The growing prevalence in the diagnosis of INOCA (Ischemia with Non-Obstructive Coronary Arteries), ANOCA (Angina with Non-Obstructive Coronary Arteries), and MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) highlights the need to reassess their clinical relevance. Historically regarded as benign syndromes, emerging evidence suggests that these conditions may cause serious cardiovascular events and considerable long-term disability. Additionally, emerging studies suggest that non-obstructive coronary artery disease (CAD) may have a higher prevalence compared to traditional obstructive forms of CAD. This leads to the need to better clarify the underlying pathogenic mechanisms as well as the risk factors associated with these syndromes. This is precisely the aim of this review, which focuses on the complex and heterogeneous mechanisms underlying these syndromes as well as the associated risk factors. This review also sums up the diagnostic steps necessary to achieve an accurate diagnosis, along with the interventional and pharmacological approaches to be implemented in light of the latest evidence.

Cardiothoracic surgery (CTS) is one of the least diverse surgical specialties in both gender and race. Aside from the inherent benefits of a diverse working environment, mitigating this diversity gap improves patient care. Mentorship is important for creating a diverse, nurturing environment for trainees. This review appraises the impact of formal mentorship for trainees and specifically assesses its significance for underrepresented groups in CTS. A literature search was performed using keywords relating to CTS, mentorship, and underrepresented groups. Principal findings were extracted and synthesized; supporting literature discussing mentorship in other surgical specialties was also included. Mentorship is desired by CTS residents. Its benefits include aiding the matching process, decreasing stress, and increasing academic productivity. Mentorship programs can be used to increase the recruitment and retention of women and others underrepresented in medicine. Mentorship is a valuable tool for which implementation must be prioritized in CTS; this requires more education on mentorship for trainees. Institutions should be using mentorship programs to diversify trainees in CTS with the objective being equality.

Background/Objectives: Sex-related differences in the presentation and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve (MV) surgery remain unclear. We aimed to identify these differences to inform personalized management. Methods: A total of 143 consecutive patients undergoing surgery for MR between 2017 and 2018 were stratified by sex and assessed for differences in characteristics. We performed 1:1 propensity score matching (PSM) by sex, with baseline characteristics as covariates, yielding 38 comparable pairs which were analyzed for differences in all-cause mortality and post-operative length of stay (LOS). Results: Females (n = 67) were more symptomatic (NYHA Class ≥ 3: 73% vs. 45%, p < 0.001), had higher logistic EuroSCORE (5.5 vs. 3.9, p = 0.006), had more urgent operations (25% vs. 11%, p = 0.020), MV replacements (28% vs. 11%, p = 0.007), and secondary MR (43% vs. 16%, p < 0.001). Females had significantly smaller end-diastolic and end-systolic left ventricular (LV) diameters, though indexed diameters showed no significant differences. After PSM, females had significantly longer LOS (7 days vs. 9 days, p = 0.033) and no differences in long-term mortality (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 0.34–4.76, p = 0.7, median follow-up: 6.67 years). An indexed LV end-systolic diameter (LVESDi) > 19 mm/m² yielded greater specificity (46.0% vs. 26.7%) and comparable sensitivity (69.4% vs. 69.2%) to LVESD > 40 mm. In subgroup analyses, female patients undergoing concomitant tricuspid intervention (HR: 6.80 [1.63–37.92], p < 0.01) or urgent operation (HR: 4.85 [1.08–21.06], p = 0.04) had worse prognoses than males. Conclusions: Females undergoing MV surgery for MR had more symptoms, higher surgical risk, and longer LOS, but similar mortality compared to males. However, concomitant tricuspid intervention and urgent operations were associated with higher mortality. Our results add to the growing body of evidence that current non-indexed LV diameter thresholds may not adequately account for sex differences.

There is a growing body of evidence investigating sex differences in the presentation, assessment, and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve surgery. It has been shown that women present at older ages, with more comorbidities and more severe symptoms. Compared with male patients, female patients have longer intervals to surgery, lower rates of surgery, and receive fewer mitral valve repairs (as opposed to replacements). On imaging, left ventricular cavity sizes and many quantitative measures of MR severity differ significantly by sex, and current guidelines do not account for this. While sex differences in surgical outcomes have been documented, these are largely limited to primary MR and are based on older studies, underscoring the need for further research. Data on sex differences in transcatheter interventions for MR are inconclusive and heterogeneous, complicating comparisons to surgery. To address these disparities, sex‐specific thresholds for intervention in primary MR, standardization of the quantification of MR severity by sex, and further prospective studies are required. As we move into an era of precision medicine, it is critical to recognize sex as a key determinant of cardiovascular care. In patients undergoing surgery for MR, further research should evaluate whether current intervention thresholds and management pathways are appropriately tailored to female patients.

Objectives: Perioperative fluid resuscitation in cardiac surgery is vital, yet the optimal strategy remains debated. This review evaluates the current evidence on colloid versus crystalloid fluid resuscitation and considers whether alternative outcome measures may help us better identify optimal methods of fluid resuscitation for patients. Methods: A search of electronic databases PubMed, Medline and Google Scholar was performed from inception to June 2025 to synthesise findings on the perioperative fluid management of patients undergoing cardiac surgery. Results: Thirteen studies, involving a total of 34,935 patients, were included in this narrative review. Evidence comparing colloids and crystalloids perioperatively in cardiac surgery is mixed. Colloids, particularly albumin, show advantages in fluid balance, reduce vasopressor use and shorten ICU stays, but carry a higher risk of acute kidney injury, especially with synthetic colloids like hydroxyethyl starch. Crystalloids are less associated with renal complications yet contribute to increased fluid retention and longer hospital stays. Few studies, however, report on fluid balance, renal function and preservation of microcirculation, limiting the understanding of fluid strategies on these relevant postoperative outcomes. Conclusions: Mortality alone may be an insufficient measure for evaluating fluid resuscitation strategies in cardiac surgery. Expanding outcome measures to include fluid balance, preservation of microcirculation and a standardised assessment of renal function could yield more clinically relevant actionable insights and support safer, more individualised fluid management. Further research is warranted to assess these outcomes and establish more holistic, patient‐centred standards in postoperative care.

Left ventricular assist device (LVAD) placement with concomitant cardiac procedures carries a similar procedural risk to isolated LVAD implantation. However, due to low rates of occurrence, data on concomitant procedural outcomes for patients with both ascending aortic aneurysms and end-stage heart failure requiring mechanical circulatory support are limited. We describe the successful concomitant treatment of aortic and left ventricular disease in a 62-year-old man who presented with acute-on-chronic congestive heart failure. Although surgical intervention is currently only recommended for aneurysms at 5.0 cm, in this case, the decision for concomitant aneurysm resection was based on the thin-walled nature of the aorta, concern about wall shear stresses, and potential acceleration of aneurysm growth with an LVAD in place. This case demonstrates the feasibility of addressing both the short- and long-term issues of aortic aneurysm growth and heart failure disease with an acceptable level of risk.