The treatment of aortic diseases has undergone profound transformation over the last decades, with the progressive incorporation of endovascular techniques either replacing or complementing conventional open surgical repair. The development of aortic stents represents one of the most significant milestones in this transition. This article reviews the historical, experimental, and clinical evolution of aortic stents, with emphasis on pioneering Brazilian contributions, including the experimental phase in animal models, the first clinical applications in aortic dissection, and the role of the national industry in the development and dissemination of these technologies. The impact of these innovations on contemporary cardiovascular surgical practice and future perspectives are also discussed.

Transcatheter aortic valve implantation (TAVI) has profoundly changed the management of severe aortic stenosis (AS), evolving from a treatment reserved for inoperable and high-risk patients to an established therapeutic option across a wide surgical risk spectrum. Although the expansion of TAVI indications has been largely supported by randomized clinical trials conducted in high-income countries, real-world experience and technological contributions from distinct healthcare systems are increasingly relevant. Brazil has played a significant role in the early adoption, structured implementation, and clinical evaluation of TAVI in Latin America. Since the first procedures performed in 2008, Brazilian centers have developed Heart Team models, contributed to national and regional registries, and generated real-world evidence demonstrating procedural safety and effectiveness comparable to international benchmarks, despite the presence of resource limitations and a higher prevalence of complex clinical and anatomical scenarios. The incorporation of TAVI into the Brazilian public health system in 2022 marked a major milestone in expanding access to minimally invasive therapy for patients with severe AS. In parallel, Brazilian scientific societies have adapted international guideline recommendations to local practice, supporting evidence-based patient selection across different surgical risk categories. Notably, Brazil has also emerged as a developer of locally engineered transcatheter valve technologies, highlighting its transition from a technology consumer to an active contributor in the field of structural heart disease. This review summarizes the historical evolution, national experience, clinical outcomes, guideline integration, technological innovation, and health economic considerations of TAVI in Brazil.

This article summarizes the author's experience with aortic valve reimplantation, focusing on technical errors that may adversely affect outcome. This is a complex surgical procedure that requires detailed knowledge of the functional anatomy of the aortic valve and how disease affects its components. The procedure was developed to correct abnormal components of the aortic root in patients with aortic root aneurysms, both sporadic and associated with genetic syndromes, with the aim of restoring the native aortic valve anatomy and function. When applied to properly selected patients and performed correctly, the very long-term outcomes are gratifying for both the patient and the surgeon.

INTRODUCTION: Robotic cardiac surgery has evolved significantly over the past decades, offering enhanced precision, improved visualisation, and minimally invasive approaches. Despite its global expansion, its adoption in Brazil remains limited, particularly due to the absence of a structured and specialty-specific training pathway.
OBJECTIVE: To present a structured proposal for the implementation of robotic cardiac surgery training in Brazil, based on current national regulations and international experience.
METHODS: This study consists of a narrative review combined with a policy analysis of Brazilian regulatory documents and international training models. Evidence regarding simulation-based training, structured curricula, and competency-based progression was analysed to support the proposed framework.
RESULTS: Current Brazilian regulations provide general guidance for robotic surgery but lack specific criteria for cardiac surgery training. In contrast, international models emphasise structured progression, simulation-based training, mentorship, and outcome-based evaluation. Based on these findings, a hybrid training model is proposed, combining short-term certification programmes and dedicated fellowship pathways.
CONCLUSION: The implementation of a structured and standardised training pathway is essential for the safe expansion of robotic cardiac surgery in Brazil. Aligning national policies with international best practices may facilitate broader adoption while ensuring surgical proficiency and patient safety.

Modern healthcare increasingly relies on predictive, proactive, participatory, and personalized paradigms. While Enhanced Recovery After Cardiac Surgery (ERACS) has transformed standard cardiac procedures, its application to heart transplantation (HT) remains unmapped. HT patients exhibit unique vulnerability across physical, psychocognitive, social, and nutritional dimensions. Integrating ERACS pathways into HT protocols represents a critical opportunity to optimize patient-centered recovery. This manuscript addresses this gap by establishing the conceptual link between these fields and proposing a novel framework for their integration.

INTRODUCTION: The myocardial ischemia-reperfusion injury (IRI) is an indispensable factor in pediatric congenital heart defect (CHD) surgery. Although effective myocardial protection strategies are crucial, the issue remains a dilemma. This study aimed to evaluate the effect of adding dexmedetomidine to modified Del Nido cardioplegia on myocardial protection in children undergoing CHD surgery.
METHODS: This was a prospective, randomized, triple-blind, controlled clinical trial. A total of 60 pediatric patients were enrolled and randomized 1:1 into two groups — an intervention group that received dexmedetomidine-enriched modified Del Nido cardioplegia and a control group that received standard modified Del Nido cardioplegia with normal saline. Primary outcomes included serum troponin I and creatine kinase-MB levels, as well as coronary sinus lactate levels. Secondary outcomes were the vasoactive-inotropic score, weaning time from mechanical ventilation, and intensive care unit length of stay.
RESULTS: Adding dexmedetomidine to modified Del Nido cardioplegia significantly improved myocardial protection in children undergoing CHD surgery. The intervention group showed significantly lower troponin I levels at all postoperative time points compared to the control group (P < 0.001). Similarly, the dexmedetomidine group had significantly lower vasoactive-inotropic score at all time points (P < 0.001). Patients in the intervention group also experienced a significantly shorter mean ventilator weaning time (P < 0.001) and intensive care unit stay duration (P < 0.001). The overall distribution of postoperative morbidities did not differ significantly between the groups (P = 0.059).
CONCLUSION: Adding dexmedetomidine to modified Del Nido cardioplegia significantly improved myocardial protection in children undergoing corrective CHD surgery.

INTRODUCTION: This retrospective study evaluated the feasibility, safety, and early recovery outcomes of intraoperative extubation combined with minimally invasive axillary thoracotomy for atrial septal defect (ASD) and ventricular septal defect (VSD) repair in pediatric patients.
METHODS: Sixty-one consecutive pediatric patients who underwent ASD (n = 43) or VSD (n = 18) repair via axillary thoracotomy between March 2017 and December 2023 were included. Patients were categorized by extubation timing into intraoperative (operating room [OR] group) and postoperative (intensive care unit [ICU] group). Baseline characteristics, operative variables, and postoperative outcomes were compared.
RESULTS: In the ASD cohort, patients extubated intraoperatively had a shorter hospital stay compared with those extubated in the ICU (2.78 ± 1.24 vs. 3.60 ± 0.99 days, P < 0.001). In the VSD cohort, the OR group included younger and lower-weight patients yet demonstrated a significantly shorter hospital stay (3.56 ± 0.73 vs. 5.78 ± 3.35 days, P = 0.013). Across the entire cohort, on-table extubation was associated with reduced hospital stay (P < 0.001), with no increase in reintubation or major complications.
CONCLUSIONS: Intraoperative extubation following axillary thoracotomy for ASD and VSD repair in pediatric patients appears safe and feasible and was associated with a significantly shorter hospital stay, even in lower-weight patients. These findings suggest that intraoperative extubation may be considered as part of enhanced recovery strategies in pediatric congenital heart surgery.