Null hypothesis significance testing (NHST) and p-values are widespread in the cardiac surgical literature but are frequently misunderstood and misused. The purpose of the review is to discuss major disadvantages of p-values and suggest alternatives. We describe diagnostic tests, the prosecutor’s fallacy in the courtroom, and NHST, which involve inter-related conditional probabilities, to help clarify the meaning of p-values, and discuss the enormous sampling variability, or unreliability, of p-values. Finally, we use a cardiac surgical database and simulations to explore further issues involving p-values. In clinical studies, p-values provide a poor summary of the observed treatment effect, whereas the three- number summary provided by effect estimates and confidence intervals is more informative and minimises over-interpretation of a “significant” result. P-values are an unreliable measure of strength of evidence; if used at all they give only, at best, a very rough guide to decision making. Researchers should adopt Open Science practices to improve the trustworthiness of research and, where possible, use estimation (three-number summaries) or other better techniques.

Patients with pulmonary arterial hypertension (PAH) may develop large pulmonary artery aneurysms (PAA) which may be complicated by rupture, dissection or intravascular thrombus formation. These patients were traditionally considered for heart-lung transplantation but more recently, there have been reports of successful lung transplantation with reconstruction of the pulmonary artery (PA). We present two patients who underwent successful transplantation for PAH with giant PAA. One patient had end stage PAH and right pulmonary artery atresia complicated by a giant main PAA. This patient underwent bilateral sequential lung transplantation with concurrent pulmonary artery reconstruction. Another patient had end stage PAH with giant PAA on a background of D-transposition of the great arteries who had a Mustard repair at 9 months of age. This patient underwent heart-lung transplantation. Both heart-lung transplantation and lung transplantation with reconstruction of the pulmonary should be considered as a treatment option for patients with PAH with PAA.