PURPOSE This study aims to introduce a robot-assisted Wheat procedure for the treatment of bicuspid aortic valve (BAV) complicated by ascending thoracic aortic aneurysm (ATAA) and severe aortic regurgitation, presenting it as a novel minimally invasive surgical option. DESCRIPTION A 59-year-old male patient, diagnosed with an ATAA measuring 45.6 mm, bicuspid aortic valve, and severe aortic regurgitation, underwent a fully robot-assisted Wheat procedure. The pathological aortic valve was replaced with a 25-mm bioprosthesis, and the aneurysmal ascending aorta was excised and reconstructed using a 28-mm vascular graft. EVALUATION The surgical procedure lasted 385 minutes, with a cardiopulmonary bypass (CPB) duration of 233 minutes and an aortic cross-clamp time of 175 minutes. The patient was extubated 16 hours postoperatively and discharged 9 days later, demonstrating excellent recovery, normal aortic valve function, and no perivalvular leakage. CONCLUSIONS The robot-assisted Wheat procedure is technically feasible and safe for selected patients with ATAA and aortic valve disease. It offers a promising non-sternotomy approach; however, further experience is essential to broaden its indications to more complex cases.
BACKGROUND:The new SP (Single-Port) robotic system is increasingly used for thoracic surgery. METHODS:A retrospective analysis of consecutive patients who underwent extra-thoracic, single-incision surgery, using the SP robotic system between December 2024 and January 2026. RESULTS:From September 2024 to January 2026, 82 patients (44 women) underwent SP robotic thoracic surgery. The median height was 165.1cm (5'5"), median BMI was 26.6. Types of operations were: thymectomy (n=28), lobectomy (n=32), segmentectomy (n=17), and pulmonary wedge resection (n=5). Median operative time for thymectomy was 101 minutes and 137 minutes for lung resection. Median chest tube duration for thymectomy was 0 h and was 7.3 h in the 54 patients who underwent pulmonary resection. Median actual blood loss of 20cc (range 15 - 40). Median hospital length of stay was 1 day for all. Median lymph node count was 29 in the right chest and 23 in the left (median of 5 N2 and 3 N1 stations). All had R0 resections. The new SP robotic stapler, used in the last 38 patients, had no malfunctions. No patient experienced major complications (Clavien-Dindo grade > IIIa). There was no 30- or 90-day mortality and the readmission rate within 60 days was 1%. CONCLUSIONS:This initial experience, the largest report outside of South Korea, shows that robotic thoracic surgery using the da Vinci single-port robotic surgical system, with the new SP robotic stapler is feasible and safe for thymectomy and complex anatomic lung resections, including lobectomy and segmentectomy.
BACKGROUND Most studies on the Ross procedure describe outcomes during the first 2 decades. The present report describes the outcomes at 30 years. METHODS From 1990 to 2004, 212 consecutive patients with a median age of 34 years underwent the Ross procedure. Freestanding aortic root replacement was used in 108 patients, and aortic root inclusion in 104. Patients have been followed prospectively for a median of 26.6 years. Valve function was assessed by echocardiography at periodic intervals. Adverse events were assessed using appropriate statistical analyses. RESULTS Patients’ 30-year survival was 79.4% (95% CI, 71.1%-85.6%), 9.1% lower than that of the Canadian general population matched for sex and age. Forty-seven (22%) patients required Ross-related reinterventions, totaling 64 surgical and 12 percutaneous procedures. Cumulative incidences at 30 years for any Ross-related reinterventions were 28.4% (95% CI - 21.8%, 37.1%), for pulmonary autograft reoperation was 19.1% (95% CI - 13.7%, 26.6%), and for pulmonary homograft was 17.1% (95% CI -1 1.9%, 24.7%). Dilated aortic annulus, older age, and freestanding aortic root replacement were associated with reoperation on the autograft by multivariable analysis. At 30 years, the cumulative incidence of autograft dysfunction (aortic insufficiency and stenosis) was 38.0% [95% CI 31.4%, 46.0%], and pulmonary homograft dysfunction was 62.6% (95% CI - 54.2%, 72.3%). CONCLUSIONS The Ross procedure is a good aortic valve substitute for young adults, but it does not restore normal lifespan, and the function of both valves deteriorates over time, including the development of autograft valve stenosis.
BACKGROUND:Gender-based disparities in operative experience are reported in many surgical subspecialties; however, data in cardiothoracic surgery (CT) are limited. This study examined gender differences in operative experience among CT surgery trainees. METHODS:A retrospective analysis of Accreditation Council for Graduate Medical Education (ACGME) case log data was performed for cardiothoracic surgery trainees graduating in 2016-2024 (excluding 2022), including integrated (I-6) and traditional pathways. Cumulative operative volumes were compared by gender across pathways, subspecialty tracks, and regions. Temporal trends were assessed, and multivariable linear regression evaluated the association between gender and operative volume after adjustment for training and program factors. RESULTS:Case logs from 724 CT surgery trainees (76.5% men, 23.5% women) were analyzed. Mean operative volume was 851 ± 207 cases, with no difference by gender. Women were more likely to pursue the thoracic track (48.8% vs 38.1%, p=0.041), and women's representation increased over time (p=0.040). Operative volume increased across training years for all trainees (p<0.001), with similar trends by gender. No gender differences were observed in total, major, thoracic, or cardiac case volumes in subgroup or adjusted analyses; minor case volume showed a non-significant trend toward higher volume among women. CONCLUSIONS:Gender representation in cardiothoracic training is improving, with more women pursuing the thoracic track. Operative volumes are comparable by gender, with no differences in total case numbers. Future studies should assess operative autonomy and case complexity across genders.
BACKGROUND Candidates for robotic-assisted mitral valve repair (R-MVr) sometimes have concomitant atrial fibrillation (AF) and/or tricuspid valve regurgitation (TR). We investigated the effect of concomitant AF and/or moderate or greater TR on choice between R-MVr and median sternotomy (MS-MVr) and the effect of surgical approach on guideline-directed management of AF and TR. METHODS From 2015-2024, patients in the STS Adult Cardiac Surgery Database who underwent MVr for degenerative mitral regurgitation with/without concomitant tricuspid valve repair (TVr), surgical ablation (SA), and/or left atrial appendage occlusion (LAAO) by either robotic or sternotomy approach were identified. Multivariable logistic regression was performed to assess our primary outcomes. RESULTS The study included 17,169 patients (8,203 MS-MVr, 8,966 R-MVr). Concomitant AF was present in 3,245 (18.9%) and moderate or greater TR in 2,565 (14.9%). Patients with AF (OR 0.51, 95% CI [0.45-0.58]), TR (OR 0.50 [0.43-0.58]) or both (OR 0.38 [0.31-0.47]) were less likely to receive R-MVr vs. MS-MVr. Compared to MS-MVr, patients undergoing R-MVr with AF less frequently had concomitant SA (OR 0.44 [0.35-0.55]) or LAAO (OR 0.40 [0.31-0.52]) and those with TR less frequently had TVr (OR 0.25 [0.19-0.32]). Operative outcomes were similar between MS-MVr and R-MVr with concomitant SA, LAAO, and/or TVr. CONCLUSIONS Surgeons are more likely to perform MS-MVr than R-MVr for patients with AF and/or TR, while guideline-directed management of AF and TR are less common with R-MVr, demonstrating a complex relationship between concomitant conditions and surgical approach. Patients deserve a steadfast commitment to guideline directed care, irrespective of surgical approach.
BACKGROUND STS and Vizient each produce rating systems for cardiac surgery performance. At our institution, during a similar timeframe and for nominally similar cohorts, STS ratings indicated exemplary performance while Vizient suggested worse than expected performance. We hypothesized that these discordant quality signals were driven by methodological differences in how each platform defines cohorts, captures data, adjusts risk, and measures outcomes. METHODS We conducted a single-institution, 12-month retrospective comparison of procedures categorized as isolated coronary artery bypass grafting (CABG) by either STS or Vizient. We compared data sources, patient cohort definitions, observation periods, risk modeling, and outcome definitions, and performed chart review of cases unique to either database. RESULTS STS identified 414 and Vizient 407 patients in their isolated CABG cohorts. Of these, 398 patients were shared, while 16 were unique to STS and 9 to Vizient. STS and Vizient recorded discrepant mortality counts (9 vs 8 deaths, respectively). Chart reviews revealed discordant operative procedure classifications and inconsistent capture of perioperative events between systems. STS relies on audited clinical registry data, clinically-defined patient cohorts and risk factors, peer-reviewed risk models and measures, and multi-year rolling data windows. Vizient uses administrative claims data and associated risk-adjustment variables and outcomes, proprietary methodologies, and shorter reporting cycles. CONCLUSIONS Discordant assessments of cardiac surgery performance by STS and Vizient quality ratings reflect multiple methodological differences. Understanding these differences is essential for assessing the credibility of these two performance rating systems, reconciling conflicting reports, educating hospital leadership and the public, and guiding evidence-based quality improvement.
BACKGROUND:Sex-related differences in valvular heart disease are increasingly recognized, yet contemporary Ross procedure literature rarely reports outcomes by sex. Given the marked male predominance in published series, whether outcomes differ by sex remains unknown. This study evaluated sex-specific outcomes following the Ross procedure in a high-volume center. METHODS:This retrospective cohort study included adults undergoing pulmonary autograft using a full root technique between 2011 and 2025. Propensity score matching (2:1 male: female) was performed using 24 preoperative variables. Primary outcomes were overall survival and freedom from reintervention. Secondary outcomes included aortic regurgitation (AR ≥ grade 2), pulmonary regurgitation (PR ≥ grade 2), New York Heart Association (NYHA) functional class, and longitudinal echocardiographic changes. RESULTS:Among 816 patients, 512 matched individuals (337 male, 175 female) were analyzed. Early outcomes were similar, including 30-day mortality (0.6% male vs 1.1% female). Estimated ten-year survival was excellent in both groups (96.4% male vs 92.9% female, P=0.410), as were reintervention rates (10-year cumulative incidence 5.0% vs 2.7%, P=0.309). In contrast, females exhibited two-fold higher AR progression (10-year incidence 11.0% vs 20.5%, P=0.005), supported by generalized estimating equations (sex-by-time P=0.039) and Cox regression (adjusted hazard ratio 2.16-3.00). Pulmonary regurgitation progression and autograft/homograft hemodynamics were similar. Females had persistently worse NYHA functional class throughout follow-up. CONCLUSIONS:While survival and reintervention rates after the Ross procedure are comparable between sexes, women experience significantly greater aortic regurgitation progression and worse functional status. These findings underscore important sex-specific differences in postoperative remodeling and mid- to long-term outcomes.
