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Current Status and Future Directions in Cardiac Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 November 2025) | Viewed by 2930

Special Issue Editors


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Guest Editor
Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
Interests: aortic surgery; minimally invasive surgery; innovations and prototyping; artificial intelligence; innovation man-agement; endovascular aortic repair; hybrid procedures; cardiac imaging; heart valve disease; connective tissue disorders; AI in preventive patient care; training; diagnostics case planning and follow-up

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Guest Editor
Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong, China
Interests: complex aortic surgery; TAVI; TEVAR; clinical outcomes in total arch frozen elephant trunk procedure; TAVI and endovascular treatment of false lumen; genetically triggered aortic aneurysm and dissection; PMCF of Evita open NEO and RCT on AMDS in DeBakey I and IIIb aortic dissection

Special Issue Information

Dear Colleagues,

Since its inception, surgical techniques and the ability to treat cardiac disease have undergone tremendous development. Pioneers and visionaries have continuously strived to improve surgical methods and innovate new technologies. Thinking outside the box and being open-minded to new developments have always been, and continue to be, essential in advancing patient care, particularly in cardiac surgery. Personalized medicine and interdisciplinary approaches now enable tailored treatment options for each individual patient. The future of cardiac surgery lies in inventions, new technologies, and innovative treatment options that aim to enhance safety, improve postoperative outcomes, and minimize surgical trauma.

This Special Issue aims to focus on innovations in cardiac surgery, including novel treatment techniques and advancements in patient care. We invite the submission of original articles, descriptions of surgical techniques, reviews, and case reports centered on technical innovations, first-in-man procedures, and innovative patient

surveillance in the following areas:

  • Aortic surgery (open surgery, hybrid procedures, endovascular repair);
  • Minimally invasive surgery (3D, totally endoscopic);
  • Structural heart valve interventions;
  • Electrophysiology;
  • AI in diagnostics and research;
  • Innovations and prototyping;
  • Mechanical assist devices;
  • Heart transplantation (organ preservation);
  • Innovative surgical techniques in pediatric cardiac surgery;
  • Anesthesiological management and innovations in spinal cord protection.

Dr. Marie-Elisabeth Stelzmüller
Prof. Dr. Randolph H.L. Wong
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • innovations
  • AI
  • minimally invasive
  • endoscopic
  • novel technologies in electrophysiology
  • hybrid procedures
  • inno-vative approaches in cardiac surgery and patient care

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Published Papers (2 papers)

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Review

17 pages, 1199 KB  
Review
Complex Coronary Artery Bypass Grafting: Intraoperative Challenges and Surgical Strategies in Contemporary Practice
by Ahmed Osman, Karim Elrakhawy and Dominique Shum-Tim
J. Clin. Med. 2026, 15(7), 2775; https://doi.org/10.3390/jcm15072775 - 7 Apr 2026
Viewed by 331
Abstract
Background: Contemporary coronary artery bypass grafting (CABG) is often performed in patients with diffuse atherosclerosis, severe calcification, prior percutaneous coronary intervention (PCI), and fragile myocardium, creating intraoperative scenarios that can compromise target selection, anastomotic quality, and completeness of revascularization. We synthesize operative [...] Read more.
Background: Contemporary coronary artery bypass grafting (CABG) is often performed in patients with diffuse atherosclerosis, severe calcification, prior percutaneous coronary intervention (PCI), and fragile myocardium, creating intraoperative scenarios that can compromise target selection, anastomotic quality, and completeness of revascularization. We synthesize operative strategies and outcomes across five predefined “complex CABG” scenarios. Methods: A focused literature review was performed targeting intraoperative CABG challenges in adult patients. Two reviewers independently screened titles/abstracts and selected studies describing operative details, technical considerations, or outcomes relevant to (1) intramyocardial/embedded coronaries, (2) severely calcified or diffuse disease requiring reconstruction, (3) small-caliber targets/flow-limited grafting, (4) iatrogenic right ventricular (RV) injury, and (5) failed PCI/stent-related surgical management. Disagreements were resolved through discussion and consensus. Results: Thirty core publications were synthesized across five complex intraoperative CABG scenarios (intramural/embedded coronaries n = 7; calcified/diffuse disease n = 7; small-caliber/flow-limited targets n = 7; iatrogenic RV injury n = 5; failed PCI/stent-related management n = 5). Intramural/embedded targets: reported intramyocardial LAD prevalence ranged from 2.2–13%, and studies emphasized structured localization strategies with a small but real risk of ventricular injury depending on technique. Severely calcified/diffuse disease: reconstructive approaches (endarterectomy, patch angioplasty, long-segment LAD reconstruction) were used to create graftable beds when standard anastomosis was not feasible, with series reporting acceptable early mortality and generally high early-to-midterm patency when paired with planned antithrombotic and imaging follow-up strategies. Small-caliber targets: vessel size alone did not preclude durable grafting when flow was optimized, with evidence supporting flow-augmenting designs (e.g., sequential grafting) and intraoperative flow verification to reduce low-flow failure in limited runoff beds. Iatrogenic RV injury: bailout techniques prioritized rapid hemostasis while preserving LAD/graft patency using buttressed closure concepts designed for constrained exposure and ongoing bleeding risk. Failed PCI/stent-related pathology: long stented segments shifted operative planning from distal target selection to target reconstruction (stentectomy/endarterectomy with long-segment LAD reconstruction), with angiographic follow-up cohorts demonstrating feasible revascularization but variable patency by territory and lesion extent. Conclusions: Complex CABG is best approached as structured, anatomy-driven problem-solving: deliberate target localization, creation of a graftable bed when needed, flow-augmenting graft design, and predefined bailout options. Standardized comparative studies are needed to define optimal strategies across these common clinically important scenarios. Full article
(This article belongs to the Special Issue Current Status and Future Directions in Cardiac Surgery)
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18 pages, 2500 KB  
Review
Management of Ventricular Arrhythmias in Patients with Left Ventricular Assist Devices: Pathophysiology, Risk Stratification, and Ablation Strategies
by Giuseppe Sgarito, Francesco Campo, Sergio Sciacca, Michele Pilato, Manlio Cipriani and Sergio Conti
J. Clin. Med. 2025, 14(18), 6604; https://doi.org/10.3390/jcm14186604 - 19 Sep 2025
Cited by 1 | Viewed by 1726
Abstract
Ventricular arrhythmias (VAs) are common and clinically important complications in patients supported by left ventricular assist devices (LVADs), occurring in up to 50% of cases within the first year after implantation. Despite the hemodynamic support provided by LVADs, VAs are linked to increased [...] Read more.
Ventricular arrhythmias (VAs) are common and clinically important complications in patients supported by left ventricular assist devices (LVADs), occurring in up to 50% of cases within the first year after implantation. Despite the hemodynamic support provided by LVADs, VAs are linked to increased morbidity and mortality, primarily through recurrent implantable cardioverter defibrillator (ICD) shocks and right ventricular failure. The underlying mechanisms of VAs in this population are multifactorial, involving structural myocardial remodeling, device-related factors, and pre-existing arrhythmic substrates. Catheter ablation has become a valuable treatment option when antiarrhythmic drug therapy and device reprogramming are inadequate, though procedural timing (pre-, intra-, or post-implantation) and approaches remain under discussion. Epicardial access during LVAD surgery may provide advantages for selected patients, while ablation after implantation poses technical challenges due to altered anatomy and electromagnetic interference. This review offers a comprehensive overview of the epidemiology, pathophysiology, risk stratification, and management of VAs in LVAD recipients, emphasizing technical considerations, procedural safety, and clinical outcomes of catheter ablation. A multidisciplinary approach remains essential in guiding personalized treatment and optimizing outcomes for this complex population. Undergoing studies will provide more insight into optimal management of arrhythmias, particularly regarding the optimal timing of catheter ablation. The impact of new technologies such as non-invasive mapping alongside pre-procedural imaging needs also to be further evaluated. Full article
(This article belongs to the Special Issue Current Status and Future Directions in Cardiac Surgery)
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