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OBJECTIVES Robotic-assisted mitral valve repair surgery has a steep learning curve, and it is not clear whether previous experience in minimally invasive mitral valve surgery (MIMVS) facilitates this process. We aimed to investigate the initial experience of 2 cardiac centres starting their robotic programmes, evaluating the impact of previous MIMVS experience. METHODS Retrospective analysis was performed for the 1st consecutive cases operated due to severe degenerative mitral valve regurgitation using the robotic surgical platform in 2 European centres, 1 transitioning from conventional surgery (centre 1) and the other from mini thoracotomy MIMVS (centre 2). Cumulative sum analysis was used to evaluate the learning process using both surgical times and a combined primary outcome including relevant intra- and postoperative results. RESULTS First 62 patients in each centre were included. All median surgical times were shorter in centre 2: cardiopulmonary bypass: 238 vs 115 min, P  < 0.001; cross-clamp: 143 vs 82 min, P  < 0.001; and total intervention: 313 vs 228 min, P  < 0.001. The combined primary outcome showed no significant differences (9.7% vs 8%; P  = 1). However, the turning point making the end of the learning phase was detected at the 60th case in centre 1 and at the 50th in centre 2. Regarding surgical time, the learning curve was steeper in centre 1 with both cardiopulmonary bypass and cross-clamp overcoming the learning phase after 32 cases, as compared to 16 cases in centre 2. CONCLUSIONS A successful robotic-assisted mitral repair programme can be safely started coming from either conventional open approach or mini thoracotomy MIMVS. However, previous mini thoracotomy MIMVS experience had positive impact on the initial learning curve. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the occurrence, type and correlation of early and late atrial arrhythmias following mitral valve repair in patients with no preoperative history of atrial arrhythmias. Methods: Patients undergoing mitral valve (MV) repair for degenerative disease were included. Early and late postoperative electrocardiograms were evaluated for the incidence and type of atrial arrhythmia (atrial fibrillation [AF] or atrial tachycardia [AT]). Results: The 192 patients were included. Early atrial arrhythmias occurred in 100/192 (52.1%) patients; AF in 61 (31.8%) patients, early AT in 15 (7.8%) and both in 24 (12.5%). In total 89% of patients were discharged in sinus rhythm. During a follow‐up time of 7.3 years, 14 patients (7.3%) died and 49 (25.5%) patients developed late atrial arrhythmias. At 10 years, the cumulative incidence of any late atrial arrhythmia, with death as competing risk, was 64% (95% confidence interval [CI] = 55%–72%). On Fine‐Gray model analysis, only early postoperative AF lasting >24 h was related to the development of late AF (hazard ratio 5.99, 95% CI = 1.78%–20.10%, p =.004). Early postoperative ATs were related to the development of late tachycardias, independent of their duration (<24 h hazard ratio 4.25, 95% CI = 1.89–9.57, p =.001 and >24 h hazard ratio 3.51, 95% CI = 1.65–7.46, p =.001). Conclusions: Early and late atrial arrhythmias were common after MV repair surgery. Only early postoperative AF lasting >24 h was a risk factor for the occurrence of late AF. Conversely, any postoperative AT was correlated to the development of late ATs. [ABSTRACT FROM AUTHOR]

The article discusses the European Association of Cardiothoracic Surgeons' perspective on the future of robotic cardiac surgery in Europe. It highlights the evolution of robotic surgical systems in reducing invasiveness and improving outcomes for procedures like coronary artery bypass grafting and mitral valve repair. The text emphasizes the potential benefits of robotic surgery, such as reduced complications, shorter recovery times, and enhanced precision, while also addressing challenges related to training, innovation, and regulatory requirements. The authors advocate for the integration of robotics in cardiac surgery to enhance patient safety, minimize morbidity, and improve postoperative outcomes, emphasizing the importance of structured training programs and collaboration with industry partners. [Extracted from the article]

We present the case of a 52-year-old woman with cardiogenic shock and refractory right ventricular failure due to spontaneous dissection of the right coronary artery. She remained dependent on mechanical support for several weeks. Both a right ventricular assist device implant and a bidirectional cavopulmonary anastomosis were explored as long-term support options. A history of malignancy and possible right ventricular functional recovery resulted in a decision in favour of the bidirectional cavopulmonary anastomosis and concomitant tricuspid valve annuloplasty. Postoperatively her clinical condition improved significantly, and she could be discharged home. Echocardiography showed normalization of right ventricular dimensions and slight improvement of right ventricular function. [ABSTRACT FROM AUTHOR]

Background: Optogenetics could offer a solution to the current lack of an ambulatory method for the rapid automated cardioversion of atrial fibrillation (AF), but key translational aspects remain to be studied. Objective: To investigate whether optogenetic cardioversion of AF is effective in the aged heart and whether sufficient light penetrates the human atrial wall. Methods: Atria of adult and aged rats were optogenetically modified to express light‐gated ion channels (i.e., red‐activatable channelrhodopsin), followed by AF induction and atrial illumination to determine the effectivity of optogenetic cardioversion. The irradiance level was determined by light transmittance measurements on human atrial tissue. Results: AF could be effectively terminated in the remodeled atria of aged rats (97%, n = 6). Subsequently, ex vivo experiments using human atrial auricles demonstrated that 565‐nm light pulses at an intensity of 25 mW/mm2 achieved the complete penetration of the atrial wall. Applying such irradiation onto the chest of adult rats resulted in transthoracic atrial illumination as evidenced by the optogenetic cardioversion of AF (90%, n = 4). Conclusion: Transthoracic optogenetic cardioversion of AF is effective in the aged rat heart using irradiation levels compatible with human atrial transmural light penetration. [ABSTRACT FROM AUTHOR]