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Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations
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Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations

A Special Issue of Journal of Clinical Medicine (ISSN 2077-0383) belonging to the section "Cardiology".

Deadline for manuscript submissions: 20 April 2027 | Viewed by 2680

Editors

Dr. Marius-Mihai Harpa

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Guest Editor
1. Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
2. Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
Interests: mitral repair; endoscopic cardiac surgery; minimally invasive heart surgery; MIDCAB; MICLATS; TCRAT; mini-AVR
Prof. Dr. Horatiu Suciu

E-Mail
Guest Editor
1. Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
2. Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania
Interests: LVAD; heart transplant; congenital heart disease; mini-AVR
Dr. Emil Marian Arbanasi

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Guest Editor
Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
Interests: aortic aneurysm; acute limb ischemia; pseudoaneurysm; vascular tissue; vascular reconstruction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the past three decades, cardiac surgery has witnessed a dynamic and profound transformation, marked by the continuous refinement of techniques aiming to reduce operative trauma without compromising surgical efficacy. Minimally invasive strategies, once regarded as experimental adjuncts, have evolved into established pillars of modern cardiovascular therapy. Pioneering efforts in limited-access cardiac interventions, alongside advances in imaging, instrumentation, and robotic assistance, have redefined surgical standards, ushering in a new era of precision, safety, and patient-centered care. The historical trajectory of this evolution highlights an unwavering commitment to innovation, interdisciplinary collaboration, and enhanced postoperative outcomes.

This Special Issue, entitled "Advances in Cardiac Surgery: Techniques, Outcomes, and Innovation", seeks to curate a collection of high-impact manuscripts that advance our current understanding and clinical application of minimally invasive cardiac interventions, as well as innovations in classical cardiac surgery. The scope of this Special Issue includes, but is not limited to, the following topics:

  • Novel surgical techniques and protocols for valve repair and replacement, coronary artery bypass grafting, and congenital cardiac anomalies;
  • Robotic, hybrid, and endovascular approaches that bridge the gap between surgical and percutaneous therapies;
  • Innovations in intra- or perioperative imaging, 3D modeling, artificial intelligence applications, and enhanced recovery protocols;
  • Anesthetic and perioperative strategies tailored to the needs of minimally invasive cardiac procedures;
  • The novel techniques employed in cardiac surgery.

Through this Special Issue, we aim to stimulate scholarly exchange, promote interdisciplinary innovation, and chart new directions in the field of cardiac surgery.

Dr. Marius-Mihai Harpa
Prof. Dr. Horatiu Suciu
Dr. Emil Marian Arbanasi
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-anonymized 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

  • endoscopic cardiac surgery
  • minimally invasive cardiac surgery
  • MIMS
  • mini-AVR
  • MIDCAB
  • TCRAT
  • LVAD
  • heart transplant
  • congenital heart disease

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Published Papers (5 papers)

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Research

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16 pages, 15045 KB  
Article
Feasibility, Technical Safety, and Early Clinical Experience with an Automated Annular Suturing Device in Minimally Invasive Valve Replacement
by Robert Balan, Parwis Massoudy, Marius Mihai Harpa, Klara Brînzaniuc and Jonah Schwarz
J. Clin. Med. 2026, 15(17), 6870; https://doi.org/10.3390/jcm15176870 - 4 Sep 2026
Viewed by 202
Abstract
Background: Minimally invasive cardiac valve surgery (MIVS) provides distinct clinical advantages, yet annular suturing remains a technically demanding step. Automated annular suturing devices (RAM®) have been developed to standardize suture placement during valve replacement. This study evaluates the initial clinical feasibility, [...] Read more.
Background: Minimally invasive cardiac valve surgery (MIVS) provides distinct clinical advantages, yet annular suturing remains a technically demanding step. Automated annular suturing devices (RAM®) have been developed to standardize suture placement during valve replacement. This study evaluates the initial clinical feasibility, technical safety, and operational integration of automated suturing during its institutional adoption phase. Methods: We retrospectively evaluated 43 consecutive patients undergoing MIVS supported by the RAM® system (2021–2025), stratified into mitral valve replacements (RAM-MVR, n = 26) and aortic valve replacements (RAM-AVR, n = 17). Technical parameters, procedural safety metrics, and perioperative outcomes were descriptively analyzed and contextualized against our broader institutional MIVS platform using percutaneous femoral cannulation (n = 182). Results: Automated annular suturing achieved a 100% technical feasibility rate (43/43, 95% CI: 91.8–100.0%) with zero mechanical device failures or intraoperative suture-line disruptions (0%, 95% CI: 0.0–8.2%). In the RAM-MVR cohort, median cross-clamp and cardiopulmonary bypass (CPB) times were 73.0 min (IQR 64.0–91.0) and 114.5 min (IQR 94.8–129.5), respectively. In RAM-AVR, median cross-clamp time was 75.0 min (IQR 71.0–83.0). Thirty-day mortality was 4.7% (2/43, 95% CI: 0.6–15.8%), secondary to non-device-related medical complications in high-risk baseline patients. Postoperative echocardiography demonstrated no paravalvular regurgitation (0%, 95% CI: 0.0–8.2%). Conclusions: Initial institutional experience demonstrates that automated annular suturing is technically feasible and safe in minimally invasive mitral and aortic valve replacement. The system enables consistent procedural execution across valve positions. These observational data support automated suturing as a feasible alternative to manual suturing in MIVS workflows. Full article
(This article belongs to the Special Issue Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations)
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22 pages, 1835 KB  
Article
Long-Term Effects of Right Ventricular Pressure and Volume Overload: A Comparative Analysis in an Ovine Model
by Hamida Al Hussein, Hussam Al Hussein, Simina-Elena Ghiragosian-Rusu, Simona Gurzu, Rita Szodorai, Carmen Sircuta, Marius Stefan Marusteri, Bogdan Cordos, David Emanuel Anitei, Andrei Atudorei, Sergiu Crisan, Dan Simionescu and Klara Brinzaniuc
J. Clin. Med. 2026, 15(17), 6836; https://doi.org/10.3390/jcm15176836 - 3 Sep 2026
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Abstract
Background/Objectives: Pressure overload (PO) and volume overload (VO) represent important mechanisms underlying right ventricular (RV) failure; however, long-term comparative data regarding their distinct pathophysiological consequences remain limited. This study aimed to compare the long-term effects of PO versus VO in a large [...] Read more.
Background/Objectives: Pressure overload (PO) and volume overload (VO) represent important mechanisms underlying right ventricular (RV) failure; however, long-term comparative data regarding their distinct pathophysiological consequences remain limited. This study aimed to compare the long-term effects of PO versus VO in a large animal model. Methods: Juvenile sheep were randomly assigned to either a PO group (n = 7) or a VO group (n = 8). PO was induced by pulmonary artery banding, whereas VO was induced by pulmonary leaflet perforation (n = 4) or transannular patch (TAP) reconstruction (n = 4). Both VO procedures resulted in moderate-to-severe pulmonary regurgitation with comparable acute hemodynamic profiles and were therefore analyzed as a single VO group for the long-term assessment. Six animals from each group completed the follow-up period. Animals were evaluated preoperatively and at one-year follow-up using invasive hemodynamic monitoring, blood gas analysis, and echocardiography, followed by postmortem histological analysis of the myocardium. Results: Both models resulted in significant reductions in stroke volume index, cardiac index, RV stroke work index, ScvO2 and tricuspid annular plane systolic excursion (TAPSE). Similarly, the TAPSE/RV systolic pressure (RVSP) ratio decreased in both groups but was significantly lower in the PO group than in the VO group (p = 0.0022). Moreover, PO showed more pronounced RV diastolic dysfunction, characterized by a significant increase in right atrial pressure from baseline (p = 0.0313) and higher RV diastolic pressure compared to VO (p = 0.0065). In contrast, VO showed a greater impact on left ventricular (LV) geometry and diastolic filling, evidenced by reduced transmitral filling (p = 0.0313) and a lower indexed LV internal diameter compared to PO (p = 0.0411). Histological analysis revealed myocardial hypertrophy and fibrosis in both groups, as well as clusters of multinucleated cardiomyocyte-like cells showing preferential ventricular distribution according to overload physiology. Conclusions: Chronic PO and VO induced distinct phenotypes of RV dysfunction with differential ventricular adaptation and remodelling patterns. Full article
(This article belongs to the Special Issue Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations)
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Review

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28 pages, 1313 KB  
Review
Post-Heart Transplant Changes and Perceived Donor-Recipient Correspondences: A Scoping Review
by Daniela Nigrelli, Marika Lo Monaco, Mariachiara Figura, Maria Rita Giammarinaro, Irene Zerilli, Israr Ahmad, Laura Iacorossi, Roberto Latina and Giuliano Anastasi
J. Clin. Med. 2026, 15(17), 6584; https://doi.org/10.3390/jcm15176584 - 26 Aug 2026
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Abstract
Background/Objectives: Heart transplantation is a life-saving treatment for advanced cardiac disease, but post-transplant adaptation may involve psychosocial, identity-related, and existential change. Some recipients interpret these changes as corresponding to donor characteristics, although the nature and evidence base of these reports remain unclear. [...] Read more.
Background/Objectives: Heart transplantation is a life-saving treatment for advanced cardiac disease, but post-transplant adaptation may involve psychosocial, identity-related, and existential change. Some recipients interpret these changes as corresponding to donor characteristics, although the nature and evidence base of these reports remain unclear. This review mapped post-transplant changes reported by adult heart transplant recipients, perceived donor–recipient correspondences, and the explanatory frameworks proposed for these phenomena. Methods: A scoping review was conducted following the Arksey and O’Malley framework, Joanna Briggs Institute guidance, and PRISMA-ScR reporting standards. PubMed, Web of Science, Scopus, CINAHL, and PsychINFO were searched in August 2026. Quantitative, qualitative, mixed-methods, conceptual, opinion, and review articles were eligible. Findings were synthesized descriptively. Results: Sixteen sources published between 1992 and 2025 were included. Empirical studies reported changes in preferences, emotional and personality-related experiences, social and physical functioning, sexuality, identity and embodiment, sensory and memory-like experiences, and spirituality. Some changes were attributed by recipients to donor characteristics, whereas correspondences supported by independently obtained donor information were reported in a limited subset of studies. Proposed explanations ranged from psychological, pharmacological, physiological, and sociocultural processes to cellular, molecular, neurocardiac, energetic, and transpersonal hypotheses. Donor-transfer hypotheses were developed in the secondary literature and were not empirically established. Methodological quality varied substantially across sources. Conclusions: Post-transplant changes and perceived donor–recipient correspondences are meaningful phenomena, but current evidence does not support the transfer of donor memory, personality, or identity through the transplanted heart. Future prospective, longitudinal, and methodologically rigorous studies should distinguish reported experience, donor attribution, and proposed explanations. Full article
(This article belongs to the Special Issue Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations)
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31 pages, 1509 KB  
Review
The Next Frontiers in Stroke Prevention: Optimizing Left Atrial Appendage Closure in Atrial Fibrillation: Current Devices, Imaging-Guided Strategies, and Emerging Approaches
by Zain Al-Abdeen Mohammed Qassim, Mohamedanas Mohamedfaruk Patni, Biji Thomas George, Subhranshu Sekhar Kar, Rajani Dube, Reema Mohammed Saeed Al Shaibani, Ghina Hasan Yassin, Yara Mamoun Theyabat, Ibrahim Alabid and Malak Mohammed Qassim
J. Clin. Med. 2026, 15(17), 6526; https://doi.org/10.3390/jcm15176526 - 24 Aug 2026
Viewed by 385
Abstract
Background/Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with ischemic stroke, systemic thromboembolism, heart failure, and mortality. Although oral anticoagulation (OAC) remains the cornerstone of stroke prevention, long-term therapy may be limited by bleeding risk, contraindications, [...] Read more.
Background/Objectives: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with ischemic stroke, systemic thromboembolism, heart failure, and mortality. Although oral anticoagulation (OAC) remains the cornerstone of stroke prevention, long-term therapy may be limited by bleeding risk, contraindications, intolerance, nonadherence, or thromboembolic events despite treatment. Left atrial appendage closure (LAAC) has therefore emerged as a non-pharmacological alternative for selected patients with nonvalvular AF. This review aimed to synthesize current evidence on LAAC, focusing on comparative efficacy versus OAC, device evolution, imaging-guided strategies, antithrombotic management, procedural optimization, unresolved challenges, and emerging technologies. Methods: This state-of-the-art narrative review was informed by targeted, non-systematic searches of PubMed and Scopus for publications from January 2009 to June 2026. Evidence was selected purposively to represent clinically relevant guidelines, randomized trials, registries, comparative observational studies, systematic reviews, meta-analyses, imaging studies, device-comparison studies, and reports of emerging technologies. The selected evidence was synthesized narratively; no exhaustive screening process, PRISMA flow diagram, formal risk-of-bias assessment, or quantitative synthesis was performed. Results: Randomized evidence was context dependent. OPTION supported LAAC as an alternative to oral anticoagulation in selected anticoagulation-eligible patients undergoing atrial fibrillation ablation. CHAMPION-AF established noninferiority of Watchman FLX to non–vitamin K antagonist oral anticoagulants for its composite efficacy endpoint in a predominantly moderate-risk, anticoagulation-eligible population and demonstrated less non-procedural bleeding, although ischemic stroke occurred numerically more often after LAAC. In contrast, CLOSURE-AF did not establish noninferiority of LAAC to physician-directed medical therapy in an older population at high risks of both stroke and bleeding. These findings indicate that the comparative value of LAAC depends strongly on patient selection, comparator therapy, endpoint composition, procedural risk, and trial design. Observational, registry, and emerging evidence was considered supportive or hypothesis-generating rather than equivalent to randomized evidence. OPTION enrolled only patients undergoing or recently undergoing AF ablation who were suitable for anticoagulation. CHAMPION-AF included 3000 anticoagulation-eligible patients but had relatively low baseline bleeding risk, while CLOSURE-AF studied 912 substantially older, higher-risk patients and did not meet its noninferiority criterion. Conclusions: LAAC has evolved into a precision-guided intervention integrating patient risk, left atrial appendage anatomy, device choice, imaging, antithrombotic therapy, and structured surveillance. Further studies are needed to optimize patient selection, standardize post-procedural therapy, and clarify its long-term role compared with contemporary direct oral anticoagulant therapy. Full article
(This article belongs to the Special Issue Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations)
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Other

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13 pages, 2748 KB  
Case Report
Restoring Ventricular Geometry: Left Ventricular Reconstruction in a Patient with a Giant Left Ventricular Aneurysm and End-Stage Heart Failure
by Moldovan Horatiu, Dobra Irina, Robu Mircea, Safta Maria Sabina, Andrada Guta, Voicu Alexandra, Gabriel Goretzki, Lucian Dorobantu, Menicanti Lorenzo and Ondin Zaharia
J. Clin. Med. 2026, 15(15), 5937; https://doi.org/10.3390/jcm15155937 - 30 Jul 2026
Viewed by 366
Abstract
Post-infarction left ventricular aneurysm is an uncommon but severe mechanical complication of transmural myocardial infarction, particularly in patients with delayed presentation or incomplete myocardial salvage. It may lead to profound distortion of left ventricular geometry, adverse remodelling, intraventricular thrombosis, mitral regurgitation, pulmonary hypertension, [...] Read more.
Post-infarction left ventricular aneurysm is an uncommon but severe mechanical complication of transmural myocardial infarction, particularly in patients with delayed presentation or incomplete myocardial salvage. It may lead to profound distortion of left ventricular geometry, adverse remodelling, intraventricular thrombosis, mitral regurgitation, pulmonary hypertension, and advanced heart failure. We report the case of a 65-year-old male patient referred two months after a late-presenting anterior ST-segment elevation myocardial infarction caused by proximal occlusion of the left anterior descending coronary artery. At admission, the patient presented with severe decompensated heart failure, low-output status, multiorgan dysfunction, and a left ventricular ejection fraction of 12%. Transthoracic echocardiography and cardiac magnetic resonance imaging demonstrated a giant apical left ventricular aneurysm involving approximately 75% of the ventricular cavity, partial intraluminal thrombosis, extensive transmural scarring in the left anterior descending territory, and imaging features suggestive of a chronic contained free-wall rupture/pseudoaneurysmal component. Following multidisciplinary evaluation, the patient underwent surgical ventricular reconstruction using an endoventricular circular restoration technique guided by an intraventricular balloon sizer, combined with left internal thoracic artery bypass grafting to the left anterior descending artery. The early postoperative course required temporary inotropic, vasopressor, inhaled nitric oxide, and intra-aortic balloon pump support, followed by progressive haemodynamic recovery. The patient was discharged on postoperative day seven with functional improvement to NYHA class II. At six-month follow-up, he remained clinically stable without overt signs of heart failure, and echocardiography showed preserved ventricular geometry and improvement of left ventricular ejection fraction to 45%. This case highlights the potential role of carefully planned, balloon-guided surgical ventricular reconstruction in selected patients with giant post-infarction left ventricular aneurysms and end-stage heart failure when residual viable myocardium is present. Full article
(This article belongs to the Special Issue Advances in Cardiac Surgery: Techniques, Outcomes, and Innovations)
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