Faculty Bibliography

BACKGROUND AND OBJECTIVE/UNASSIGNED:Thymic epithelial tumors (TETs)-including thymomas and thymic carcinomas-are rare anterior mediastinal malignancies characterized by variable biology, frequent paraneoplastic syndromes, and high recurrence potential. Recent advances in pathologic classification, staging systems, imaging, surgical techniques, and systemic therapies have led to significant changes in clinical management. Complete R0 surgical resection remains the cornerstone of curative treatment; however, the increasing adoption of minimally invasive approaches, refinement of multimodal therapy for advanced disease, and emerging molecular profiling are reshaping contemporary clinical practice. This narrative review aims to provide a comprehensive overview of evolving surgical approaches and multidisciplinary management strategies for thymoma, highlighting recent advances and clinical challenges. METHODS/UNASSIGNED:This review synthesizes literature published from 2010 to 2025 on the management of thymoma. Key areas assessed include updates to World Health Organization (WHO) histopathologic classification and Tumor-Node-Metastasis (TNM) staging; diagnostic strategies and imaging modalities; comparisons of open, video-assisted thoracoscopic surgery (VATS), and robotic-assisted surgical techniques; multimodal therapy, including neoadjuvant and adjuvant chemotherapy and radiotherapy; management of recurrent and metastatic disease; and evolving molecular and immunologic treatment approaches. Evidence from international databases and institutional outcomes was incorporated to evaluate the role of multidisciplinary management and treatment at high-volume centers. KEY CONTENT AND FINDINGS/UNASSIGNED:Modern thymoma management has shifted toward more individualized, multidisciplinary decision-making. Minimally invasive surgery, particularly robotic-assisted thoracic surgery, provides safe and oncologically equivalent outcomes for early-stage tumors with reduced perioperative morbidity. For locally advanced or initially unresectable disease, neoadjuvant chemotherapy increases the likelihood of achieving R0 resection, while adjuvant radiotherapy improves local control in high-risk cases. Recurrent disease, often detected years after initial treatment, benefits most from repeat surgical resection when feasible. Molecular profiling has identified potential genomic alterations in selected subtypes, supporting the use of targeted agents and, more cautiously, immunotherapy, although thymoma's autoimmune biology increases the risk of severe immune-related toxicities. Across studies, treatment at specialized, high-volume centers consistently correlates with better outcomes. CONCLUSIONS/UNASSIGNED:Evolving surgical techniques, improved staging systems, and expanding systemic therapies have transformed the management of thymoma into a highly individualized, multimodal discipline. While complete resection remains central to curative intent, optimal outcomes require coordinated multidisciplinary care, careful patient selection for minimally invasive approaches, and personalized systemic strategies for advanced or recurrent disease. Continued international collaboration and molecularly informed research will be essential to refining future standards of care for this rare malignancy.

BACKGROUND/UNASSIGNED:Primary aldosteronism (PA), a renin-independent state of aldosterone excess, is associated with excess risk of stroke, myocardial infarction, atrial fibrillation, heart failure, and chronic kidney disease compared with essential hypertension. Emerging evidence suggests that renin-independent aldosterone excess exists on a continuum rather than as a dichotomous disease state, including subclinical primary aldosteronism (sPA), even in normotensive individuals. Whether sPA is associated with major adverse cardiovascular events (MACE) prior to overt hypertension remains incompletely characterized. OBJECTIVE/UNASSIGNED:To synthesize available evidence linking renin suppression and mild aldosterone excess to cardiovascular outcomes. METHODS/UNASSIGNED:A narrative review of the literature was conducted using PubMed/MEDLINE, the Cochrane Library, and Web of Science from inception through May 2025, to identify cohort studies evaluating renin phenotype, aldosterone levels, and cardiovascular outcomes. RESULTS/UNASSIGNED:Suppressed renin and higher aldosterone levels, even within conventionally normal ranges, are associated with incident hypertension, left ventricular hypertrophy (LVH), atrial fibrillation, and cardiovascular events. In overt PA, significantly higher rates of cardiovascular diseases have been observed compared with blood pressure-matched essential hypertension. Emerging population-based data suggest a graded cardiovascular risk extending below traditional diagnostic thresholds. CONCLUSION/UNASSIGNED:Biochemical phenotypes consistent with sPA may represent an early cardiometabolic state associated with elevated risk of MACE, even before overt PA criteria are met. The absence of standardized diagnostic thresholds and randomized interventional data currently limits clinical translation. Prospective trials evaluating renin-guided screening and early mineralocorticoid receptor antagonism are needed to determine whether intervention at the subclinical stage reduces long-term cardiovascular harm.

Once considered a surgical frontier fraught with risk, aortic arch aneurysms now represent a domain of evolving innovation. Despite their rarity, they pose severe risks of dissection, rupture, and mortality if not adequately managed. Primarily caused by prior aortic dissections, atherosclerosis, or connective tissue disorders, these aneurysms are often found incidentally on CTA or MRA imaging. Medical management focuses on reducing aortic wall stress through blood pressure control, risk factor modification, and regular imaging to monitor growth. Surgical intervention is typically indicated when the aneurysm diameter exceeds 5.5 cm, exhibits rapid growth, or causes symptoms such as compression or dissection. Open repair remains the gold standard for treatment due to its superior long-term outcomes, though hybrid and endovascular approaches are favored for high-risk patients due to reduced perioperative morbidity. Innovations in hybrid techniques and endovascular devices, alongside advancements in cerebral perfusion strategies, are shaping the future of personalized and minimally invasive approaches to aortic arch repair. This comprehensive review delves into the current management strategies for these aneurysms.

Delayed chest closure is frequently required following heart and lung transplantation due to graft edema, bleeding, size mismatch, or hemodynamic instability, yet current open-chest management strategies rely largely on improvised spacers with recognized mechanical and physiologic limitations. We describe the design and initial clinical application of a modular open-chest management system intended to provide controlled sternal separation while minimizing mediastinal compression and direct cardiac interaction. The device incorporates interchangeable plates and crossbars constructed from a biocompatible-fiberglass-reinforced polymer selected for mechanical strength, low profile, partial radiopacity, and MRI compatibility. Observational clinical use in thoracic transplant recipients demonstrated reproducible deployment, stable chest wall mechanics, preserved ventricular filling, and compatibility with postoperative imaging without device-related complications. This approach may provide a more standardized and physiologically consistent alternative to improvised open-chest techniques in selected transplant patients requiring delayed closure.

Cardiac tumors, though rare, present significant diagnostic and therapeutic challenges due to their heterogeneous nature and anatomical complexity. This narrative review synthesizes current evidence on prevalence, diagnostic modalities, and management strategies for primary and metastatic cardiac tumors. Echocardiography, cardiac MRI, and CT remain cornerstone imaging tools for differentiating tumors from non-neoplastic masses, while advances in PET/CT and tissue characterization techniques refine staging and treatment planning. Surgical resection with clear margins (R0) is critical for resectable tumors, particularly benign myxomas, though malignant tumors like sarcomas require multimodal approaches combining surgery, radiotherapy, and systemic therapies. Emerging strategies such as heart autotransplantation and staged resections offer promise for complex cases, while oligometastatic disease management highlights the role of stereotactic radiotherapy and immunotherapy. Key challenges include standardizing resection margins, optimizing neoadjuvant therapies, and addressing high recurrence rates in malignancies. Future directions emphasize integrating AI-driven imaging analysis, molecular biomarkers, and genomic profiling to personalize therapies, alongside global registries to enhance data on rare tumors. Equitable access to advanced diagnostics and multidisciplinary collaboration are essential to improve outcomes. This review underscores the need for standardized guidelines, technological innovation, and patient-centered research to address gaps in cardiac oncology.