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We report our initial cases of robotic left atrial appendage occlusion (LAAO) device deployment. From June 2021 to December 2024, all consecutive patients undergoing robotic-assisted LAAO (isolated or with robotic-assisted CABG) using an epicardial clip were enroled. The study protocol was approved by the Institutional Review Board (IRB 45CFR164.512). A total of 28 patients were included, 22 of which underwent a concomitant CABG. Transesophageal echocardiogram confirmed excellent exclusion of the LA appendage in all but one patient. There were no postoperative strokes, myocardial infarctions, reoperation for bleeding, unplanned revascularisation, or deaths. At a median of 1.4 [0.9-1.8] years, there was 1 non-cardiac mortality (cancer) and 1 stroke. Nine (32.1%) patients were off OAC, while 21 (75.0%) were off class I-III antiarrhythmic drugs. These early results show optimal stroke prevention outcomes, considering the high-risk level of the patients. Longer follow-up is warranted to confirm these outcomes.

Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder characterized by a dynamic left ventricular outflow tract (LVOT) obstruction and an increased risk of sudden cardiac death. For patients with symptoms refractory to medical management, or intolerant to the new selective myosin inhibitor, septal reduction therapy (SRT) with surgical septal myectomy (SM) is indicated. This narrative review provides a contemporary assessment of septal myectomy, integrating its historical development, technical advancements, and comparative long-term outcomes. SM is established as the current reference standard, offering extensive anatomical relief and favorable long-term survival in clinical registries. It consistently achieves residual LVOT gradients <10 mmHg and enables correction of complex accessory mitral pathologies, leading to significant reverse ventricular and atrial remodeling. In contrast, ASA, a less invasive alternative for high-risk surgical candidates, is limited by incomplete tissue necrosis. This results in higher residual gradients (15-20 mmHg), increased rates of re-intervention (10-20%) and incidence of permanent pacemaker implantation (10-17.4%) and an associated greater risk of long-term all-cause mortality (>5 years). The disparity in long-term survival and the risk associated with sequential septal reduction procedures underscore the critical need for precise patient selection guided by institutional expertise. Furthermore, advancements like virtual surgical myectomy and transapical beating-heart septal myectomy are expanding the scope of intervention. This review synthesizes comparative contemporary data on HOCM management, highlighting the need for prospective, multicenter studies to address enduring knowledge gaps concerning equitable access, genotype integration, and long-term comparative effectiveness as current evidence remains dominated by retrospective studies.

Background: International guidelines recommend tight blood pressure (BP) control in patients with thoracic aortic aneurysm (TAA). Hypertension in TAA patients has been associated with an increased rate of aneurysm growth and also with aortic dissection or aortic rupture. We aimed to study BP control in TAA patients referred by a primary or cardiology provider to a tertiary aortic management program. Methods: This retrospective study analyzed 3525 consecutive patients with confirmed TAA diagnosis referred by a primary-care or cardiology provider for management at the Lankenau Aortic Surgical Program between January 2021 and December 2024. Blood pressure was registered using an appropriately sized cuff and a calibrated automated sphygmomanometer. Clinical and demographic data were compared between patients with different stages of hypertension, based on the 2023 ESH guidelines. Results: The overall rate of above-target BP in TAA patients was 54.2% (1911/3525). From the hypertension group, Stage 1 (BP > 140/90) accounted for 53.4% (1020/1911) of patients, with Stage 2 (BP > 160/100) accounting for 12.6% (241/1911) and Stage 3 (BP > 180/110) for 1.8% (35/1911). Among associations of hypertension with demographic data by zip code, no significant differences were observed between groups with respect to race, median household income, or house value. There was a tendency of lower BP in patients from residential areas with higher rates of college graduates compared to those without college education (OR: 0.995; p = 0.059). Conclusions: Hypertension remains both highly prevalent and inadequately controlled in patients with TAA, even within specialized care environments. These findings emphasize the need for a more comprehensive approach to risk factor management to improve outcomes in this high-risk population.

We reviewed the available literature on patients undergoing aortic repair for acute type A aortic dissection (ATAAD) with either aortic root preservation (RP) or root replacement (RR). Original research studies that evaluated the long-term outcomes of the RP versus RR group were identified from 2000 to 2025. Median overall survival (OS) was the primary endpoint. Reoperation-free OS was the secondary endpoint. Sensitivity analyses were performed including risk-adjusted populations, subgroups, and using the leave-one-out method. Seventeen studies were included in the qualitative and quantitative synthesis, incorporating data from 7569 patients with a follow-up period of up to 25 years. According to our analysis, RP (4266 patients) demonstrated higher OS compared to RR (2589 patients) groups (HR: 0.83; 95% CI:0.76, 0.91; p < 0.01). The median OS was 13.57 years for the RP group and 13.48 years for the RR group. Nonetheless, the reoperation-free OS was higher in the RR group (HR: 1.39; 95% CI: 1.16, 1.67; p < 0.01). Valve-sparing RR (VSRR) demonstrated the highest long-term OS (p < 0.05). RP is associated with superior OS but a higher risk of reoperation, while RR offers greater durability with fewer reoperations, and VSRR may provide the optimal balance of longevity and native valve preservation, warranting further prospective studies.

Iatrogenic aortic regurgitation after mitral valve surgery is the consequence of either direct stitching-related perforation or indirect distortion of aortomitral fibrous continuity by the mitral ring/prosthesis. This review aims at describing the reported cases of iatrogenic aortic valve regurgitation following mitral valve surgery, focusing primarily on its management. PubMed, ScienceDirect, DOAJ, and Cochrane databases were searched from inception until December 2023 for case reports and case series describing iatrogenic aortic valve regurgitation following mitral valve surgery. The literature review found 17 articles describing 20 cases of new onset aortic valve regurgitation after mitral valve surgery. Among them, 5 patients did not undergo reoperation, either due to medical decision or patient refusal. The non-coronary cusp was predominantly affected (11 cases), the left coronary cusp involved in 4 cases, and a mixed mechanism occurred in 5 cases. Subsequent surgical interventions included aortic valve replacements in 5 cases and aortic valve repair in 4 cases. A suggested management decision algorithm is finally proposed. Iatrogenic aortic valve regurgitation after mitral valve surgery remains an unfortunate complication. Attention should be given to prevent this complication. Intraoperative transesophageal echocardiography plays a crucial role for early detection. Management strategies vary from medical therapy to surgical interventions. The reparative strategy requires a surgical procedure associated with significant mortality.

Thoracic aortic disease (TAD) encompasses a spectrum of life-threatening conditions, including thoracic aortic aneurysm (TAA), acute type A aortic dissection (ATAAD), and bicuspid aortic valve (BAV)-associated aortopathy. While genetic mutations are well-documented contributors, emerging evidence highlights epigenetic mechanisms as critical regulators of TAD pathogenesis. This comprehensive review explores the role of epigenetic modifications-DNA methylation, histone modifications, and microRNA (miRNA) regulation-in vascular remodeling, extracellular matrix degradation, and endothelial dysfunction. Aberrant DNA methylation patterns have been implicated in TAA and ATAAD, influencing genes responsible for vascular integrity and inflammation. Histone modifications modulate smooth muscle cell phenotype switching, impacting aneurysm progression. Additionally, dysregulated miRNA expression contributes to endothelial barrier disruption and extracellular matrix remodeling, presenting novel avenues for biomarker discovery. The reversibility of epigenetic modifications offers a promising therapeutic target, with pharmacological agents such as histone deacetylase inhibitors and miRNA-based therapies showing potential in preclinical models. This review underscores the translational potential of epigenetic biomarkers for early disease detection, risk stratification, and precision medicine approaches. Further research is needed to integrate these findings into clinical practice, paving the way for innovative diagnostic and therapeutic strategies in TAD management.