Pub Date : 2026-03-01Epub Date: 2025-11-21DOI: 10.1016/j.athoracsur.2025.11.013
J. Hunter Mehaffey MD, MSc , Justin Schaffer MD , Robert B. Hawkins MD, MSc , Makoto Mori MD, PhD , Raymond Strobel MD, MSc , Irbaz Hameed MD, PhD , Ram Subramanyan MD, PhD , Michael Bowdish MD , Vinay Badhwar MD
There is a growing recognition of the importance of longitudinal outcomes after cardiac surgery defining durability of interventions, with an increasing number of publications using a variety of data sources. The purpose of this review is to provide a clinically relevant summary of commonly used longitudinal data sources in cardiac surgery to facilitate broader research use. A group of clinical cardiac surgeons with content expertise in longitudinal data identified the commonly used and high-quality data sources. An overview is provided for each data source as as specific strengths and limitations unique to the clinical interpretation of studies from each data set.
{"title":"Longitudinal Data Sets in Cardiac Surgery","authors":"J. Hunter Mehaffey MD, MSc , Justin Schaffer MD , Robert B. Hawkins MD, MSc , Makoto Mori MD, PhD , Raymond Strobel MD, MSc , Irbaz Hameed MD, PhD , Ram Subramanyan MD, PhD , Michael Bowdish MD , Vinay Badhwar MD","doi":"10.1016/j.athoracsur.2025.11.013","DOIUrl":"10.1016/j.athoracsur.2025.11.013","url":null,"abstract":"<div><div>There is a growing recognition of the importance of longitudinal outcomes after cardiac surgery defining durability of interventions, with an increasing number of publications using a variety of data sources. The purpose of this review is to provide a clinically relevant summary of commonly used longitudinal data sources in cardiac surgery to facilitate broader research use. A group of clinical cardiac surgeons with content expertise in longitudinal data identified the commonly used and high-quality data sources. An overview is provided for each data source as as specific strengths and limitations unique to the clinical interpretation of studies from each data set.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 532-543"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-24DOI: 10.1016/j.athoracsur.2025.09.041
Antonia Kreso MD
{"title":"From Pickup to Patient: How Far Should a Heart Travel?","authors":"Antonia Kreso MD","doi":"10.1016/j.athoracsur.2025.09.041","DOIUrl":"10.1016/j.athoracsur.2025.09.041","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Page 687"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-07DOI: 10.1016/j.athoracsur.2025.12.026
Elliot L. Servais MD
{"title":"When Minimally Invasive Meets Minimally Anesthetized: Is Less Really More?","authors":"Elliot L. Servais MD","doi":"10.1016/j.athoracsur.2025.12.026","DOIUrl":"10.1016/j.athoracsur.2025.12.026","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 714-715"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145946732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-21DOI: 10.1016/j.athoracsur.2025.07.043
Kylie I. Holden MD, MS , Ashley H. Ebanks NP , Amir M. Khan MD , Anthony Johnson DO , Michael McMullan MD , Charles S. Cox Jr. MD , Matthew T. Harting MD, MS , Damien J. LaPar MD, MSc , CDH Study Group
Background
Surgical decision making for congenital heart disease (CHD) with concomitant congenital diaphragmatic hernia (CDH) remains a notable challenge. This study analyzed the relationship between surgical timing and outcomes for patients with both CDH and CHD (CDH + CHD).
Methods
A retrospective analysis of patients with CDH + CHD was performed using data from the multiinstitutional CDH Study Group registry (2007-2022). CDH was categorized by defect size (A-D, smallest to largest) and cardiac anomalies stratified by Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category. Multivariable regression models and Loess smoothing analyses were used, focusing on patient mortality as a function of defect size and surgery timing.
Results
Among 9261 patients with CDH, 1886 had CDH + CHD, and 209 (11.1%) underwent both cardiac and diaphragm repair. A total of 94.3% (n = 197) underwent diaphragmatic repair before the cardiac operation, and STAT category distribution was as follows: 1, 30.1%; 2, 27.3%; 3, 15.8%; 4, 20.1%; and 5, 6.7%. Overall mortality was 23.4%. Multilevel mix-effects logistic regression identified extracorporeal life support as a significant predictor of in-hospital mortality (odds ratio, 5.74; P = .001). When stratified by STAT category, patient mortality correlated with CDH Study Group stage. Median time between operations was 46 days (survivors, 51; nonsurvivors, 39; P = .20) and varied by STAT category. Survival after cardiac operations was greatest 30 to 80 days after CDH repair.
Conclusions
CHD operation outcomes are influenced by CDH size or severity and STAT category risk. CDH repair is almost universally completed before a CHD operation, with the most selected timing for CHD operations occurring 30 to 80 days after CDH repair. These data provide insight into current practice and evidence to guide surgical decision making strategies for patients with CDH + CHD.
{"title":"Surgical Approaches in Congenital Heart Disease With Congenital Diaphragmatic Hernia: A Multiinstitutional Analysis","authors":"Kylie I. Holden MD, MS , Ashley H. Ebanks NP , Amir M. Khan MD , Anthony Johnson DO , Michael McMullan MD , Charles S. Cox Jr. MD , Matthew T. Harting MD, MS , Damien J. LaPar MD, MSc , CDH Study Group","doi":"10.1016/j.athoracsur.2025.07.043","DOIUrl":"10.1016/j.athoracsur.2025.07.043","url":null,"abstract":"<div><h3>Background</h3><div>Surgical decision making for congenital heart disease (CHD) with concomitant congenital diaphragmatic hernia (CDH) remains a notable challenge. This study analyzed the relationship between surgical timing and outcomes for patients with both CDH and CHD (CDH + CHD).</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients with CDH + CHD was performed using data from the multiinstitutional CDH Study Group registry (2007-2022). CDH was categorized by defect size (A-D, smallest to largest) and cardiac anomalies stratified by Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category. Multivariable regression models and Loess smoothing analyses were used, focusing on patient mortality as a function of defect size and surgery timing.</div></div><div><h3>Results</h3><div>Among 9261 patients with CDH, 1886 had CDH + CHD, and 209 (11.1%) underwent both cardiac and diaphragm repair. A total of 94.3% (n = 197) underwent diaphragmatic repair before the cardiac operation, and STAT category distribution was as follows: 1, 30.1%; 2, 27.3%; 3, 15.8%; 4, 20.1%; and 5, 6.7%. Overall mortality was 23.4%. Multilevel mix-effects logistic regression identified extracorporeal life support as a significant predictor of in-hospital mortality (odds ratio, 5.74; <em>P</em> = .001). When stratified by STAT category, patient mortality correlated with CDH Study Group stage. Median time between operations was 46 days (survivors, 51; nonsurvivors, 39; <em>P</em> = .20) and varied by STAT category. Survival after cardiac operations was greatest 30 to 80 days after CDH repair.</div></div><div><h3>Conclusions</h3><div>CHD operation outcomes are influenced by CDH size or severity and STAT category risk. CDH repair is almost universally completed before a CHD operation, with the most selected timing for CHD operations occurring 30 to 80 days after CDH repair. These data provide insight into current practice and evidence to guide surgical decision making strategies for patients with CDH + CHD.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 606-614"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-27DOI: 10.1016/j.athoracsur.2025.08.009
Esteban Aguayo MD , Oh Jin Kwon MD , Mitchell Won MD , Saad Mallick MD , Troy Coaston BS , Amulya Vadlakonda BS , Kevin Tabibian BS , Yas Sanaiha MD , Richard J. Shemin MD , Peyman Benharash MD
Background
Patients with end-stage renal disease (ESRD) are at increased risk for calcific aortic stenosis. Given limited data on the efficacy of transcatheter aortic valve replacement (TAVR) in this population, the present study examined acute mortality, complications, and 30-day nonelective readmissions in a national cohort of patients with ESRD.
Methods
The 2016 to 2021 National Readmissions Database was queried to identify all TAVR admissions (in patients aged ≥18 years). Patients were stratified into ESRD and non-ESRD cohorts. Primary outcomes included in-hospital mortality and 30-day readmissions, whereas perioperative complications, length of stay, and hospitalization costs were secondarily assessed. Multivariable logistic regression and Nelson-Aalen cumulative hazard analysis were used to evaluate factors associated with mortality and readmissions, stratified by institutional TAVR volume. Low-volume and high-volume hospitals were defined by quartiles of annual procedural volume.
Results
Among 411,311 patients undergoing TAVR, 7.3% had ESRD. After risk adjustment, ESRD remained associated with higher mortality (adjusted odds ratio, 1.79; 95% CI, 1.59-2.00) and readmissions (adjusted odds ratio, 1.87; 95% CI, 1.78-1.96). Additionally, ESRD was linked to increased length of stay (β, +1.3 days; 95% CI, 1.1-1.5) and costs (β, +$1.0K; 95% CI, 0.5K-1.5K). After accounting for TAVR volume, non-ESRD was associated with a lower risk of mortality and readmission at high-volume hospitals compared with low-volume hospitals, whereas ESRD was associated with similar risks regardless of institutional volume.
Conclusions
Patients with ESRD are at increased risk for postoperative mortality, hospital resource use, and readmissions. This association was not mitigated at high–TAVR volume centers. Given the increased risk of mortality and readmission, careful patient selection and optimization are crucial for patients with ESRD who are undergoing TAVR.
{"title":"Impact of Transcatheter Aortic Valve Replacement Volume on Outcomes in Patients With End-Stage Renal Disease","authors":"Esteban Aguayo MD , Oh Jin Kwon MD , Mitchell Won MD , Saad Mallick MD , Troy Coaston BS , Amulya Vadlakonda BS , Kevin Tabibian BS , Yas Sanaiha MD , Richard J. Shemin MD , Peyman Benharash MD","doi":"10.1016/j.athoracsur.2025.08.009","DOIUrl":"10.1016/j.athoracsur.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>Patients with end-stage renal disease (ESRD) are at increased risk for calcific aortic stenosis. Given limited data on the efficacy of transcatheter aortic valve replacement (TAVR) in this population, the present study examined acute mortality, complications, and 30-day nonelective readmissions in a national cohort of patients with ESRD.</div></div><div><h3>Methods</h3><div>The 2016 to 2021 National Readmissions Database was queried to identify all TAVR admissions (in patients aged ≥18 years). Patients were stratified into ESRD and non-ESRD cohorts. Primary outcomes included in-hospital mortality and 30-day readmissions, whereas perioperative complications, length of stay, and hospitalization costs were secondarily assessed. Multivariable logistic regression and Nelson-Aalen cumulative hazard analysis were used to evaluate factors associated with mortality and readmissions, stratified by institutional TAVR volume. Low-volume and high-volume hospitals were defined by quartiles of annual procedural volume.</div></div><div><h3>Results</h3><div>Among 411,311 patients undergoing TAVR, 7.3% had ESRD. After risk adjustment, ESRD remained associated with higher mortality (adjusted odds ratio, 1.79; 95% CI, 1.59-2.00) and readmissions (adjusted odds ratio, 1.87; 95% CI, 1.78-1.96). Additionally, ESRD was linked to increased length of stay (β, +1.3 days; 95% CI, 1.1-1.5) and costs (β, +$1.0K; 95% CI, 0.5K-1.5K). After accounting for TAVR volume, non-ESRD was associated with a lower risk of mortality and readmission at high-volume hospitals compared with low-volume hospitals, whereas ESRD was associated with similar risks regardless of institutional volume.</div></div><div><h3>Conclusions</h3><div>Patients with ESRD are at increased risk for postoperative mortality, hospital resource use, and readmissions. This association was not mitigated at high–TAVR volume centers. Given the increased risk of mortality and readmission, careful patient selection and optimization are crucial for patients with ESRD who are undergoing TAVR.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 589-596"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-25DOI: 10.1016/j.athoracsur.2025.11.020
Bu Long MD , Yahong Liu BS , Furong Lin MD , Yaoliang Zhang MD , Guilin Peng PhD , Chao Yang PhD , Sida Liao MD , Lan Lan PhD
Background
High-flow nasal cannula (HFNC) oxygen therapy is widely used primarily for preoxygenation and postextubation respiratory support. However, its intraoperative application remains uncommon. This study evaluated the effects of the HFNC on respiratory mechanics and hemodynamics in thoracoscopic surgery under spontaneous ventilation.
Methods
This randomized trial included 165 patients scheduled for thoracoscopic surgery from 2023 to 2024. Patients were assigned to 3 ventilation supports: double-lumen endotracheal tube (intubation group, n = 55), laryngeal mask airway group (n = 55), or HFNC (n = 55). Intraoperative respiratory and hemodynamic changes, postoperative recovery, and adverse effects were analyzed.
Results
The oxygenation index was comparable intraoperatively but higher in the HFNC group 5 minutes after extubation (P = .018). Intraoperative carbon dioxide was higher in the HFNC and laryngeal mask airway groups (P < .05) but gradually normalized postoperatively. The HFNC shortened extubation time (30 vs 33 vs 37 minutes; P = .005) and postoperative anesthesia care unit stay (70 vs 75 vs 85 minutes; P < .001) and reduced the incidence of nausea, sore throat, and dizziness in the 24 hours postoperatively (P = .005, P = .001, P = .002). HFNC patients demonstrated improved early mobility and nocturnal sleep and lower numeric pain rating scale score at rest and during activity (P < .05). Propofol and opioid use was lower in the HFNC group (P = .016, P < .001), whereas dexmedetomidine consumption was higher (P = .002).
Conclusions
The HFNC provides a stable form of anesthesia compared with laryngeal mask and intubation and is associated with early improved rehabilitation in thoracoscopic surgery.
背景：高流量鼻插管（HFNC）氧疗主要用于预充氧和拔管后呼吸支持。然而，术中应用仍不常见。本研究评估HFNC对自主通气胸腔镜手术中呼吸力学和血流动力学的影响。方法：本随机试验纳入165例计划于2023年至2024年进行胸腔镜手术的患者。患者被分配到三种通气支持：双腔气管内管（插管组，n=55），喉罩气道（LMA组，n=55）或HFNC （n=55）。分析术中呼吸和血流动力学变化、术后恢复情况及不良反应。结果：术中氧合指数比较，拔管后5 min HFNC组氧合指数较高（P = 0.018）。HFNC组和LMA组术中二氧化碳含量较高（P < 0.05），但术后逐渐恢复正常。HFNC缩短了拔管时间（30 min vs 33 min vs 37 min, P = 0.005）和术后麻醉护理单位停留时间（70 min vs 75 min vs 85 min, P < 0.001），降低了术后24小时恶心、咽痛、头晕的发生率（P = 0.005, P = 0.001, P = 0.002）。HFNC患者表现出早期活动能力和夜间睡眠改善，休息和活动时数值疼痛评定量表得分较低（P < 0.05）。HFNC组丙泊酚和阿片类药物用量较低（P = 0.016, P < 0.001），右美托咪定用量较高（P = 0.002）。结论：与喉罩和插管相比，HFNC提供了一种稳定的麻醉形式，并与胸腔镜手术早期康复改善有关。
{"title":"Randomized Trial of High-Flow Nasal Cannula vs Double-Lumen Endotracheal Tube or Laryngeal Mask for Thoracoscopic Surgery","authors":"Bu Long MD , Yahong Liu BS , Furong Lin MD , Yaoliang Zhang MD , Guilin Peng PhD , Chao Yang PhD , Sida Liao MD , Lan Lan PhD","doi":"10.1016/j.athoracsur.2025.11.020","DOIUrl":"10.1016/j.athoracsur.2025.11.020","url":null,"abstract":"<div><h3>Background</h3><div>High-flow nasal cannula (HFNC) oxygen therapy is widely used primarily for preoxygenation and postextubation respiratory support. However, its intraoperative application remains uncommon. This study evaluated the effects of the HFNC on respiratory mechanics and hemodynamics in thoracoscopic surgery under spontaneous ventilation.</div></div><div><h3>Methods</h3><div>This randomized trial included 165 patients scheduled for thoracoscopic surgery from 2023 to 2024. Patients were assigned to 3 ventilation supports: double-lumen endotracheal tube (intubation group, n = 55), laryngeal mask airway group (n = 55), or HFNC (n = 55). Intraoperative respiratory and hemodynamic changes, postoperative recovery, and adverse effects were analyzed.</div></div><div><h3>Results</h3><div>The oxygenation index was comparable intraoperatively but higher in the HFNC group 5 minutes after extubation (<em>P</em> = .018). Intraoperative carbon dioxide was higher in the HFNC and laryngeal mask airway groups (<em>P</em> < .05) but gradually normalized postoperatively. The HFNC shortened extubation time (30 vs 33 vs 37 minutes; <em>P</em> = .005) and postoperative anesthesia care unit stay (70 vs 75 vs 85 minutes; <em>P</em> < .001) and reduced the incidence of nausea, sore throat, and dizziness in the 24 hours postoperatively (<em>P</em> = .005, <em>P</em> = .001, <em>P</em> = .002). HFNC patients demonstrated improved early mobility and nocturnal sleep and lower numeric pain rating scale score at rest and during activity (<em>P</em> < .05). Propofol and opioid use was lower in the HFNC group (<em>P</em> = .016, <em>P</em> < .001), whereas dexmedetomidine consumption was higher (<em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>The HFNC provides a stable form of anesthesia compared with laryngeal mask and intubation and is associated with early improved rehabilitation in thoracoscopic surgery.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 705-714"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-15DOI: 10.1016/j.athoracsur.2025.11.028
Gillian C. Alex MD , Kathryn Engelhardt MD, MS , Ravi Rajaram MD, MSC , William Burfeind MD , Leigh Ann Jones BS , Zouheri ElHalabi BS, BE , Robert Habib PhD , Christopher W. Seder MD , Elizabeth David MD
The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) is the largest and most comprehensive clinical registry for thoracic surgical procedures worldwide. Designed to provide risk-adjusted benchmarking, support quality improvement, and advance research, the GTSD now houses >800,000 records from >300 participating sites. The 2025 annual update highlights several key developments. A major revision of the data collection form reduced abstraction burden while introducing new variables to support long-term outcome modeling. Web-based risk calculators for pulmonary resection and esophagectomy were launched in 2024, and long-term risk models were introduced in 2025. Procedural trends reflect the continued rise of minimally invasive and robotic-assisted techniques, accompanied by improved outcomes across morbidity and mortality measures. The star rating system has been retired in favor of more nuanced risk-adjusted metrics. The Access and Publications program, Participant User File program, and Task Force on Funded Research continue to ensure data reliability and facilitate broad scientific output. Collectively, these initiatives reinforce the GTSD’s role as both a cornerstone of quality improvement and a driver of new knowledge in thoracic surgery, advancing surgical excellence and patient outcomes.
{"title":"The Society of Thoracic Surgeons General Thoracic Surgery Database: 2025 Annual Update","authors":"Gillian C. Alex MD , Kathryn Engelhardt MD, MS , Ravi Rajaram MD, MSC , William Burfeind MD , Leigh Ann Jones BS , Zouheri ElHalabi BS, BE , Robert Habib PhD , Christopher W. Seder MD , Elizabeth David MD","doi":"10.1016/j.athoracsur.2025.11.028","DOIUrl":"10.1016/j.athoracsur.2025.11.028","url":null,"abstract":"<div><div>The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD) is the largest and most comprehensive clinical registry for thoracic surgical procedures worldwide. Designed to provide risk-adjusted benchmarking, support quality improvement, and advance research, the GTSD now houses >800,000 records from >300 participating sites. The 2025 annual update highlights several key developments. A major revision of the data collection form reduced abstraction burden while introducing new variables to support long-term outcome modeling. Web-based risk calculators for pulmonary resection and esophagectomy were launched in 2024, and long-term risk models were introduced in 2025. Procedural trends reflect the continued rise of minimally invasive and robotic-assisted techniques, accompanied by improved outcomes across morbidity and mortality measures. The star rating system has been retired in favor of more nuanced risk-adjusted metrics. The Access and Publications program, Participant User File program, and Task Force on Funded Research continue to ensure data reliability and facilitate broad scientific output. Collectively, these initiatives reinforce the GTSD’s role as both a cornerstone of quality improvement and a driver of new knowledge in thoracic surgery, advancing surgical excellence and patient outcomes.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"121 3","pages":"Pages 521-531"},"PeriodicalIF":3.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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