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.

INTRODUCTION: Advanced heart failure is an important cause of mortality in Brazil. Limited access to heart transplantation and the high cost of imported devices reinforce the need for national technological solutions. The K Pump-Mackenzie project proposes the development of a fully implantable mechanical circulatory assist device, integrated with 5G telemetry, with potential application in the unified health system of Brazil, the Sistema Único de Saúde.
METHODS: A centrifugal prototype rotor, with real-time control system and integrated flow and pressure sensors, was developed. The device was submitted to laboratory tests to evaluate mechanical performance, operational stability, structural integrity, and connectivity via 5G network. The preclinical protocol in the sheep model was designed and approved by the Comissão de Ética no Uso de Animais, from the Faculdade Evangélica Mackezie do Paraná, in accordance with Conselho Nacional de Segurança Alimentar e Nutricional guidelines.
RESULTS: In bench tests, the device showed controlled rotation of up to 10,000 rpm, adjustable flow between 2 and 6 L/min, and average latency of < 20 ms in data transmission. Continuous operational stability was observed for up to 72 hours, with adequate functioning of the monitoring and safety systems.
CONCLUSION: K Pump-Mackenzie demonstrated technical feasibility and satisfactory performance in initial bench validation. The planned preclinical stage will be fundamental to evaluate safety and biological performance, constituting a necessary step for future clinical application, and will take place in 2026.

OBJECTIVE: To evaluate the association between postoperative acute kidney injury (AKI) and outcomes in adults undergoing cardiovascular surgery who required a prolonged intensive care unit (ICU) stay.
METHODS: We conducted a retrospective cohort study of consecutive cardiovascular surgery patients with ICU stay ≥ 72 hours. AKI was defined and staged using creatinine-based Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcome was in-hospital mortality. Secondary outcomes were time to extubation, ICU days until ward transfer, and perioperative transfusion exposure (red blood cells/fresh frozen plasma/platelet/apheresis); initiation of renal replacement therapy was assessed exploratorily. Multivariable logistic regression examined the association between AKI and mortality, adjusting for age, sex, baseline renal function/chronic kidney disease (estimated glomerular filtration rate category), hypertension, diabetes, chronic obstructive pulmonary disease, ejection fraction (or Age Creatinine Ejection Fraction score), procedure type (coronary artery bypass grafting/valve/combined), cardiopulmonary bypass and cross-clamping times, transfusions, and post-cardiopulmonary bypass vasoactive/inotropic use where available.
RESULTS: AKI was frequent after cardiovascular surgery and was independently associated with higher in-hospital mortality in adjusted analyses. Patients with AKI also had longer time to extubation, greater transfusion requirements, and prolonged ICU stay, with a stepwise worsening across KDIGO stages. Findings were consistent in sensitivity analyses. Incomplete urine-output data were acknowledged as a limitation, as oliguria forms part of KDIGO definitions.
CONCLUSION: Among cardiovascular surgery patients with prolonged ICU stay, postoperative AKI is a strong predictor of in-hospital mortality and adverse resource-related outcomes. Emphasis on prevention, early detection, and optimized perioperative management may improve prognosis in this high-risk population.

INTRODUCTION: This study explored the function and molecular mechanism of long non-coding ribonucleic acid taurine up-regulated gene 1 (TUG1) in children with ventricular septal defect (VSD).
METHODS: To establish an in vivo VSD model, 10 pregnant mice were administered valproic acid via intraperitoneal injection (VSD group, n = 10). Another 10 pregnant mice were used as the control group and administered 0.9% sodium chloride solution via intraperitoneal injection. Subsequently, the cardiac function and cardiac tissue histopathological characteristics in both groups were evaluated. TUG1, miR-222-3p, and hypoxia-inducible factor 1-alpha subunit inhibitor (HIF1AN) expression levels in cardiac tissues were tested. P19 cells were chosen to simulate VSD in vitro model, and the cell progression was tested. P19 cells were induced to differentiate into cardiomyocytes with dimethyl sulfoxide, and test of the shape and beating frequency of cardiomyocytes was conducted. Left ventricular fractional shortening, ejection fraction, and systolic and diastolic thickness of the cardiac anterior wall were significantly reduced in VSD fetal mice. VSD formation, aortic overlay, and dysplasia were observed.
RESULTS: TUG1 and HIF1AN were upregulated, and miR-222-3p was downregulated in VSD mice. Silencing TUG1 or HIF1AN or elevating miR-222-3p facilitated P19 cell progression and differentiation, whereas lowering miR-222-3p did the opposite. TUG1 was a molecular sponge of miR-222-3p, which targeted HIF1AN. Elevating HIF1AN reversed the impacts of silencing TUG1 or elevating miR-222-3p on P19 cells.
CONCLUSIONS: The findings of this study could offer a new insight into the molecular basis of VSD and lay the groundwork for new diagnostic techniques.

INTRODUCTION: Acute Physiologic and Chronic Health Evaluation (APACHE) II is an effective tool to predict outcomes in cardiac surgery recovery. The present study aimed to evaluate the efficacy and compare the performance of the APACHE II and Simplified Acute Physiology Score (SAPS 3) scoring tools as predictive indices of mortality in cardiac surgery patients.
METHODS: This was a retrospective observational study, evaluating patients over 18 years of age who underwent cardiac surgeries between 2020 and 2023. A receiver operating characteristic curve analysis was conducted to evaluate the sensitivity and specificity of the APACHE II and SAPS 3 tools in detecting intensive care unit (ICU) mortality in critically ill patients. Binary logistic regression was performed to assess the odds of mortality between groups (primary outcome) using data on comorbidities.
RESULTS: APACHE II was efficient in predicting mortality in cardiac surgery (sensitivity = 81%; specificity = 75%) as was SAPS 3 (sensitivity = 75%; specificity = 64%). Binary logistic regression revealed that mortality was significantly associated with comorbidities (chronic obstructive pulmonary disease and non-dialysis-dependent chronic kidney disease) and the type of surgery, with a higher risk in emergency procedures compared to elective ones.
CONCLUSION: In conclusion, APACHE II and SAPS 3 proved to be efficient tools for predicting mortality in cardiac surgery patients admitted to the ICU. This study contributes to understanding these tools in a regional context and specifically in cardiac surgeries, as well as assessing other predictors that may be important for identifying risk groups and predicting mortality after cardiac surgeries.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has become a viable option for patients with severe aortic valve stenosis across a broad range of surgical risk in recent years. The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score, a novel indicator of malnutrition and inflammation, has been discovered to be inversely linked with prognosis in several cancer types. The purpose of this study is to examine the performance of the HALP score in predicting one-month major adverse cardiac events and one-year mortality in patients treated with TAVI.
METHODS: This study included 395 consecutive patients treated with TAVI, separated into two groups based on their HALP scores: low and high. Our study's primary endpoint was all-cause death within a year after discharge following the TAVI operation. The secondary endpoint was a composite endpoint that included periprocedural complications and events in one month.
RESULTS: Patients with a low median HALP score had a higher risk of one-month composite events and one-month death. In multivariate analysis, chronic kidney disease (odds ratio [OR]: 4.67, 95% confidence interval [CI]: 2.36 - 9.25, P < 0.001) and HALP score < 3.4 (OR: 1.235, 95% CI: 1.091 - 1.397, P < 0.001) were independent predictors of first-year mortality. Kaplan-Meier analysis for computing cumulative survival found that patients with low HALP scores based on a receiver operating characteristic curve cutoff of 3.4 had increased mortality rates throughout short-term follow-up.
CONCLUSION: The HALP score may be a significant independent predictor of short-term prognosis and mortality in patients treated with TAVI, beyond conventional risk-scoring tools for better disease management.