Background: Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with its integration into cardiac surgery offering significant advancements in precision, efficiency, and patient outcomes. However, a comprehensive understanding of AI’s applications, benefits, challenges, and future directions in cardiac surgery is needed to inform its safe and effective implementation. Methods: A systematic review was conducted following PRISMA guidelines. Literature searches were performed in PubMed, Scopus, Cochrane Library, Google Scholar, and Web of Science, covering publications from January 2000 to November 2024. Studies focusing on AI applications in cardiac surgery, including risk stratification, surgical planning, intraoperative guidance, and postoperative management, were included. Data extraction and quality assessment were conducted using standardized tools, and findings were synthesized narratively. Results: A total of 121 studies were included in this review. AI demonstrated superior predictive capabilities in risk stratification, with machine learning models outperforming traditional scoring systems in mortality and complication prediction. Robotic-assisted systems enhanced surgical precision and minimized trauma, while computer vision and augmented cognition improved intraoperative guidance. Postoperative AI applications showed potential in predicting complications, supporting patient monitoring, and reducing healthcare costs. However, challenges such as data quality, validation, ethical considerations, and integration into clinical workflows remain significant barriers to widespread adoption. Conclusions: AI has the potential to revolutionize cardiac surgery by enhancing decision making, surgical accuracy, and patient outcomes. Addressing limitations related to data quality, bias, validation, and regulatory frameworks is essential for its safe and effective implementation. Future research should focus on interdisciplinary collaboration, robust testing, and the development of ethical and transparent AI systems to ensure equitable and sustainable advancements in cardiac surgery.

We thank Haq and Khan for their thoughtful commentary

Background: Subvalvular aortic stenosis (SAS) is an important cause of fixed left ventricular outflow tract obstruction and the second most common form of aortic stenosis. Although traditionally considered a congenital lesion, increasing evidence suggests that SAS often behaves as a progressive condition influenced by anatomical and hemodynamic factors. The disease may lead to significant complications, including left ventricular hypertrophy and progressive aortic regurgitation. Materials and Methods: A narrative review of the current literature was performed to summarize contemporary knowledge regarding the epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of subvalvular aortic stenosis. Relevant studies were identified through searches of major medical databases and were critically analyzed to provide an overview of current concepts and clinical practice. Results: Subvalvular aortic stenosis demonstrates considerable anatomical and clinical heterogeneity, ranging from discrete subaortic membranes to fibromuscular tunnel-type obstruction. The condition often progresses over time, with increasing LVOT gradients and a high incidence of associated aortic regurgitation. Echocardiography remains the primary diagnostic modality, while advanced imaging techniques provide additional anatomical detail and assist in surgical planning. Surgical resection remains the cornerstone of treatment when significant obstruction or related complications develop. Conclusions: Subvalvular aortic stenosis is a complex and progressive disease requiring careful imaging assessment and timely surgical management. Although surgical outcomes are generally excellent, recurrence and progressive aortic valve involvement remain important long-term considerations. Ongoing research aimed at improving risk stratification and optimizing surgical strategies may further enhance patient outcomes.

Background: The Langendorff isolated heart model remains one of the most widely used experimental platforms for cardiovascular research. However, conventional bubble oxygenation is associated with several limitations, including inefficient gas utilization and incompatibility with protein-containing perfusates due to excessive foam formation. The present study evaluated whether membrane oxygenation could improve myocardial preservation and facilitate the use of a protein-enriched perfusion solution in a constant-pressure Langendorff system. Methods: A total of 48 male Wistar rats were allocated to six experimental groups (n = 8 per group). In the first experimental series, myocardial performance was compared between a conventional bubble oxygenator, a Terumo CAPIOX^® FX05 membrane oxygenator, and a Novalung iLA membrane oxygenator. In the second series, standard Krebs–Henseleit buffer was compared with a bovine serum albumin-enriched perfusate under membrane oxygenation. Hemodynamic parameters, coronary flow, and perfusate pH were assessed throughout a 180 min ischemia–reperfusion protocol. Results: Both membrane oxygenators demonstrated significantly improved myocardial preservation compared with the conventional bubble oxygenator, as evidenced by superior systolic and diastolic function, enhanced coronary flow, and improved overall cardiac performance. No significant differences were observed between the two membrane oxygenators. Membrane oxygenation additionally enabled stable supplementation of the perfusate with bovine serum albumin, which resulted in further improvements in ventricular function and coronary perfusion. Perfusate pH remained comparable among groups. Furthermore, membrane oxygenation reduced Carbozen consumption by approximately 33%, increasing the number of experiments that could be performed using a standard gas cylinder. Conclusions: The present findings suggest that membrane oxygenation may represent a simple and effective refinement of the Langendorff isolated heart model. Beyond improving myocardial preservation, it enables the use of protein-enriched perfusates and substantially reduces gas consumption. These findings support the incorporation of membrane oxygenation into modern Langendorff systems and provide a foundation for the development of more physiologically relevant isolated organ perfusion models.