In their article in the Journal, Dr Hrytsyna and colleagues report their experience with a protocolized method of assessing myocardial recovery with the aim of aggressive left ventricular assist device (LVAD) explantation.1 This single-institution retrospective review has 2 helpful characteristics: a large LVAD population (544 patients) and a long-standing protocol-based assessment for explantation, initiated in 2016. After 4 years of using this protocol, 57 patients (10%) met the authors’ screening criteria and underwent speed manipulation under echocardiographic guidance (including pump stoppage).

Patrick and colleagues1 present an analysis of socioeconomic status (SES) in patients undergoing coronary artery bypass grafting in this month's Journal. The authors employ the validated Area Deprivation Index (ADI), which is a block-level measure of SES based on 17 indicators from the US Census data. The ADI is assigned based on the 9-digit patient ZIP Code. The authors then converted ADI to neighborhood socioeconomic status (NSES) by subtracting from 1.0 so that low NSES correlated with low SES.

In this month's Journal, MacGregor and colleagues1 present a single-center, retrospective analysis of long-term follow-up of patients undergoing isolated surgical ablation via the Cox-Maze IV procedure (CMP-IV) for atrial fibrillation between 2001 and 2019. Perioperative outcomes were excellent, with 6% of patients requiring new pacemaker implantation, 0% 30-day mortality, and only 1% experiencing postoperative stroke—none of which was associated with permanent deficits. These clinical outcomes appear to be durable as well.

The complication rate after thoracoabdominal aortic aneurysm repair has improved over the previous decades, in part because of a decline in spinal cord injury.1 Adjuncts such as cerebrospinal fluid drainage, hybrid approaches, circulatory support, permissive hypothermia, and segmental artery reimplantation are increasingly used. However, spinal cord ischemia remains a devastating complication, at a rate of 11% in a recent large study.2 Efforts continue to further reduce the morbidity and costs associated with paralysis.

Chemtob and colleagues1 assess the Cleveland Clinic screening algorithm for robotic surgery in patients with isolated degenerative mitral valve disease. They report that 60% of patients who were evaluated in the study met their criteria for a robotic approach. Furthermore, when they analyzed outcomes between patients undergoing conventional sternotomy compared with robotic approaches, they found no differences with outstanding outcomes in both groups. Based on these data, the authors suggest their screening algorithm is valid for selecting patients for a robotic approach.

Dr Hirji and colleagues present an analysis comparing different etiologies of functional mitral regurgitation (FMR) in this month's Journal.1 They have elected to classify atrial FMR as due to atrial enlargement or heart failure with preserved ejection fraction and ventricular FMR as related to any ventricular dysfunction. Significant baseline differences are notable, reflecting the considerable heterogeneity of FMR patients. The rate of operative mortality was low and not different between the groups.