Transseptal atriotomy provides better exposure to the mitral valve in challenging cases but has conflicting results with postoperative rhythm disturbances. We aimed to investigate long term results of limited transseptal atriotomy in cases with a small left atrium.

From January 2010 through February 2014, 1214 patients underwent mitral valve surgery at the SBÜ Kartal Kosuyolu High Specialization Training and Research Hospital. Left atrium diameter on 2-dimensional (2-D) echocardiography defined in 119 patients who had small left atrium and met the inclusion criteria were enrolled in the study, of which 57 patients (47.9%) underwent transseptal atriotomy (Group TS), while 62 patients (52.1%) underwent a left atriotomy (Group LA). Data was retrospectively collected. Long-term analyses were performed based on survival. The mean follow-up duration was 10.7 ± 4.2 years.

Isolated mitral procedures were performed in 49 patients (41.2%). Concomitant tricuspid valve surgery was performed in 42 patients (35.3%), concomitant aortic valve surgery in 24 patients (20.2%), and concomitant coronary artery bypass grafting in 15 patients (12.6%). The procedure rates were comparable in both Groups (p > 0.05). There was no significant difference in pre-operative variables. Ischemic time and total perfusion time were found to be similar in the Group TS vs. Group LA (87.6 ± 33.5 vs. 77.4 ± 27.8 minutes and 117.2 ± 38.4 vs. 112.3 ± 33.8 minutes respectively; p > 0.05). New-onset arrhythmia was higher in the Group TS but did not reach statistical significance (26.3% vs. 19.4%; p = 0.5). The rate of permanent pacemaker insertion was similar (5.3% vs. 4.8%; p = 0.9). Follow-up was completed in all cases and survival rate was 64.7% (64 ± 7% in Group TS vs. 58 ± 7% in Group LA; p > 0.05). Log rank analyses shows similar survivals (Group TS: 11.7 ± 0.6 years, 95% CI: 10.5–12.9; Group LA: 11.8 ± 0.6 years, 95% CI: 10.6–12.9; p > 0.05). In the multivariate Cox regression analysis, age, obesity, procedure type, and left ventricular dysfunction were found to be independent risk factors for late mortality. Regardless of tricuspid valve surgery, concomitant coronary artery bypass grafting (CABG) had worse survival compared to isolated mitral procedures and concomitant aortic valve replacement (AVR) (12.5 ± 0.5 years for mitral, 11.4 ± 1 years for concomitant AVR, and 8.2 ± 1.2 years for concomitant CABG; p < 0.01).

Limited transseptal atriotomy was not found to be inferior when compared to left atriotomy in cases with a small left atrium undergoing while mitral valve (MV) should be performed when the exposure is challenging.

Since the decision to proceed with valve re- placement remains controversial due to conflicting prog- nostic evidence, the use of normal-flow low-gradient aor- tic stenosis (NFLGAS) presents a clinical dilemma. Thus, this study aimed to evaluate the clinical utility of two- dimensional strain echocardiography (2D-STE) in distin- guishing therapeutic outcomes between transcatheter aortic valve implantation (TAVI) and conservative management in patients with NFLG AS.

This retrospective cross-sectional study analyzed 97 patients diagnosed with NFLG AS between October 2019 and June 2023. Patients were divided into two groups based on treatment strategy: 34 underwent TAVI, and 63 received conservative management. Clinical data were collected at baseline, discharge, and 6-month follow-up. Key echocardiographic parameters included left ventricular (LV) ejection fraction (LVEF), aortic valve area (AVA), relative wall thickness (RWT), obtained via transthoracic echocardiography (TTE), and LV global longitudinal strain (LVGLS) measured using 2D-STE. Multivariable linear regression models were used to adjust for potential confounding factors. Kaplan–Meier analysis was employed to compare 6-month cardiac event-related readmission rates between the two groups.

Preoperatively, the mean LVGLS was –14.2% ± 1.5%. In the TAVI group, LVGLS significantly improved to –16.7% ± 1.4% at discharge and further to –18.5% ± 1.3% at 6-month follow-up (p < 0.001). After adjusting for potential confounders, the improvement in LVGLS remained significant in the TAVI group (p < 0.001). In contrast, the conservative management group showed no significant changes in LVGLS across the same time points (–14.0% ± 1.8%, –14.2% ± 1.6%, and –14.7% ± 2.2%, respectively; p = 0.118). The TAVI group also exhibited a significantly lower 6-month cardiac event-related readmission rate compared to the conservative group (χ² = 4.53; p = 0.033; hazard ratio (HR) = 0.47, 95% confidence interval (CI): 0.24–0.94).

These preliminary findings suggest that TAVI may offer significant improvements in LVGLS and reduce short-term cardiac event-related readmissions in symptomatic NFLG AS patients. Nonetheless, further validation in larger, prospective studies is warranted to confirm these potential clinical benefits.

Coronary artery crossing (CACr) constitutes a rare but clinically relevant anomaly of intrinsic coronary arterial anatomy. Current literature on this subject comprises isolated case reports and one case series. The purpose of this report is to present all cases of CaCr that have been reported in the English literature, highlighting its clinical implications.

We present the case of a patient with intermittent chest discomfort associated with psychological stress and evidence of crossing between the left anterior descending (LAD) artery and the first diagonal artery (DgA) on invasive coronary angiography. Myocardial bridging was also noted in the mid LAD artery but not at the crossing point or any other crossing artery segments, and produced obstructive (≥50%) dynamic lumen compromise. The patient was discharged in good condition and was prescribed aspirin, a statin, and diltiazem.

This review included 24 records that represented 27 patients, including the one presented in this report. The anomaly has been predominantly diagnosed in male patients and the diagnosis has predominantly been made using computed tomography coronary angiography. The most frequent CACr pattern revealed in 12 patients (44%) was a crossing between the LAD and left circumflex arteries while the second most frequent CACr pattern revealed in six patients (22%) was a crossing between the LAD artery and a DgA. There were five cases (19%) with evidence of an intramyocardial course, either at the point of vessel crossover or beyond that point. The crossing coronary arteries themselves were found to have atherosclerotic lesions in three patients (11%). Even though CaCr has not been associated with any clinical repercussions, cardiologists and cardiac surgeons should bear knowledge of this anomaly not only for diagnostic purposes when performing coronary artery angiograms but also in order to properly select and execute a revascularization procedure. Furthermore, CaCr may be associated with clinically relevant, functional coronary artery abnormalities such as spasm affecting the segments of the arteries crossing over each other or having an intramyocardial course. Unique patterns of coronary blood flow and wall shear stress may also be created at the crossover area, potentially increasing the risk of developing atherosclerosis.

Prolonged mechanical ventilation (PMV) is a common and serious complication after heart valve surgery, associated with increased morbidity, mortality, and healthcare resource utilization. Although several predictive models exist, many are limited by population homogeneity or lack of intraoperative variables. This study aimed to develop and validate a practical predictive model for PMV risk stratification to facilitate early intervention and optimize resource allocation.

This was a retrospective study of adult patients who underwent elective heart valve surgery between January 2013 and January 2023. Patients from Center A were randomly assigned to a training cohort (n = 349) or an internal validation cohort (n = 149, with a 7:3 ratio). PMV was defined as mechanical ventilation lasting more than 48 hours postoperatively. Preoperative, intraoperative, and early postoperative variables were analyzed. Univariate and multivariate logistic regression analyses were used to identify independent predictors in the training cohort. A predictive nomogram was subsequently developed. Model performance was evaluated using discrimination (area under the receiver operating characteristic (AUROC) curve), calibration (calibration plots, Hosmer–Lemeshow test), and clinical utility (decision curve analysis (DCA) and clinical impact curve (CIC)).

Data were analyzed from 498 patients (training: n = 349; internal validation: n = 149). The incidence of PMV was 32.7% in the training cohort. Multivariate analysis identified six independent predictors: age (per 1-year increase), body mass index (per 1 kg/m² increase), chronic obstructive pulmonary disease severity (per 1-grade increase), forced expiratory volume in 1 s (per 1% increase), left ventricular ejection fraction (per 1% increase), and cardiopulmonary bypass time (per 10 minute increase). The nomogram demonstrated strong discrimination, with area under the curve (AUC) values of 0.847 (95% confidence interval (CI), 0.798–0.882) in training and 0.891 (95% CI, 0.858–0.927) in internal validation. Calibration was good across cohorts (Hosmer–Lemeshow p > 0.05). The DCA and CIC indicated that the model provided meaningful clinical benefit compared with treating all or no patients when the predicted probability threshold ranged from 40% to 100%.

PMV was associated with higher in-hospital mortality, increased healthcare resource utilization, and reduced long-term survival. The proposed predictive model may aid in optimizing perioperative management, thereby improving outcomes and reducing costs.

A minimally invasive surgical technique for aortic valve replacement using a custom surgical retractor specifically designed for transcervical approach to cardiothoracic surgery has previously been described. We hypothesized that the adjunct and integration of robotic technology may improve surgical dexterity and render the transcervical approach advantageous over lateral approaches for robotic aortic valve replacement (AVR). We therefore sought to evaluate its feasibility. This is a preclinical cadaveric feasibility study; no human outcomes are reported. Clinical validation will be addressed in future trials.

A dry lab was firstly set up in the robotic operating room (OR) to explore the concept, with chest phantom incorporating synthetic aortic root mounted atop the surgical table. The minimally invasive surgery was then repeated on five fresh frozen cadavers using an identical setup. The specially designed transcervical retractor system was mounted on the table for exposure. A da Vinci Xi robot was docked from the side and arms allocated for instrumentation or camerascope. Key steps of AVR were performed by console and bedside surgeons working in harmony. Objective procedural metrics were prospectively recorded for each cadaver, including pericardial opening time, aortotomy creation, leaflet excision, prosthesis delivery, inspection and deployment, and aortotomy closure. All times were measured from video timestamps by two independent observers.

Quantitative findings are summarised. A transient loss of visualisation occurred once when adipose tissue obscured the 30° scope; switching to a 0° lens resolved the issue. No difficulty was encountered passing the prosthesis through the uniportal access; however, in two cadavers mild resistance required momentary elevation of the sternum via the retractor ratchet. The cadaver provided a realistic representation of transcervical anatomy, surgical approach for detailing instrumentation and OR setup, similar to live surgery. Key steps of the aortic valve replacement procedure were successfully executed by console surgeon and bedside assistant working in harmony and integrating the use of the robot with the specially designed transcervical retractor system.

Advanced Videoscopic Aortic surgery, Transcervical Approach, Robot assisted (AVATAR) AVR looks feasible. Key steps were easily performed with the robot when used in cooperation with the robot enabling retraction system.

Minimally invasive cardiac surgery (MICS) offers several advantages that can be particularly beneficial for older patients. However, nothing is currently known about the impact of MICS on myocardial protection. Thus, this study aimed to compare myocardial protection in valve surgery between patients who received MICS and those who underwent conventional open cardiac surgery (OPEN).

We retrospectively included all adult patients (≥18 years) who received elective or urgent valve surgery in our department. We compared the peak value and area under the curve (AUC) of the high-sensitive troponin T (TnT) and creatine kinase muscle-brain type (CK-MB) concentrations during the first, second, and third 24 h period and the cumulative catecholamine dosages of adrenaline, noradrenaline, and enoximone at 72 h after removal of the aortic cross-clamp in patients who received valve replacement or reconstruction for MICS versus OPEN.

The peak TnT release in the first (p = 0.025) and second 24 h interval (p = 0.046), as well as the TnT AUC in the first 24 h (p = 0.024), were lower in the MICS group with reconstruction. The peak CK-MB release was relevantly lower in the first (p = 0.093) and third 24 h period (p = 0.067), as well as the CK-MB AUC between 48 and 72 h (p = 0.055). However, the peak release and AUC for TnT and CK-MB did not differ between MICS and OPEN in the replacement population. The noradrenaline dosage was lower (p = 0.023) for MICS in the replacement population. In the reconstruction population, the dosage of adrenaline (p = 0.036), noradrenaline (p = 0.043), and enoximone (p = 0.012) was lower in the MICS group than in the OPEN group.

In addition to known factors of myocardial protection, such as ischemia time and cardioplegia, MICS seems to promote improved myocardial protection during valve reconstruction, while the postoperative catecholamine requirement is reduced after valve reconstruction and replacement. These additional benefits of MICS might be especially advantageous for old and frail patients undergoing cardiac surgery.