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PubMed displayed almost 37,000 hits for the search term “cardiac surgery AND 2022.” As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

s S15 Purpose: Ex vivo lung perfusion (EVLP) is being increasingly used as a method of evaluating high-risk lungs for transplantation. Previous reports comparing EVLP outcomes with standard transplantation did not match for recipient and transplant characteristics. We examined the outcomes of a large cohort of patients who received EVLP lungs with a propensity score matched conventional cohort. Methods: Patients (1/06-4/15) who received at least one EVLP lung were included in the study. Of the 958 transplants performed, 133 utilized EVLP lungs. 170 lung blocks were evaluated by EVLP during the same period. Propensity matching (1:1, nearest neighbor) was used to identify a matched cohort of 133 patients from patients receiving a conventional lung. Matching factors included age at transplant, pulmonary disease, cold ischemic time, and single vs double lung transplant. Quantile-quantile plots were used to check balance. Re-transplant, heart-lung transplant, and transplant of patients bridged with extracorporeal life support were excluded. Results: Both groups had similar distributions of propensity scores. The EVLP group had lower donor pO2s (408.3 +/95.5 mmHg vs 451.3 +/74.3 mmHg, p< 0.0001), a higher proportion of DCD donors (53 [39.8%] vs 7 [5.2%], p< 0.0001), and a higher number of donor smokers (74 [55.6%] vs 59 [44.4%], p= 0.04). Mean EVLP time was 278 +/62.9 min. Kaplan-Meier survival was similar between the two groups (p= 0.30, Fig 1). Freedom from PGD2/3 at 72h was better in the EVLP group (110 [82.7%] vs 91 [68.4%], p= 0.01) with a trend towards lower 30-day mortality (4 [3%] EVLP, 9 [6.8%] non-EVLP, p= 0.17). Median [95%CI] ICU stay (4[3-6]days non-EVLP vs 4[3-4]days EVLP, p= 0.83) and median [95%CI] hospital stay were similar between groups (23[20-27] days non-EVLP vs 21[19-23] days EVLP, p= 0.21). Conclusion: EVLP is a reliable technique for selecting lungs suitable for transplantation. Short and long term outcomes are excellent and comparable or superior to conventionally selected and preserved donor lungs.