This article describes the development of aortic valve-sparing operations and their current status in surgical practice. They are classified into two general types of operations: aortic root remodeling and aortic valve reimplantation. Both techniques have been modified over the years from their original descriptions, but both remain useful in appropriately selected patients with aortic root and proximal aortic aneurysms, provided the aortic valve cusps are reasonable. Aortic valve reimplantation has proven more durable in young patients with aortic root aneurysms associated with genetic syndromes, whereas remodeling of the aortic root may be appropriate for older patients with ascending aortic aneurysms, dilated sinotubular junction, and secondarily dilated aortic sinuses. These operations were developed to preserve the native aortic valve and have expanded the armamentarium to treat patients with aortic root aneurysms and reasonably normal aortic cusps. In addition to a description of their development, a summary of current results of aortic valve reimplantation worldwide is presented, along with the author's personal perspective on its reproducibility.

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.

INTRODUCTION: Pulmonary valve replacement is increasingly common in patients with congenital heart disease. The limited durability of conventional bioprostheses has led to the introduction of the INSPIRIS RESILIA valve, initially designed for the aortic position. However, evidence on its performance in the pulmonary position is limited and heterogeneous.
METHODS: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed®, Excerpta Medica dataBASE, Cochrane Library, and ClinicalTrials. Observational studies with patients undergoing pulmonary valve replacement with the INSPIRIS RESILIA bioprosthesis were included. Data on baseline characteristics, transvalvular gradients, mortality, complications, prosthetic insufficiency, and need for reintervention were extracted. This study was registered in the International Prospective Register of Systematic Reviews (CRD420251117859).
RESULTS: Three retrospective cohort studies and two retrospective case series were identified that included pediatric and adult populations, mainly with a diagnosis of tetralogy of Fallot. The findings were consistent in showing adequate perioperative safety. Smaller studies showed favorable results. In contrast, larger studies with longer follow-up reported more rapid progression to moderate/severe pulmonary insufficiency and shorter durability of the bioprosthesis.
CONCLUSION: INSPIRIS RESILIA may be associated with acceptable short-term outcomes in pulmonary valve replacement, but its medium- and long-term durability may be inferior to that of reference bioprostheses. Medium- and long-term safety remains inconclusive due to limited follow-up, modest sample sizes, heterogeneity in definitions, possible confounding by anatomical substrate, and study limitations.