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: This study aims to compare the perioperative and long-term outcomes of reoperative coronary artery bypass grafting (CABG) with primary CABG in a propensity score-matched patient cohort.
METHODS: We retrospectively analyzed 2,021 patients who underwent CABG between January 2003 and January 2024. Among them, 35 (1.7%) patients underwent redo CABG. Using 1:1 propensity score matching based on age, ejection fraction, diabetes mellitus, and hypertension, 36 patients who underwent primary CABG were selected for comparison. Patients with incomplete records or combined cardiac procedures were excluded. Perioperative variables, in-hospital mortality, and long-term survival were analyzed.
RESULTS: The redo CABG group had significantly longer intensive care unit stays (2.15 ± 2.37 vs. 1.39 ± 1.36 days, P = 0.006), hospital stays (12.11 ± 17.40 vs. 7.36 ± 2.21 days, P = 0.009), and postoperative bleeding (899.12 ± 445.17 vs. 576.39 ± 323.92 ml, P = 0.001). Hospital mortality occurred in two patients (5.7%) in the redo group and one patient (2.8%) in the primary group (P = 0.614). Kaplan-Meier survival analysis showed higher long-term survival in the redo CABG group (77.1%) compared to the primary CABG group (58.3%), though not statistically significant (P = 0.168).
CONCLUSION: Despite the increased perioperative complexity, redo CABG is associated with low in-hospital mortality and promising long-term outcomes when appropriate patient selection and meticulous surgical technique are employed. These findings are especially relevant in guiding revascularization strategies for patients with prior CABG, where redo surgery is often underutilized despite its clinical viability.

INTRODUCTION: The Ozaki procedure reconstructs the aortic valve with autologous pericardium, but long-term leaflet durability remains uncertain. Coronary artery disease (CAD) may reflect a systemic atheroinflammatory milieu associated with impaired leaflet integrity.
METHODS: We retrospectively studied 733 patients undergoing Ozaki reconstruction from 2015 to 2020 and assessed the association between CAD and aortic regurgitation (AR) ≥ 2 at last echocardiographic follow-up. Baseline heterogeneity was addressed using propensity-score overlap weighting based on age, sex, body mass index, body surface area, weight, diabetes, European System for Cardiac Operative Risk Evaluation II, aortic stenosis, bicuspid valve, and peripheral artery disease. Effects were estimated as weighted risk ratios (RRs) using Poisson models with robust variance. Sensitivity analyses used stabilized inverse probability of treatment weighting (IPTW) and an extended model including prior myocardial infarction/percutaneous coronary intervention.
RESULTS: Of 733 patients, 365 (49.8%) had CAD. Unadjusted AR ≥ 2 rates were 10.1% in CAD vs. 5.7% in no-CAD patients (P = 0.037). After overlap weighting, weighted risks were 12.7% vs. 6.2%, yielding RR 2.05 (95% CI, 1.01 – 4.18; P = 0.048), with excellent covariate balance. IPTW showed consistent results: RR 2.22 (95% CI, 1.38 – 3.56; P = 0.001). Regurgitation-free survival was lower in CAD patients (log-rank P = 0.0087).
CONCLUSION: CAD was associated with an approximately two-fold higher risk of AR ≥ 2 after Ozaki reconstruction. This association likely reflects systemic atheroinflammatory processes rather than a direct mechanical effect, supporting closer postoperative surveillance in CAD patients.

INTRODUCTION: Cardiac myxoma (CM) is the most common primary cardiac tumor. Multiple CMs are rare and can lead to heart failure and arterial embolism. This study aimed to explore clinical characteristics, surgical treatment experience, and follow-up strategies for multiple CMs.
METHODS: A retrospective analysis was conducted on eight patients with multiple CMs who underwent surgical treatment. Clinical characteristics were analyzed by extracting relevant clinical data, electrocardiography and echocardiography findings, surgical treatment details, and postoperative follow-up information. All patients had undergone cardiopulmonary bypass surgery. Pathological analysis was performed on all tumors, and postoperative cardiac ultrasound follow-up was also conducted.
RESULTS: Multiple CMs were uncommon, representing only 5.9% of all cases. Among 136 patients with cardiac tumors admitted during the same period, only eight had multiple CMs. All patients with multiple CMs underwent complete tumor resection. The size of the resected tumors was approximately 5 – 80 (39.3 ± 20.3) mm. The follow-up period ranged from one to nine years. The recurrence rate was 37.5% (3/8), and all recurrent cases underwent reoperation for tumor resection. There were no perioperative deaths, and overall surgical outcomes were satisfactory.
CONCLUSION: Our study reveals that surgery is the best strategy for multiple CMs. The tumor should be completely resected, and color Doppler echocardiography is recommended every six months postoperatively to detect tumor recurrence. Those cases of multiple myxomas have had high recurrence rate after resection (37.5%) but were submitted successfully to a new resection. Timely surgical resection provides favorable outcomes for patients with multiple or recurrent CMs.