Myocardial fibrosis (MF) is the excessive deposition of extracellular matrix (ECM) from myofibroblasts and is crucial in patients with heart failure (HF). Much work is still needed to fully understand its features and clinical role. This review aims to summarize the state-of-the-art of MF knowledge, focusing on assessment, quantification, predictive value, and future therapies. We performed a literature search about MF studies published between 2014 and 2024, including clinical studies on MF assessment or quantification, the role of MF as a prognostic factor in patients with HF, basic science studies on fibrosis assessment, and the role of the main mechanisms involved in MF. We identified 5161 potentially relevant articles. After excluding non-appropriate ones, we had 186 potentially suitable studies. After full reading and a review of references, 40 articles were included in our review: 8 were about MF assessment, 5 about quantification, and 27 about fibrosis as a prognostic factor. MF is a crucial process in patients with cardiac diseases and leads to HF and arrhythmias. Assessment and quantification have taken great steps forward, but more research is needed to strengthen MF’s role as a prognostic factor in the future. Basic science will play a key role in anti-fibrosis treatment.

Minimally Invasive Cardiac Surgery (MICS) was developed in the late 1990s and has taken giant strides over the last 30 years. Nowadays, it is an important part of the cardiac surgery practice, accounting for one-third of total heart surgeries globally, with remarkable results. It is mostly performed for Mitral Valve repair but also for Aortic Valve Replacement and coronary artery bypass. However, the chronological evolution that led MICS to its current status has never been properly described. The best format to share a historical journey is the state-of-the-art (SotA) review. To the best of our knowledge, there are no orthodox SotA reviews on MICS. The aim of our study is to describe the current key MICS techniques, their historical development, and to discuss their role in the future of our specialty.

Infective Endocarditis (IE) incidence has increased in recent years, driven by emerging risk factors affecting both elderly and young adults. Also, the role of Non-Bacterial Thrombotic Endocarditis (NBTE) is gaining importance as it is a subtle, probably underdiagnosed entity. Moreover, the COVID-19 pandemic has influenced the epidemiology of endocarditis, raising questions about their relationship, diagnosis, and management. Diagnosis of IE is sometimes challenging, and classic criteria are now being rediscussed. The aim of our study is to provide a narrative review about how and why IE incidence is rising, the role of NBTE, the impact of the COVID-19 pandemic on endocarditis patterns, and the current diagnostic challenges we face in the post-pandemic era.

Minimally Invasive Cardiac Surgery (MICS) has traditionally been defined according to the extent of surgical access, primarily focusing on the avoidance of full sternotomy and the reduction in incision size. However, the rapid evolution of cardiac surgery, including technological innovation, robotic platforms, hybrid procedures, and enhanced perioperative management, has progressively challenged the adequacy of purely anatomical definitions of invasiveness. Contemporary surgical practice suggests that the overall impact of a procedure on the patient extends beyond the surgical incision itself and includes several physiological and patient-centered dimensions. This narrative review discusses the contemporary meaning of invasiveness in cardiac surgery and examines the limitations of conventional definitions of MICS based exclusively on surgical exposure. This narrative review is based on a non-systematic literature search of PubMed, Scopus, and Web of Science, and uses a thematic synthesis approach to explore the multidimensional concept of surgical invasiveness in cardiac surgery. Particular attention is given to the growing role of patient-centered outcomes and perioperative burden in defining procedural invasiveness. Building upon emerging conceptual perspectives in the literature, this review highlights a multidimensional interpretation of MICS, in which technical, physiological, and recovery-related factors collectively contribute to the assessment of surgical invasiveness.