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Cardiac Surgery: Clinical Advances

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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

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13 pages, 553 KiB

Open AccessArticle

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 159

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 “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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