The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses have led to the implementation of the frozen elephant trunk (FET) technique. This one-step hybrid operation consists of a total aortic arch replacement combined with an antegrade delivery of a stent–graft for the descending aorta, which acts as a proximal landing zone facilitating a potential distal endovascular reintervention. In this manner, this technique addresses acute and chronic arch disease with an acceptable morbidity and mortality. Several FET prosthetic devices are available on the global market and have exhibited favourable outcomes, although with some disadvantages in complex cases; similarly, the hybrid procedure described in this review has also been associated with complications, such as coagulopathy and neurological and graft-related events. The purpose of this review is to thus provide key insights into successful hybrid aortic arch replacements and to discuss useful tips and relevant considerations regarding its use.

Endovascular recanalization has revolutionized the treatment of peripheral artery disease (PAD), offering minimally invasive alternatives to open surgery. However, permanent metallic stents, while effective in restoring blood flow, are associated with long-term complications such as chronic inflammation, restenosis, and stent thrombosis. Bioresorbable scaffolds (BRS) have emerged as an innovative solution, providing temporary mechanical support while delivering antiproliferative drugs before fully degrading, thus eliminating the risks associated with permanent implants. Significant advancements in bioresorbable materials have led to the development of new-generation scaffolds with improved radial strength, controlled degradation rates, and enhanced drug-eluting properties. Several BRS platforms, including polymer- and magnesium-based designs, are undergoing clinical and preclinical evaluation for peripheral applications. Early trials suggest that BRS may offer comparable short-term patency rates to conventional stents while potentially reducing late adverse events. However, challenges such as scaffold thrombosis, mechanical integrity in large and calcified vessels, and long-term efficacy remain under investigation. This narrative review explores the evolution of BRS technology, the mechanisms of scaffold resorption, current clinical evidence, and future prospects for their use in peripheral endovascular interventions. As research progresses, BRS may represent a paradigm shift in the treatment of PAD, offering a balance between structural support and vascular restoration.

Minimally invasive mitral surgery is increasingly preferred due to reduced trauma and faster recovery. However, its technical complexity is exacerbated in patients with anatomical anomalies like scoliosis, affecting up to 8.3% of the elderly population. Severe scoliosis causes significant thoracic distortion and alters the positioning of cardiovascular structures, complicating access, visualization, and instrumentation. These factors make minimally invasive mitral valve replacement more complex, as this approach relies on optimal exposure of the mitral valve through a limited incision. We present the case of a 71-year-old female with severe scoliosis undergoing minimally invasive mitral valve replacement with a mechanical prosthesis and septal myectomy. Access was achieved via a 5 cm right mini-thoracotomy in the second intercostal space. This case report discusses the surgical challenges encountered and the unique considerations and adjustments required in performing cardiac surgery in patients with altered thoracic anatomy, and the importance of preoperative assessment and intraoperative flexibility.

Objectives: A minimally invasive approach by a right mini-thoracotomy has been developed for surgical ablation of atrial fibrillation. However, the efficacy and safety compared to a median sternotomy remains unclear. Methods: We searched PubMed, Embase, and the Cochrane Library for eligible studies. Meta-analysis was performed for primary (recurrence of atrial tachyarrhythmias at 1 and 2 years) and secondary (hospital and ICU stay, adverse events, 30-day mortality, cardiopulmonary bypass, and aortic cross-clamp time) end-points. We compared end-points using risk ratio (RR) for binary outcomes and mean difference (MD) for continuous ones. We calculated 95% confidence intervals (CI) and used the random-effects model for all outcomes. We performed subgroup analysis for the main outcome based on lesion set, energy source, type of surgery, and propensity score matching. Results: We included 12 observational studies (n = 3122). No difference was found for the primary outcome at 1 (RR 0.8; [95% CI]: 0.62-1.03; P = 0.08) and 2 years (RR 0.9; [95% CI]: 0.74-1.13; P = 0.4). The thoracotomy group had lower complications (RR 0.72; [95% CI]: 0.55-0.97; P = 0.016), 30-day mortality (OR 0.26; [95% CI]: 0.10-0.70; P = 0.007), hospital stay (MD −5.35; [95% CI]: −7.94 to 2.77; P < 0.001), and ICU stay (MD −2.21; [95% CI]: −3.02 to 1.40; P < 0.001). Cardiopulmonary bypass and aortic clamping time were significantly higher in the thoracotomy group. Conclusions: This meta-analysis found that surgical ablation by a mini-thoracotomy might achieve similar rhythm control to a median sternotomy while possibly improving safety and promoting faster recovery. However, conclusions are limited by the observational nature of the evidence and randomized trials are warranted.

Coronary artery aneurysms are defined as a focal dilatation exceeding 1.5 times the diameter of the adjacent normal segment. They are found in up to 5% of patients undergoing coronary angiography. Giant coronary artery aneurysms (GCAAs), typically defined as >20 mm in diameter, with an incidence of ⁓0.02%. We present the case of an 82-year-old female who underwent coronary artery bypass grafting due to a giant right coronary artery aneurysm measuring 85 mm, identified on preoperative contrast-enhanced computed tomography (CT). The patient exhibited symptoms consistent with pericardial irritation secondary to aneurysms size and was found to have significant right heart compression. Surgical intervention included opening and resection of the aneurysmal sac and bypassing the affected segment using a saphenous vein graft. Intraoperatively, it was discovered that the aneurysm wall was dissected, with a high risk of rupture. This case highlights the importance of timely recognition and surgical management of GCAAs.