Cardiothoracic Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped cardiothoracic surgery practice.

TAVR vs SAVR for Aortic Stenosis

From inoperable to low-risk

SAVR only → PARTNER (2010) → PARTNER 2 → PARTNER 3/Evolut (low-risk) → durability questions

The ongoing debate

CABG gold standard → DES → SYNTAX → EXCEL controversy → ISCHEMIA

Less surgery, same survival

Lobectomy gold standard → JCOG0802 → CALGB 140503 → small nodule paradigm shift

Through smaller windows

Full sternotomy → mini-sternotomy → VATS → robotic → hybrid → outcomes evidence

The age threshold shifts

Mechanical default → bioprosthetic longevity → TAVR-in-valve option → age shifts → patient preference