Introduction This review aims to provide an overview of diagnosing and managing traumatic haemothorax for young surgeons. Content Of 27,333 polytrauma patients in Germany in 2021, 35 % were admitted with thoracic trauma. In polytrauma patients, chest injuries are an independent negative predictor of 30-day mortality. These patients should be treated in an evidence-based and standardized manner to reduce mortality and morbidity. There are several methods of immediate diagnosis that should be used depending on hemodynamic stability. In addition to physical examination and chest X-ray, more specific techniques such as the eFAST protocol and Computed tomography (CT) of the chest are available. Once the source of bleeding has been identified, acute treatment is given depending on hemodynamic stability. Thoracic drainage remains the gold standard in the initial management of hemothorax. If surgery is required because of an active source of bleeding, a hemothorax that has not been completely relieved, or associated injuries, either a minimally invasive or open approach can be used. The main focus is to stabilize the patient and avoid early and late complications. Summary and Outlook Rapid and prompt diagnosis and management of traumatic hemothorax is essential for patient outcome and should be taught to all young surgeons who are in direct contact with these patients.

Background and Objectives: Acute type A aortic dissection (AAD) is a life-threatening disease. No differences between men and women have been made in the treatment of AAD so far and knowledge about sex differences regarding long-term outcomes is limited. Materials and Methods: Between 01/2004 and 12/2021, 874 patients were operated on for AAD, including 313 (35.8%) women and 561 (64.2%) men. Clinical and surgical records, including long-term follow-up information, were obtained and analyzed retrospectively. To account for differences in the outcome determined by different preoperative life expectancies, a subgroup analysis for a set of patients matched according to their remaining life expectancy was performed. Results: At the time of AAD, women were older than men (69.1 ± 13.0 vs. 61.8 ± 13.3 years, p < 0.001) and had a shorter remaining statistical life expectancy (18.6 ± 10.8 vs. 21.4 ± 10.4 years, p < 0.001). Significantly more DeBakey type II AAD was found in women (37.1% vs. 25.7%, p < 0.001). Comorbidities and preoperative status at the time of presentation were similar in women and men. More hemiarch procedures (63.3% vs. 52.0%, p < 0.001) and less arch replacements (8.6% vs. 16.6%, p < 0.001) were performed in women, resulting in shorter cross-clamp times for women (92 ± 39 vs. 102 ± 49 min, p < 0.001). The in-hospital mortality was similar in women and men (11.5% vs. 12.7%, p = 0.618). Long-term survival was significantly shorter in women compared to men (9.8 [8.1–11.5] vs. 15.1 [11.9–18.4] years, p = 0.011). A matched subgroup analysis revealed that when comparing groups with a similar remaining life expectancy, the long-term survival showed no significant differences between women and men (9.8 [7.9–11.6] vs. 12.4 [10.1–14.7] years, p = 0.487). Conclusions: There are sex differences in AAD, with DeBakey type II dissection being more frequent in women. The seemingly worse long-term outcome can mostly be attributed to the shorter remaining statistical life expectancy at the time of presentation.

Zusammenfassung: Hintergrund: Obwohl die Thoraxchirurgie ein anspruchsvolles und vielseitiges chirurgisches Fachgebiet ist, wird in den kommenden Jahren ein Mangel an qualifizierten und motivierten Assistenzärzten für die Thoraxchirurgie erwartet. Es wird mit einem Mangel von ca. 7300 Chirurgen in der stationären Versorgung gerechnet. Daher ist es dringend erforderlich, mehr interessierte junge Medizinstudierende zu gewinnen und die medizinische Ausbildung unserer nächsten Generation von Chirurgen zu verbessern.Methoden: Eine Onlineumfrage mit 39 Fragen zur Demografie der Teilnehmer, medizinischen Ausbildung, zum Interesse an der chirurgischen Ausbildung und der thoraxchirurgischen Weiterbildung sowie zur Attraktivität der Facharztausbildung wurde erstellt, um den aktuellen bundesweiten Status quo unter Medizinstudierenden zu evaluieren.Ergebnisse: Insgesamt konnten 224 Fragebögen zur Auswertung herangezogen werden. Grundsätzlich zeigte sich zu Beginn des Studiums ein hohes Interesse an der (Thorax-)Chirurgie. Hervorzuheben ist, dass ein Drittel nicht wusste, dass der „Thoraxchirurgische-Facharzt“ ein eigenständiger Facharzt ist. Diese Aussage wirft weitere Fragen bzgl. der Präsenz der Thoraxchirurgie im Medizinstudium auf. Gefragt nach typischen Eigenschaften, die die Studierenden mit der Thoraxchirurgie verbinden, wurde zum Großteil mit „einer hohen praktischen Tätigkeit“ geantwortet. Was sie von einer chirurgischen Weiterbildung abhält, wurde vorrangig mit der schlechten Vereinbarkeit von Familie und Beruf begründet.Schlussfolgerung: Die Studierenden wissen genau, was sie sich für ihre Zukunft wünschen und wo die Chirurgie ihre Schwachpunkte hat. Sie wünschen sich eine transparente und praxisorientierte Weitbildung, die Vereinbarkeit von Familie und Beruf sowie die Anerkennung ihrer Arbeit und Person.

Transcatheter aortic-valve replacement (TAVR) is increasingly being used for the treatment of aortic-valve stenosis. Therefore, the total number of patients with an aortic-valve prosthesis is increasing, causing the incidence of prosthetic-valve endocarditis to increase. Methods: Between March 2016 and July 2019, ten patients underwent surgery due to prosthetic-valve endocarditis after TAVR. They were identified in our institutional database and analyzed. Results: Infective endocarditis was diagnosed 17 ± 16 month after TAVR. Mean age was 79 ± 4.4 years. Microbiological detection showed 6/10 positive blood cultures for enterococcus faecalis. Median EuroScore II was 24.64%. The mean size of the surgically replaced aortic prosthesis was 23.6 ± 1.3 and that of the TAVR was 28.4 ± 2.3 mm. The surgically implanted aortic valves had a mean gradient of 8.5 ± 2.2 mmHg. One patient died in hospital due to septic multiorgan failure. After discharge, all patients survived with a mean follow-up of 9 ± 8 month. Conclusions: With a rising number of patients after TAVR, prosthetic-valve endocarditis will increasingly occur in patients who were previously considered high or intermediate risk. Our results show that patients with TAVR infective endocarditis can be operated on with good results. Surgical therapy should not be withheld from TAVR patients with infective endocarditis.

Background: Thoracic surgery is an expanding surgical specialty, but a shortage of qualified and motivated thoracic surgery residents is expected. It is estimated that around 23 % of all surgical specialist jobs will be vacant by 2030. We therefore need to assess the current clinical situation and urgently improve the recruitment and training of our next generation of surgeons. Methods: Using the online survey (Lime Survey), a questionnaire (28 questions) was created to analyze the current nationwide situation of residency in thoracic surgery. The survey was sent to all postgraduate trainees in thoracic surgery departments in Germany. The current status on residency-programs, scientific interest, the attractiveness of thoracic surgery, and the demographics of the participants were evaluated. The survey also evaluated specific ways to increase attractiveness. The survey was conducted in collaboration with "Frauen in der Thoraxchirurgie" by the "Junges Forum der Deutschen Gesellschaft f & uuml;r Thoraxchirurgie". The survey was sent to all residents and young specialists in Germany. A total of 187 participants responded. Results: Out of 187 participants, 123 questionnaires (65.8 %) were completed. Mean age was 36.3 +/- 6.9 years. 62.6 % of the participants were male. About 70 % work in an independent thoracic surgery department, while the rest is affiliated with another specialty department. 50 % have completed a doctorate in medicine. Conclusion: The development of an objective and structured training plan could define the roles and responsibilities of the senior surgeon and the trainee, leading to improved training and, at the very least, ensuring good recruitment of junior thoracic surgeons.