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Medicina
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Recent Progress in Cardiac Surgery
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Recent Progress in Cardiac Surgery

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 November 2026 | Viewed by 4112

Special Issue Editors

Prof. Dr. Giuseppe Nasso

E-Mail Website
Guest Editor
Department of Cardiac Surgery, Santa Maria Hospital—GVM Care & Research, 70124 Bari, Italy
Interests: mitral valve; TAVI; aortic valve; coronary artery bypass; minimally invasive cardiac surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Walter Vignaroli

E-Mail Website
Guest Editor Assistant
Department of Cardiac Surgery, San Carlo di Nancy, GVM Care & Research, 00137 Rome, Italy
Interests: mitral valve; TAVI; aortic valve; coronary artery bypass; ascending aorta; valve sparing; ventricular assist device; robotic cardiac surgery; minimally invasive cardiac surgery

Special Issue Information

Dear Colleagues,

Cardiac surgery has witnessed remarkable transformation over the past decades, evolving from conventional open-heart procedures to minimally invasive and robot-assisted techniques. These advances have been driven by technological innovation, improved prosthetic materials, and a deeper understanding of cardiovascular pathophysiology. This Special Issue aims to highlight the forefront of cardiac surgical innovation, showcasing breakthroughs that are reshaping clinical practice and enhancing patient outcomes. We particularly welcome original research and clinical studies presenting novel surgical techniques, robotic and minimally invasive approaches, perioperative management strategies, and advancements in cardiac device engineering. Contributions that integrate clinical expertise, technological innovation, and translational insights are highly encouraged. By bringing together cutting-edge research and practical experience, this issue seeks to serve as a comprehensive resource for surgeons, cardiologists, and researchers dedicated to advancing the field of cardiac surgery and defining its future directions. 

Prof. Dr. Giuseppe Nasso
Guest Editor

Dr. Walter Vignaroli
Guest Editor Assistant

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. Medicina is an international peer-reviewed open access monthly 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 2200 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

  • mitral valve
  • TAVI
  • aortic valve
  • coronary artery bypass
  • ascending aorta
  • valve sparing
  • innovation in cardiac surgery
  • ventricular assist device
  • ECMO
  • cardiac support

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Published Papers (4 papers)

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Review

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17 pages, 814 KB  
Review
Silent Stroke in Adult Cardiac Surgery: Mechanisms, Clinical Impact, and Preventive Strategies
by Ignazio Condello, Michele Dell’Aquila, Salvatore Condello, Giorgia Falco, Antonio Totaro, Youssef El Dsouki, Sotirios Prapas, Konstantinos Katsavrias, Augusto D’Onofrio, Joshua Newman, Nirav Patel, Robert Kalimi, Mario Gaudino and Antonio Maria Calafiore
Medicina 2026, 62(4), 675; https://doi.org/10.3390/medicina62040675 - 1 Apr 2026
Viewed by 706
Abstract
Background and Objectives: Overt perioperative stroke remains a feared complication of adult cardiac surgery. Diffusion-weighted magnetic resonance imaging (DWI-MRI) has revealed a more prevalent form of cerebral injury, termed silent stroke or silent brain injury (SBI). Covert ischemic lesions occur without focal [...] Read more.
Background and Objectives: Overt perioperative stroke remains a feared complication of adult cardiac surgery. Diffusion-weighted magnetic resonance imaging (DWI-MRI) has revealed a more prevalent form of cerebral injury, termed silent stroke or silent brain injury (SBI). Covert ischemic lesions occur without focal neurological deficits but are increasingly associated with postoperative delirium, cognitive decline, and elevated long-term cerebrovascular risk. Despite growing recognition, the true burden, mechanisms, and clinical relevance of SBI remain incompletely integrated into perioperative practice. Materials and Methods: We performed a narrative review of the literature published between January 2000 and December 2025, identified through PubMed/MEDLINE and Scopus. Eligible studies included prospective and retrospective cohorts, randomized trials, systematic reviews, and meta-analyses involving adult patients undergoing coronary artery bypass grafting, valve surgery, or minimally invasive cardiac procedures, with or without cardiopulmonary bypass, and reporting MRI-detected ischemic lesions or validated surrogate markers of cerebral injury. Pediatric studies, transcatheter interventions, case reports, and non-English publications were excluded. Sixty studies met the inclusion criteria. Results: Silent stroke occurred more frequently than clinically apparent stroke, with new DWI-MRI lesions detected in approximately 20–60% of patients following cardiac surgery. Lesions were typically small, multifocal, and embolic in distribution, predominantly affecting cortical and watershed regions. Cardiopulmonary bypass-related factors, including aortic manipulation, cerebral microembolization, hemodilution, hypoperfusion, and impaired oxygen delivery, emerged as key contributors. Several studies demonstrated associations between SBI burden and postoperative delirium, early cognitive dysfunction, and functional decline. Perfusion-based neuroprotective strategies showed mechanistic benefit, although no single intervention conclusively prevented SBI. Conclusions: Silent stroke represents the most frequent form of neurological injury in adult cardiac surgery. Evidence suggests that these covert lesions reflect clinically meaningful cerebral injury, with potential short- and long-term consequences. Recognition of silent stroke as a relevant neurological endpoint supports a shift toward multimodal, perfusion-driven neuroprotective strategies and the routine incorporation of MRI-based outcomes in future cardiac surgical research. Full article
(This article belongs to the Special Issue Recent Progress in Cardiac Surgery)
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26 pages, 925 KB  
Review
Atrial Secondary Mitral Regurgitation: Pathophysiology, Diagnosis, and Surgical Implications
by Damiano Venturiello, Giuseppe Campolongo, Emiliano Marco Navarra and Giuseppe Speziale
Medicina 2026, 62(3), 520; https://doi.org/10.3390/medicina62030520 - 11 Mar 2026
Viewed by 1155
Abstract
Background and Objectives: Atrial secondary mitral regurgitation (A-SMR), also referred to as atrial functional mitral regurgitation, has emerged as a distinct clinical phenotype characterized by left atrial enlargement, mitral annular dilatation, and preserved left ventricular geometry and systolic function. Frequently associated with long-standing [...] Read more.
Background and Objectives: Atrial secondary mitral regurgitation (A-SMR), also referred to as atrial functional mitral regurgitation, has emerged as a distinct clinical phenotype characterized by left atrial enlargement, mitral annular dilatation, and preserved left ventricular geometry and systolic function. Frequently associated with long-standing atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), A-SMR challenges the traditional ventricular-centered classification of functional mitral regurgitation (MR) and is increasingly recognized as a clinically relevant condition. Materials and Methods: This narrative review provides an updated and critical overview of current evidence on A-SMR. We summarize available data on pathophysiology, diagnostic imaging, natural history, and therapeutic strategies, with particular emphasis on implications for cardiac surgery and clinical decision-making. Evidence was derived from observational studies, registry analyses, interventional reports, and contemporary guideline documents. Results: A-SMR is primarily driven by atrial remodeling and annular dilatation, with minimal contribution from ventricular distortion or leaflet tethering. Echocardiography and Magnetic Resonance Imaging (MRI) play a central role in diagnosis and phenotypic characterization, allowing differentiation from ventricular functional MR and identification of distinct A-SMR subtypes with potential therapeutic implications. A-SMR is a progressive condition associated with worsening symptoms and adverse clinical outcomes. Rhythm control strategies may reduce MR severity in selected patients by promoting atrial reverse remodeling. Transcatheter edge-to-edge repair (TEER) represents a treatment option for selected high-risk patients, although concerns regarding long-term durability remain in this predominantly annular disease. From a pathophysiological standpoint, surgical mitral valve repair based on annuloplasty directly targets the dominant mechanism of A-SMR and has been associated with favorable outcomes in appropriately selected patients. Conclusions: A-SMR is a distinct and increasingly recognized form of functional MR requiring a mechanism-oriented diagnostic and therapeutic approach. The 2025 ESC/EACTS Guidelines for the management of valvular heart disease have acknowledged A-SMR as a specific clinical phenotype, although dedicated phenotype-specific management recommendations remain limited. Surgical mitral valve repair, particularly when combined with AF ablation, represents a rational treatment strategy in selected patients and may improve long-term outcomes. Full article
(This article belongs to the Special Issue Recent Progress in Cardiac Surgery)
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17 pages, 343 KB  
Review
Mini- and Micro-Invasive Approaches in Cardiac Surgery: Current Techniques, Outcomes, and Future Perspectives
by Walter Vignaroli, Barbara Pala, Giuseppe Nasso, Stefano Sechi, Giuseppe Campolongo, Giuseppe Speziale and Emiliano Marco Navarra
Medicina 2026, 62(1), 102; https://doi.org/10.3390/medicina62010102 - 2 Jan 2026
Cited by 1 | Viewed by 1486
Abstract
Over the past three decades, cardiac surgery has undergone a deep transformation, shifting from full median sternotomy to minimally invasive (MICS) and micro-invasive techniques. These approaches aim to achieve equivalent therapeutic outcomes while reducing surgical trauma, postoperative pain, hospitalization time, and healthcare costs. [...] Read more.
Over the past three decades, cardiac surgery has undergone a deep transformation, shifting from full median sternotomy to minimally invasive (MICS) and micro-invasive techniques. These approaches aim to achieve equivalent therapeutic outcomes while reducing surgical trauma, postoperative pain, hospitalization time, and healthcare costs. Minimally invasive strategies are now widely applied to aortic and mitral valve surgery, coronary artery bypass grafting, atrial fibrillation ablation, and combined procedures. Key advancements such as sutureless prostheses, video- and robotic-assisted systems, and enhanced imaging technologies have improved surgical precision and clinical outcomes while promoting faster recovery and superior cosmetic results. Evidence from randomized trials and observational studies demonstrates that MICS provides mortality and morbidity rates comparable to conventional surgery, with additional benefits in high-risk, elderly, and frail patients. Micro-invasive transcatheter interventions, particularly transcatheter aortic valve implantation (TAVI) and transcatheter mitral repair or replacement, have further expanded therapeutic options for patients unsuitable for open-heart surgery. Their success has fostered debate not between conventional and minimally invasive surgery, but between minimally invasive and micro-invasive approaches. Hybrid procedures—combining surgical and percutaneous techniques—exemplify a multidisciplinary evolution aimed at tailoring treatment to patient-specific anatomy, comorbidities, and risk profiles. Despite clear advantages, these techniques present challenges, including a steep learning curve, increased procedural costs, and the requirement for specialized equipment and institutional expertise. Optimal patient selection based on clinical risk assessment and advanced imaging remains essential. Future directions include refinement of robotic platforms, artificial intelligence-based decision support, miniaturization of instruments, and broader validation of emerging technologies in younger and low-risk populations. Minimally and micro-invasive cardiac surgery represent a paradigm shift toward patient-centered care, offering reduced physiological burden, improved functional recovery, and long-term outcomes comparable to conventional techniques. As innovation continues, these approaches are poised to become integral to modern cardiac surgical practice. Full article
(This article belongs to the Special Issue Recent Progress in Cardiac Surgery)

Other

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22 pages, 1237 KB  
Systematic Review
Valve-in-Valve TAVR in Surgical Stentless Aortic Bioprostheses, a Challenging Scenario
by Sara Saltarocchi, Mizar D’Abramo, Emmanouela Chourda, Paolo De Orchi, Flaminia Spunticchia, Marco Totaro, Mattia Vinciguerra, Silvia Romiti, Gabriele Giunti, Ernesto Greco and Fabio Miraldi
Medicina 2026, 62(5), 844; https://doi.org/10.3390/medicina62050844 - 28 Apr 2026
Viewed by 324
Abstract
Background and objectives: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an established treatment for failed surgical bioprostheses in patients at high surgical risk. However, procedures performed in degenerated stentless aortic valves remain particularly challenging because of the absence of a [...] Read more.
Background and objectives: Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an established treatment for failed surgical bioprostheses in patients at high surgical risk. However, procedures performed in degenerated stentless aortic valves remain particularly challenging because of the absence of a radiopaque frame, variable surgical implantation techniques, and a potentially increased risk of coronary obstruction. Evidence in this specific setting is limited. We conducted a systematic review of the literature to identify studies reporting ViV TAVI in degenerated stentless surgical bioprostheses. Materials and methods: Case reports and case series were included when patient-level or clearly identifiable data were available. Baseline characteristics, anatomical features, procedural strategies, and clinical outcomes were extracted and analyzed using a descriptive approach. A total of 54 studies were included, encompassing 294 ViV TAVI procedures performed in failed stentless aortic valves. Results: The mean patient age was 73.9 years, and the average STS-PROM score was 13.45%, reflecting a high-risk population. The most frequently treated prosthesis was the Medtronic Freestyle valve, and the predominant mechanism of failure was regurgitation. Transfemoral access represented the most common approach, while balloon-expandable and self-expanding transcatheter valves were used with similar frequency. Coronary protection strategies were adopted in a minority of procedures, whereas adjunctive procedural techniques such as pre- or post-dilation were relatively common. Device-related complications were mainly driven by coronary obstruction, while cardiac complications included myocardial infarction and unplanned coronary intervention. Overall, VARC-3 device success was achieved in the majority of procedures, with acceptable short-term mortality despite the complexity of the treated population. Conclusions: ViV TAVR in degenerated stentless bioprostheses appears feasible and generally effective but remains associated with specific procedural challenges, particularly related to coronary obstruction risk. Careful anatomical assessment and tailored procedural planning are essential, and larger contemporary studies are needed to better define optimal management strategies in this complex setting. Full article
(This article belongs to the Special Issue Recent Progress in Cardiac Surgery)
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