Epigenetic modifications play a fundamental role in the progression of coronary artery disease (CAD). This panoramic review aims to provide an overview of the current understanding of the epigenetic mechanisms involved in CAD pathogenesis and highlights the potential implications for personalized medicine approaches. Epigenetics is the study of heritable changes that do not influence alterations in the DNA sequence of the genome. It has been shown that epigenetic processes, including DNA/histone methylation, acetylation, and phosphorylation, play an important role. Additionally, miRNAs, lncRNAs, and circRNAs are also involved in epigenetics, regulating gene expression patterns in response to various environmental factors and lifestyle choices. In the context of CAD, epigenetic alterations contribute to the dysregulation of genes involved in inflammation, oxidative stress, lipid metabolism, and vascular function. These epigenetic changes can occur during early developmental stages and persist throughout life, predisposing individuals to an increased risk of CAD. Furthermore, in recent years, the concept of personalized medicine has gained significant attention. Personalized medicine aims to tailor medical interventions based on an individual’s unique genetic, epigenetic, environmental, and lifestyle factors. In the context of CAD, understanding the interplay between genetic variants and epigenetic modifications holds promise for the development of more precise diagnostic tools, risk stratification models, and targeted therapies. This review summarizes the current knowledge of epigenetic mechanisms in CAD and discusses the fundamental principles of personalized medicine.

Introduction. The most common minimally invasive approach for aortic valve replacement (AVR) is the partial upper mini-sternotomy. The aim of this study is to understand which preoperative computed tomography (CT) features are predictive of longer operations in terms of cardio-pulmonary bypass timesand cross-clamp times. Methods. From 2011 to 2022, we retrospectively selected 246 patients which underwent isolated AVR and had a preoperative ECG-gated CT scan. On these patients, we analysed the baseline anthropometric characteristics and the following CT scan parameters: aortic annular dimensions, valve calcium score, ascending aorta length, ascending aorta inclination and aorta–sternum distance. Results. We identified augmented body surface area (>1.9 m²), augmented annular diameter (>23 mm), high calcium score (>2500 Agatson score) and increased aorta–sternum distance (>30 mm) as independent predictors of elongated operation times (more than two-fold). Conclusions. Identifying the preoperative predictive factors of longer operations can help surgeons select cases suitable for minimally invasive approaches, especially in a teaching context.

The increasing interest in tricuspid regurgitation (TR) is due to the deep link between mortality and the severity of TR, as well as the limited application of surgical solutions in a setting marked by high in-hospital mortality, attributed to the late presentation of the disease. This delay in intervention is likely associated with a limited understanding of valvular and ventricular anatomy as well as the pathophysiology of the disease, leading to an underestimation of TR severity. With the rapid development of transcatheter solutions showing early safety and efficacy, there is a growing necessity to accurately understand and diagnose the valvular disease process to determine suitable management strategies. This review will outline the normal and pathological anatomy of the tricuspid valve, classify the anatomical substrates of TR, and present new risk stratification methods to determine the appropriate timing for both medical and surgical treatment.

Mitral valve repair has evolved significantly with the advent of advanced surgical and transcatheter techniques. Innovations such as 3D visualization, robotic surgery, and transcatheter edge-to-edge repair have improved procedural precision and expanded treatment options for high-risk patients. Emerging technologies, including transcatheter mitral valve repair, annuloplasty, and chordal systems, offer tailored solutions for complex mitral pathology. Personalized treatment strategies, guided by multimodality imaging and artificially intelligence-driven planning, are reshaping clinical decision-making. Ongoing trials and next-generation devices are poised to enhance long-term outcomes, marking a shift toward minimally invasive, precision-guided mitral valve therapy. This review aims to provide a comprehensive overview of recent technological advances, clinical applications, and future directions in mitral valve repair across surgical and interventional domains.

Infective endocarditis (IE) continues to represent a major challenge for global health systems. In 2019, its annual incidence was estimated at 13.8 cases per 100,000 individuals, contributing to approximately 66,300 deaths worldwide. Due to its high morbidity and mortality rates, enhancing preventive measures has become a priority in both clinical practice and ongoing research efforts. Since the publication of the 2015 ESC Guidelines for the management of IE, several pivotal studies have emerged, prompting a re-evaluation and potential update of the existing recommendations. One growing concern is the increasing antibiotic resistance among oral streptococci, particularly to macrolides such as azithromycin and clarithromycin, which now show higher resistance levels than penicillin. Changes in national antibiotic stewardship programs may have inadvertently contributed to a rise in IE incidence, in part due to altered prophylactic practices. At the same time, advances in diagnostic modalities—including more widespread and targeted use of echocardiography in patients with positive blood cultures for organisms like Enterococcus faecalis, Staphylococcus aureus, and various streptococci—have likely improved detection rates. Additionally, innovations in imaging, particularly computed tomography (CT) and nuclear medicine techniques, have enhanced the diagnosis of IE, especially among patients with prosthetic heart valves or implantable cardiac devices. This has allowed for better characterization of patient populations, aiding in the refinement of diagnostic criteria and therapeutic approaches. Furthermore, updated antibiotic treatment protocols, informed by EUCAST’s antimicrobial susceptibility data, have helped tailor antimicrobial regimens to current resistance trends. The combination of improved diagnostic sensitivity and evolving microbial resistance patterns has also led to an increased number of patients being considered for cardiac surgery as part of their treatment pathway. This review seeks to synthesize the latest findings and guideline revisions, offering an integrated overview of recent progress in the diagnosis, medical treatment, and surgical management of infective endocarditis. It will also explore current therapeutic strategies and operative indications in light of the most recent evidence.

Donor heart preservation is still a critical determinant of outcomes after heart transplantation, particularly as transplant programs increasingly rely on extended-criteria and donation-after-circulatory-death donors. This narrative review provides an overview of the evolution of donor heart preservation, from conventional static cold storage to contemporary technologies designed to reduce ischemia–reperfusion injury, improve graft assessment, and expand organ utilization. We discuss the physiological rationale and clinical evidence supporting commonly used cardioplegic solutions, including University of Wisconsin, Celsior, and histidine–tryptophan–ketoglutarate solutions. We then examine advanced preservation strategies, including controlled hypothermic preservation systems and ex vivo normothermic machine perfusion, which allow improved temperature control, continuous monitoring, functional assessment, and, in the case of machine perfusion, potential metabolic optimization of the graft during transport. Current evidence suggests that these technologies could extend acceptable preservation times, facilitate long-distance procurement, and support the use of marginal and DCD grafts. However, their widespread adoption is limited by logistical complexity, costs, and the need for further independent studies evaluating long-term clinical outcomes. Modern preservation platforms can represent a major paradigm shift in heart transplantation, with the potential to improve graft availability and post-transplant outcomes.