technique avoids the significant problem of caliber discrepancy, and this type of suture consolidates with the physiological increases in airway pressure due to Valsalva maneuver or coughing, because the internal "endobronchial" pressure generated is applied radially on the smaller caliber bronchus, pushing it and causing it to adhere to the larger caliber external bronchus.

Routine daily chest radiographs (CXR) in intensive care units (ICUs), including cardiovascular (CVICUs) and cardiothoracic (CTICUs), are widely used for early complication detection during the post-operative period. However, evidence suggests that this practice lacks clinical utility, with low diagnostic and therapeutic yields. The evidence consistently demonstrates that an on-demand CXR strategy, performed only for specific clinical indications, offers comparable patient safety, reduced radiation exposure, and substantial cost savings without increasing adverse outcomes, ICU length of stay, or mortality. For post-cardiothoracic surgery patients, complications such as pleural effusions and pneumothoraces are of important concern, yet routine CXRs rarely identify such abnormalities, with very few requiring intervention. Data support an on-demand approach, even after procedures such as chest tube removal, as clinical signs and symptoms are reliable indicators of complications. Transitioning from routine to on-demand CXR practices aligns with evidence-based guidelines, including Choosing Wisely® and the Critical Care Societies Collaborative recommendations. This approach promotes high-value care, minimizes unnecessary imaging, and supports the safe, cost-effective management of ICU patients. Routine CXRs should be reconsidered as standard practice in favor of tailored, patient-specific imaging strategies.

Endograft infections following thoracic endovascular treatment are rare but associated with high morbidity and mortality. This study describes our experience with the surgical management of infections involving descending thoracic and thoracoabdominal aorta. The study retrospectively reviewed patients who underwent open descending thoracic and thoracoabdominal aortic aneurysm repair between January 1991 and March 2025, including cases of stent graft infections and secondary aortobronchial or aortoenteric fistula. Perioperative characteristics, operative outcomes and overall survival were evaluated. Of 2220 patients who underwent descending thoracic and thoracoabdominal aortic aneurysm repair, 20 patients (0.9%) received surgical treatment for endograft infections: 8 with endograft infection; 7 with aortoesophageal fistula; and 5 with aortobronchial fistula. The extent of repair involved the descending thoracic aneurysm in 18 patients (90%), and thoracoabdominal aortic aneurysm in 2 patients (10%). Endograft explantation and in-situ aortic reconstruction were performed in 19 patients (95%) while flap reconstruction was utilized in 16 patients (80%). Operative mortality was 6 patients (30%). Postoperative stroke occurred in 1 patient (5%) and temporary paraparesis also occurred in 1 patient (5%). Overall survival was 43.5% at 1 year and 36.3% at 5 years. Management of endograft infection involving the descending thoracic and thoracoabdominal aortic aneurysm remains challenging. Surgical repair, including endograft explantation, in-situ reconstruction, and flap installation, yielded acceptable mortality and morbidity rates in this high-risk patient population.

Lung transplantation for cancer is controversial. The hesitancy has largely been driven by historical outcomes. However, early-stage lung cancer does not significantly affect the outcome of lung transplant for other end-stage lung diseases. We have also made more donor lungs available and hence can consider transplanting patients where the only curative option is to resect both lungs. With careful patient selection, experienced transplant centers can achieve acceptable long-term lung transplant results in patients with cancer as compared to those with other end-stage lung diseases. Additionally, there are two ongoing trials investigating the role of lung transplant for lung cancer and aim to expand access to lung transplants for cancer patients and potentially change medical opinion. If more than one type of patient can benefit from transplant, is it ethical to only allocate donor allografts to patients with chronic lung disease simply because that is what we have always done? Is one disease process more deserving of treatment than another?

Ventricular assist device (VAD) technologies have advanced in recent years from large, pulsatile devices to smaller continuous flow (CF) pumps. As such, their design has allowed surgeons to pioneer less invasive methods of implantation with alternative configurations to treat a larger number of patients with varied types of cardiomyopathies who are often sick with high-risk clinical scenarios. In recent years, these patients appear to have a higher degree of vascular disease and have had multiple prior cardiac surgeries. In this review, we highlight both standard as well as alternative VAD configurations including additional inflow and outflow cannulation techniques along with considerations for biventricular support for both durable biventricular VADs and as a total artificial heart configuration.

In this review, we describe the evolution of the surgical management of Hypoplastic Left Heart Syndrome from its initial description through the development of contemporary interventional strategies. Through this account, we highlight lessons learned from prior comparisons and how these apply to the current debate, Norwood vs Hybrid palliations. The Congenital Heart Surgeons Society - Critical Left Ventricular Outflow Tract Obstruction Cohort has played an important role in defining outcomes and shows promise for future understanding.

Biventricular heart failure remains a challenging issue in patients with end-stage cardiomyopathy requiring mechanical circulatory support options. Also, the Achilles heel of durable left ventricular assist devices (LVADs) remains right ventricular failure that significantly impacts morbidity and mortality. With recent changes in the heart transplant allocation system, there has been major shifts in practice patterns in the use of extracorporeal membranous oxygenation (ECMO), temporary VADs, and durable VADs in the treatment of biventricular failure and strategies for bridge to heart transplantation. Direct comparisons between devices are often difficult to make as there is a learning curve both at the provider level and institution level for each of these devices and strategies. The field continues to rapidly evolve, and the application of artificial intelligence may further hasten this growth.

Reoperative total arch replacement (TAR) following prior cardiovascular surgery presents significant technical challenges and is associated with higher risk profiles. With increasing numbers of patients undergoing reoperation as a result of successful outcomes from primary procedures, we sought to compare the clinical outcomes of reoperative TAR with those of first-time TAR. We reviewed 474 patients who underwent TAR at our institution from 1997 to 2024. Of these, 171 patients (36%) had previously undergone cardiovascular surgery, while the remaining 303 (64%) were undergoing TAR for the first time. Demographic, procedural, and outcome data were collected and analyzed. Comparisons between the reoperative and primary groups were made, and multivariable regression was used to identify covariates associated with major postoperative adverse events (MAEs). Patients in the reoperative group were younger on average (61.5 ± 13.5 vs 70.7 ± 10.9 years, P < 0.001), but presented with a higher burden of comorbidities, including ischemic heart disease (15.8% vs 7.3%, P = 0.006), prior strokes (38.6% vs 15.5%, P < 0.001), and renal impairment (24.6% vs 12.5%, P = 0.001). Operative times were significantly longer for reop TAR, with extended circulatory arrest (48.4 ± 12.8 vs 36 ± 10.8 minutes, P < 0.001), cardiac ischemia (118.2 ± 44.2 vs 99 ± 32.1 minutes, P < 0.001), and cardiopulmonary bypass duration (180.7 ± 38.2 vs 146.7 ± 26.3 minutes, P < 0.001). The reoperative group had higher operative mortality (4.1% vs 0.3%, P = 0.007) and a 2.3-fold increased risk of MAEs (OR 2.27, 95% CI 1.01-5.1, P = 0.046). Reoperative TAR is associated with increased operative risk, longer procedural times, and higher rates of operative complications compared to first-time TAR. Despite these challenges, successful outcomes can be achieved with thorough preoperative planning and attention to key technical details.