Objective: To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps. Methods: Between 2002 and 2007, 10 665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149 (1.4%) developed a DSWI. Negative pressure wound therapy (NPWT) followed by sternal osteosynthesis with musculocutaneous coverage was used in 92 (61.7%) patients. A retrospective review was done using a prospectively maintained database to identify risk factors for recurrent infection in this group of patients. Results: Of the 92 patients who underwent sternal osteosynthesis, nine (9.8%) developed recurrent sternal infection requiring hardware removal. Univariate analysis showed that preoperative methicillin-resistant Staphylococcus aureus (MRSA) status (33.3% vs 6.1%; p = 0.03) and prolonged intubation time in ICU (44.4% vs 14.6%; p ≪ 0.05) were significant risk factors. Two-thirds of these patients were also found to be infected with the same germ as the one responsible for their initial DSWI. No death was reported and sternal integrity was preserved in all patients despite plate removal. Conclusions: To lower the rate of RSI in patients treated with transverse sternal ostheosynthesis along with myocutaneous coverage for DSWI, surgeons must consider the MRSA preoperative status as a significant predictor of RSI and/or persistent infection. Chest-wall integrity in patients with RSI can be maintained after hardware removal, even after only a few weeks following initial plating.

Intraoperative haemostasis is of paramount importance in the practice of cardiovascular surgery. Over the past 70 years, topical haemostatic methods have advanced significantly and today we deal with various haemostatic agents with different properties and different mechanisms of action. The particularity of coagulation mechanisms after extracorporeal circulation, has encouraged the introduction of new types of topic agents to achieve haemostasis, where conventional methods prove their limits. These products have an important role in cardiac, as well as in vascular, surgery, mainly in major vascular procedures, like aortic dissections and aortic aneurysms. This article presents those agents used for topical application and the mechanism of haemostasis and offers general recommendations for their use in the operating room.

Recently, multilayer stents for type B aortic dissections (TBAD) have been proposed to decrease false lumen flow, increase and streamline true lumen flow, and retain branch vessel patency. We aimed to provide a protocol with standardized techniques to investigate aortic remodeling of TBAD by multilayer flow modulators (MFM) in static geometric and hemodynamic analyses. Combining existing literature and new insights, a standardized protocol was designed. Using pre- and postoperative CT scans, geometric models were constructed, lumen dimensions were calculated, computational fluid dynamics (CFD) models were composed, and velocity and pressures were calculated. Sixteen TBAD cases treated with MFM were included for analysis. For each case, aortic remodeling was analyzed using post-processing medical imaging software. After 3D models were created, geometrical anatomical measurements were performed, and meshes for finite element analysis were generated. MFM cases were compared pre- and postoperatively; true lumen volumes increased (p < 0.001), false lumen volumes decreased (p = 0.001), true lumen diameter at the plane of maximum compression (PMC) increased (p < 0.001), and false lumen index decreased (p = 0.008). True lumen flow was streamlined, and the overall fluid velocity and pressures decreased (p < 0.001 and p = 0.006, respectively). This protocol provided a standardized method to evaluate the effects of MFM treatments in TBAD on geometric analyses, PMC, and CFD outcomes.

The atrial septal defect is, after bicuspid aortic valve disease, the most common congenital cardiac disease present in the adult population. The most common atrial septal defects are the ostium secundum type (75–80%), followed by the ostium primum type (15%). The sinus venosus atrial septal defects (SV-ASD), defined as a communication in the posterior part of the interatrial septum, account for about 5 to 10% of atrial septal defects. Approximately 90% of SV-ASDs are associated with partial anomalous pulmonary venous drainage (PAPVD). The minimally invasive approach has gained ground in the treatment of ASDs, especially those of the ostium secundum type. The sinus venosus type is a relatively uncommon form of ASD, which, when associated with a PAPVD, is considered a complex cardiac malformation, and is usually treated in a classical manner, through median sternotomy. We describe the case of a 45-year-old woman diagnosed in adolescence with SV-ASD with PAPVD, who successfully underwent minimally invasive repair with fresh autologous pericardial patch reconstruction through an anterolateral mini-thoracotomy incision. The patient presented with shortness of breath and fatigue after heavy exertions, episodes of paroxysmal nocturnal dyspnea, palpitations during effort and at rest, and had a history of syncope dating from 17 years previously. Echocardiography revealed an SV-ASD with PAPVD in the right atrium and the intraoperative examination discovered that both right pulmonary veins were draining into the superior vena cava.

A 52-year old woman was referred for bone marrow biopsy. Active bleeding was seen when the trocar was removed. The biopsy needle was replaced (Fig. 1) and the patient referred for computed tomography (CT), which revealed an aortic injury (Fig. 2). Emergency sternotomy was performed; the lesion was repaired off-pump. The patient was discharged.

Background/Objectives: Minimally invasive valve surgery (MIVS) is increasingly employed as an alternative to conventional median sternotomy (MS) in the treatment of valvular heart disease. However, its impact on postoperative quality of life (QoL) remains incompletely understood. This systematic review and meta-analysis aimed to compare QoL outcomes between MIVS and MS, focusing on physical, psychological, and social dimensions, both in the short- and long-term postoperative periods. Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Wiley Online Library databases for studies published between January 2020 and September 2025. Eligible studies included adult patients undergoing MIVS or MS and assessed QoL using validated instruments (SF-36, EQ-5D, MLHFQ, KCCQ). Random-effects models were used for meta-analysis, and standardized mean differences (SMDs) were calculated to estimate pooled effects. Results: Fifty-six studies with a combined sample of over 10,000 patients were included. MIVS was associated with significantly better short-term QoL outcomes across physical (SMD = 0.88; 95% CI: 0.74–1.02) and psychological domains (SMD = 0.47; 95% CI: 0.35–0.59). Patients also experienced earlier social reintegration and improved body image perception. Although these benefits diminished beyond 12 months, MIVS maintained a modest but persistent advantage in long-term QoL (≥5 years). Structured psychological support and cardiac rehabilitation programmes further enhanced physical and emotional recovery. Conclusions: MIVS confers meaningful benefits in postoperative QoL, particularly during the early recovery phase. Sustained improvements depend on comprehensive postoperative care, including rehabilitation and psychosocial support. Further long-term, standardized research is required to strengthen evidence and guide patient-centred surgical decision-making.