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.

OBJECTIVE: To explore the relationship between admission blood glucose and postoperative acute kidney injury (AKI) after off-pump coronary artery bypass grafting (OPCABG).
METHODS: One hundred seventy-seven patients who underwent OPCABG in the Cardiac Surgery Department of our hospital were selected for a retrospective study and were divided into 41 patients in the AKI group and 136 patients in the non-AKI group according to the occurrence of AKI in their postoperative period; the indexes of the patients at the time of admission were statistically analyzed using Student's t-test for continuous variables and χ² test for categorical variables; and the relationship between preoperative fasting plasma glucose (FPG) and the occurrence of AKI was explored by multivariable logistic regression analysis. Normality of continuous variables was assessed using the Shapiro-Wilk test.
RESULTS: The preoperative FPG and glycosylated hemoglobin (HbA1c) measurements of patients in the AKI group were higher than those in the non-AKI group, and the difference was statistically significant (P < 0.05); the results of the logistic regression model showed that elevated preoperative blood creatinine, elevated preoperative uric acid, elevated preoperative hyperglycemia, elevated preoperative HbA1c level, and elevated preoperative neutrophil-to-lymphocyte ratio value were the OPCABG surgery patients' independent risk factors for postoperative AKI (P < 0.05).
CONCLUSION: Preoperative hyperglycemia — assessed by both FPG and HbA1c — is an independent risk factor for AKI after OPCABG. Clinicians should prioritize glycemic control before surgery to reduce AKI risk.

Ionizing radiation is associated with an increased risk of malignancy, especially in fetuses. Therefore, in the rare situation of a pregnant patient in need of a pacemaker, alternatives to conventional fluoroscopy are required. We describe a case of successful implantation of a Ventricle-paced, Dual-sensing, Dual-response pacemaker without fluoroscopy in a 32-year-old female patient using electroanatomic 3D mapping. She had severe bradycardia due to complete atrioventricular block, which impeded intrauterine growth restriction in the fetus.

INTRODUCTION: Understanding the biomechanical behavior of the aortic root is essential for improving surgical planning and patient-specific simulations. Traditional tests such as planar biaxial testing are limited by small sample size and loss of three-dimensional (3D) structure. We propose a novel method combining static pressurization and micro-computed tomography (CT) imaging of intact human aortic roots to simultaneously obtain accurate 3D geometry and biomechanical data.
OBJECTIVE: To evaluate the mechanical properties of healthy human aortic roots under physiological pressure conditions.
METHODS: Ten aortic roots were collected from unused human donor hearts (non-cardiac death) with family consent. The roots were gradually pressurized from 20 to 120 mmHg in 20 mmHg increments and scanned at each step using high-resolution micro-CT. Measurements included diameter, stress-strain curves, and Young's modulus.
RESULTS: 3D reconstructions of all ten aortic roots were successfully performed. The mean donor age was 61.2 years (49.5 – 65.6). At 80 mmHg, the median diameter of the sinotubular junction was 32.2 mm (29 – 36). Stress-strain analysis revealed non-linear behavior, with significantly lower stiffness at low pressure (20 – 80 mmHg, median Young's modulus 0.6 [0.5 – 0.8] MPa) compared to high pressure (80 – 120 mmHg, 3.2 [2.5 – 5.6] MPa, P = 0.001).
CONCLUSION: This study demonstrated that ex vivo micro-CT combined with static pressurization can reliably evaluate the mechanical properties of healthy human aortic roots under physiological pressure ranges. The method provided high-fidelity 3D reconstructions and reproducible biomechanical metrics, consistent with existing literature. These results supply robust input for computational modeling and may help optimize root- surgical procedure.

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.