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Cardiac Surgery: Clinical Advances
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Cardiac Surgery: Clinical Advances

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

Deadline for manuscript submissions: 25 March 2026 | Viewed by 5890

Special Issue Editors

Dr. Carmelo Dominici

E-Mail Website
Guest Editor
Unit of Cardiac Surgery, Ospedale Maggiore della Carità, 28100 Novara, Italy
Interests: aortic valve repair; mitral valve repair; off-pump coronary artery bypass (OPCAB); grown-up congenital heart (GUCH) and paediatric congenital heart disease
Dr. Giovanni Casali

E-Mail Website
Guest Editor
Unit of Cardiac Surgery (Head), Ospedale Maggiore della Carità, 28100 Novara, Italy
Interests: off-pump coronary artery bypass (OPCAB) surgery; aortic surgery; heart failure surgery
Dr. Antonio Nenna

E-Mail Website
Guest Editor
Unit of Cardiac Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
Interests: cardiac surgery; heart valve surgery; critical care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

"Cardiac Surgery: Clinical Advances" offers an insightful exploration into the cutting-edge developments transforming heart surgery. This comprehensive guide delves into the latest techniques, technologies, and breakthroughs that are reshaping the landscape of cardiovascular care. From minimally invasive procedures to innovative surgical tools, this Special Issue provides invaluable knowledge for clinicians, researchers, and healthcare professionals seeking to stay at the forefront of cardiac surgery.

This Special Issue aims to highlight the most recent clinical advances in cardiac surgery, providing a platform for showcasing innovations in surgical techniques, patient management, and postoperative care. It seeks to inform and inspire the medical community on the future direction of cardiac surgery practices. The issue will cover pioneering research, including the integration of robotics, 3D imaging, and AI-driven technologies in surgery. Additionally, it will explore advances in personalized medicine, regenerative therapies, and novel drug-delivery systems that enhance patient outcomes in cardiac procedures.

We are seeking original research articles, review papers, and clinical studies that present novel insights or significant improvements in the field of cardiac surgery, considering adult, pediatric, and ACHD/GUCH procedures. Submissions that focus on the application of new technologies and surgical innovations are highly encouraged.

Whether you are aiming to enhance patient outcomes or broaden your understanding of the field, this Special Issue is an essential resource for navigating the future of heart health.

Dr. Carmelo Dominici
Dr. Giovanni Casali
Dr. Antonio Nenna
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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • cardiac surgery
  • surgical innovation
  • minimally invasive techniques
  • robotic surgery
  • personalized medicine
  • advanced surgical technologies

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Published Papers (5 papers)

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Research

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14 pages, 23275 KB  
Article
Long-Term Clinical Outcomes of Minimally Invasive Direct Coronary Artery Bypass Grafting
by Sleiman Sebastian Aboul-Hassan, Maria Luszczyn, Ryszard Stanislawski, Maciej Peksa, Marcin Nawotka, Siarhei Amelchanka, Lukasz Moskal, Tomasz Stankowski and Romuald Cichon
J. Clin. Med. 2025, 14(21), 7590; https://doi.org/10.3390/jcm14217590 - 26 Oct 2025
Viewed by 712
Abstract
Background/Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) surgery, performed through a left minithoracotomy, has emerged as an alternative to conventional coronary artery bypass grafting (CABG), which requires a full sternotomy. This procedure is ideal for patients with isolated proximal left anterior [...] Read more.
Background/Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) surgery, performed through a left minithoracotomy, has emerged as an alternative to conventional coronary artery bypass grafting (CABG), which requires a full sternotomy. This procedure is ideal for patients with isolated proximal left anterior descending (LAD) artery disease or high surgical risk. The aim of this study was to assess the long-term clinical outcomes of MIDCAB performed at a single center with stratification by revascularization strategy. Methods: A total of 480 patients who underwent off-pump MIDCAB between 2012 and 2024 at a single center were retrospectively analyzed and categorized into three distinct groups: complete revascularization (MIDCAB-CR), hybrid coronary revascularization (MIDCAB-HCR) and incomplete revascularization (MIDCAB-IR). Short- and long-term outcomes, including mortality, major adverse cardiac and cerebral events (MACCE) and LITA–LAD graft patency were evaluated. Median follow-up was 3.39 years. Results: In-hospital mortality was 1.4%. At a median follow-up duration of 3.39 years, the overall LITA–LAD graft patency was 94.4% with 5- and 10-year survival rates of 78% and 60%, respectively. MIDCAB-CR and MIDCAB-HCR groups showed comparable long-term survival and freedom from MACCE, both significantly better than those observed in the MIDCAB-IR groups. Conclusions: These findings support the safety and durability of MIDCAB as an effective revascularization strategy, especially when performed as complete or hybrid revascularization. Incomplete revascularization may be considered in selected high-risk patients but is associated with worse outcomes. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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15 pages, 966 KB  
Article
Long-Term Follow-Up of Left Atrial Appendage Exclusion: Results of the V-CLIP Multi-Center Post-Market Study
by Elias Zias, Katherine G. Phillips, Marc Gerdisch, Scott Johnson, Ahmed El-Eshmawi, Kenneth Saum, Michael Moront, Michael Kasten, Chanderdeep Singh, Gautam Bhatia, Hiroo Takayama and Ralph Damiano
J. Clin. Med. 2025, 14(15), 5473; https://doi.org/10.3390/jcm14155473 - 4 Aug 2025
Viewed by 1056
Abstract
Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods [...] Read more.
Background: Cardiac surgery patients with pre- or post-operative atrial fibrillation are at an increased risk for thromboembolic stroke, often due left atrial appendage (LAA) thrombus. Surgical LAA exclusion (LAAE) can be performed and must be complete to avoid increased thrombus formation. Methods: This prospective, multi-center, post-market study (NCT05101993) evaluated the long-term safety and performance of the epicardial V-shape AtriClip device. Patients ≥18 years who had received V-shape AtriClip devices during non-emergent cardiac surgery consented to a prospective 12-month follow-up visit and LAA imaging. The primary performance was LAAE without residual left atrium-LAA communication, assessed by imaging at the last follow-up visit. The primary safety was device- or implant procedure-related serious adverse events (SAEs) (death, major bleeding, surgical site infection, pericardial effusion requiring intervention, myocardial infarction) within 30 days. Results: Of 155 patients from 11 U.S. centers, 151 patients had evaluable imaging. Complete LAAE was obtained in all patients. Primary performance in the intent-to-treat population was met, with 97% (95% CI 93.52%, 99.29%; p = 0.0001) complete LAAE. Primary safety was met, with 100% (95% CI 97.75%, 100%; p < 0.0001) of patients free from pre-defined SAEs within 30 days. One device-related SAE was reported, which resolved intraprocedurally. Conclusions: AtriClip V-Clip showed safe and successful LAAE through 12 months of follow-up. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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12 pages, 553 KB  
Article
Disproportionate vs. Proportionate Secondary Mitral Regurgitation: A Long-Term Pilot Analysis After Mitral Valve Surgery
by Giovanni Alfonso Chiariello, Michele Di Mauro, Emmanuel Villa, Piergiorgio Bruno, Andrea Mazza, Natalia Pavone, Marialisa Nesta, Alberta Marcolini, Rudy Panzera, Andrea Armonia, Gaia De Angelis, Serena D’Avino, Antonio Nenna, Annalisa Pasquini and Massimo Massetti
J. Clin. Med. 2025, 14(10), 3470; https://doi.org/10.3390/jcm14103470 - 15 May 2025
Viewed by 1005
Abstract
Objectives: The treatment of secondary mitral regurgitation (MR) is still controversial. In 2019, a new conceptual framework was introduced, distinguishing between patients with a degree of MR “proportionate” to the left ventricular (LV) dilatation and patients in whom the severity of MR is [...] Read more.
Objectives: The treatment of secondary mitral regurgitation (MR) is still controversial. In 2019, a new conceptual framework was introduced, distinguishing between patients with a degree of MR “proportionate” to the left ventricular (LV) dilatation and patients in whom the severity of MR is “disproportionate” to the LV dilatation. The aim of this study was to compare the long-term outcome of patients with disproportionate vs. proportionate secondary MR who underwent mitral valve (MV) surgery. Methods: From January 2012 to June 2022, 96 patients with a preoperative diagnosis of pure secondary MR and LV dysfunction underwent MV surgery. The patients were divided in two groups, disproportionate vs. proportionate MR, according to echocardiographic parameters. A 5.2 (3.5–7.5) years complete clinical and echocardiographic follow-up was performed. Results: In the study period, 61 patients with disproportionate and 35 patients with proportionate MR underwent surgical MV repair or MV replacement. The thirty-day outcome was comparable in the two groups. At long-term follow-up, mortality was 5% in the disproportionate group vs. 11% in the proportionate group (p = 0.2), and cardiovascular mortality was 3% vs. 9%, respectively (0.5). Rehospitalization for heart failure was 6% vs. 20% (p = 0.04), and the rate of patients with New York Heart Association (NYHA) functional class ≥ III was 8% vs. 26%, respectively (p = 0.01). LV volumes were significantly higher in the proportionate group, thus presenting a lower LV ejection fraction (p < 0.001 and p = 0.03, respectively). No cases of recurrent MR have been observed. Conclusions: In this first exploratory analysis, patients with disproportionate secondary MR seem to present a possible benefit in terms of mortality and cardiovascular mortality, although not ones reaching statistical significance. Nevertheless, significant advantages were observed in terms of rehospitalization for heart failure, clinical status and symptoms, LV volumes, and LV function. Among patients referred to cardiac surgery, identifying the subset of patients with functional MR, who may obtain more significant advantages from surgery, seems relevant for patient selection, risk stratification, and to predict long-term outcomes. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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Review

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23 pages, 2369 KB  
Review
ECMO in Refractory Septic Shock: Patient Selection, Timing and Hemodynamic Targets
by Debora Emanuela Torre and Carmelo Pirri
J. Clin. Med. 2025, 14(22), 7904; https://doi.org/10.3390/jcm14227904 - 7 Nov 2025
Viewed by 490
Abstract
Background: Septic shock remains a major cause of mortality in critical care, driven by profound vasoplegia, myocardial depression and refractory circulatory collapse. Conventional therapy occasionally fails to restore adequate perfusion, leading to life-threatening multi-organ failure. Methods: This narrative review examines current evidence [...] Read more.
Background: Septic shock remains a major cause of mortality in critical care, driven by profound vasoplegia, myocardial depression and refractory circulatory collapse. Conventional therapy occasionally fails to restore adequate perfusion, leading to life-threatening multi-organ failure. Methods: This narrative review examines current evidence on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) as a salvage strategy for refractory septic shock, focusing on the pathophysiological rationale, patient selection, timing of initiation and hemodynamic management. Results: Data from observational studies and registry analyses suggest that V-A ECMO may improve survival in patients with septic cardiomyopathy (SCM), with reported survival rates approaching 40% in selected adult cohorts and over 50% in pediatric populations. Early initiation, phenotype-guided selection and precise hemodynamic titration are critical to optimize outcomes. Conclusions: The role of ECMO in septic shock remains controversial and should be restricted to experienced centers and well-defined phenotypes. Future research must refine selection criteria, standardize support strategies and evaluate long-term functional recovery beyond survival. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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29 pages, 1626 KB  
Review
Alternative Arterial Access in Veno-Arterial ECMO: The Role of the Axillary Artery
by Debora Emanuela Torre and Carmelo Pirri
J. Clin. Med. 2025, 14(15), 5413; https://doi.org/10.3390/jcm14155413 - 1 Aug 2025
Cited by 3 | Viewed by 2152
Abstract
Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used to support patients with refractory cardiogenic shock or cardiac arrest. While femoral artery cannulation remains the most common arterial access, axillary artery cannulation has emerged as a valuable alternative in selected cases. Objective [...] Read more.
Background: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used to support patients with refractory cardiogenic shock or cardiac arrest. While femoral artery cannulation remains the most common arterial access, axillary artery cannulation has emerged as a valuable alternative in selected cases. Objective: This narrative review aims to synthesize current evidence and expert opinion on axillary artery cannulation in V-A ECMO, focusing on its technical feasibility, physiologic implications, and clinical outcomes. Methods: A comprehensive literature search was performed in PubMed and Scopus using relevant keywords related to ECMO, axillary artery, cannulation techniques, and outcomes. Emphasis was placed on prospective and retrospective clinical studies, expert consensus statements, and technical reports published over the past two decades. Results: Axillary cannulation provides antegrade aortic flow, potentially reducing the risk of differential hypoxia and improving upper body perfusion. However, the technique presents unique technical challenges and may carry risks such as hyperperfusion syndrome or arterial complications. Emerging data suggest favorable outcomes in selected patient populations when performed in experienced centers. Conclusions: Axillary cannulation represents a promising arterial access route in V-A ECMO, particularly in cases with contraindications to femoral cannulation or when upper-body perfusion is a concern. Further prospective studies are needed to better define patient selection criteria and long-term outcomes. Full article
(This article belongs to the Special Issue Cardiac Surgery: Clinical Advances)
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